Risk Modeling for Root Caries and Mortality in Older Adults

Abstract

The purpose of this study was to explore the possible association between root caries incidence and mortality in a random sample of North Carolina black and white community-dwelling older adults. Data were collected from two databases: Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the Piedmont 65+ Dental Study (PDS). The EPESE study provided mortality data and information pertaining to medical, social, and sociodemographic data. The PDS assessed root caries incidence and other conditions pertaining to oral health. Inclusion criteria for the present study required that each subject had to be examined at least two times during an 84-month period, retain at least one natural tooth, and not have any contraindications for periodontal probing. A total of 646 subjects met the study criteria and were included in the data analysis. Dental exams were conducted in each of the participants' homes. The dental exams were scheduled at baseline, 18-months, 36 months, 60 months, and 84 months. The exposure variable was root caries incidence. The outcome variable was death due to all causes and cardiovascular disease. Other variables used in the study included educational level, geographic community, age, sex, race, functional indices, cognitive state, tobacco use, and medical conditions. Final multivariable risk models were composed of those variables that were significant or confounded the association of root caries and mortality. Odds ratios and hazards ratios with 95% confidence intervals were derived from logistic regression and Cox's partial likelihood regression models respectively. Results showed that root caries incidence was predictive of mortality due to all causes with both the continuous (OR 1.16, CI. 1.02, 1.31 and dichotomized (OR 1.94, CI. 1.22, 3.08) exposure variable. Similar findings were seen with the survival models. This association was independent of other explanatory variables in the risk models. In conclusion, root caries is most likely a marker for a decline in systemic health.