Periodontitis and the risk of all‐cause and cause‐specific mortality among US adults with diabetes: A population‐based cohort study.

Aim: To evaluate the association between periodontitis, all‐cause and cause‐specific mortality, and its prognostic utility among adults with diabetes. Materials and Methods: Periodontal health records were retrieved from the NHANES database for 4297 participants with diabetes aged >30 years at baseline during 1988–1994, 1999–2004 and 2009–2014. Multivariable Cox proportional hazards regression model was applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for moderate/severe periodontitis with all‐cause and cause‐specific mortality in participants with diabetes. Area under the curve (AUC) was used to assess predictive value. Results: During a median follow‐up of 15.41 years, 1701 deaths occurred. After multivariate adjustments, moderate/severe periodontitis was significantly associated with increased risk of all‐cause (HR: 1.27; 95% CI: 1.07–1.50; p =.005) and cardiovascular disease (CVD)‐related (HR: 1.35, 95% CI: 1.03–1.76, p =.031) mortality in participants with diabetes. The absolute risk difference based on the cumulative incidence information was 0.022 (5‐year, 95% CI: 0.021–0.023) and 0.044 (10‐year, 95% CI: 0.041–0.048). Periodontitis improved the prediction of all‐cause (AUC: 0.652; 95% CI: 0.627–0.676) and CVD‐related (AUC: 0.649; 95% CI: 0.624–0.676) mortality over standard risk factors (all‐cause: AUC: 0.631; 95% CI: 0.606–0.656; CVD‐related: AUC: 0.629; 95% CI: 0.604–0.655). Conclusions: Moderate/severe periodontitis is associated with an increased risk of all‐cause and CVD‐related mortality in adults with diabetes. Periodontitis might represent a marker for residual risk. [ABSTRACT FROM AUTHOR]