ORAL HEALTH AND MORTALITY AMONG OLDER ADULTS: A DOUBLY ROBUST SURVIVAL ANALYSIS

Abstract

Abstract Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for non-random selection bias in estimating their relationship. The present study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting confounding factors with a doubly robust survival estimation. Data came from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and linked the National Death Index (NDI) mortality data through December 2015. The analytic sample consisted of 4,880 adults aged 50 years and above. Oral health measures included subjective oral health evaluation (self-rated oral health) and objective clinical indicators (edentulism, periodontitis, and untreated dental caries). Cox proportional hazards regression models and inverse probability weighting with regression adjustment (IPWRA) were utilized to assess the relationship between oral health and mortality. Good self-rated oral health was significantly associated with lower mortality risk (hazard ratio: 0.83, 95% CI: 0.74-0.93). Moderate periodontitis (hazard ratio: 1.18, 95% CI: 1.05-1.33), severe periodontitis (hazard ratio: 1.50, 95% CI: 1.21-1.87), and edentulism (hazard ratio: 1.13, 95% CI: 1.01-1.26) were significantly associated with higher risks of all-cause mortality, adjusting for socio-demographic characteristics, medical conditions, and health behaviors. Untreated dental caries was related to mortality in Cox models, but became non-significant when IPWRA estimators were applied. Both subjective and objective oral health are risk factors for mortality among older adults. Maintaining good oral health plays a crucial role in longevity.