Association of Oral Microbiome Diversity and All‐Cause Mortality in the General US Population and in Individuals With Chronic Diseases: A Prospective Cohort Study

ABSTRACT Aim To investigate whether oral microbiome diversity is associated with all‐cause mortality in the general US population and in individuals with chronic diseases. Materials and Methods We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009–2012), representing 164,000,205 US adults, using a survey‐weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all‐cause mortality. Results During a survey‐weighted mean follow‐up period of 8.86 years, 429 all‐cause deaths (survey‐weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all‐cause mortality risk. Significant differences in all‐cause mortality risk were observed among the different clusters based on oral microbiome β‐diversity (log‐rank p < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all‐cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity. Conclusions Higher oral microbiome diversity was significantly associated with a lower all‐cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.