Tooth loss mediates the association between smoking and an increased risk of dementia among older adults: The JAGES prospective cohort study

Author:

Kusama Taro12,Takeuchi Kenji123,Kiuchi Sakura24,Tamada Yudai23,Tabuchi Takahiro5,Osaka Ken2

Affiliation:

1. Division of Statistics and Data Science, Liaison Center for Innovative Dentistry Tohoku University Graduate School of Dentistry Sendai Japan

2. Department of International and Community Oral Health Tohoku University Graduate School of Dentistry Sendai Japan

3. Department of Preventive Medicine Nagoya University Graduate School of Medicine Nagoya Japan

4. Frontier Research Institute for Interdisciplinary Sciences Tohoku University Sendai Japan

5. Cancer Control Center Osaka International Cancer Institute Osaka Japan

Abstract

AbstractAimTooth loss has various causes; however, its cause‐specific effects on health outcomes remain unclear. This study evaluated whether the association between past/current smoking and risk of dementia was mediated by tooth loss.Materials and MethodsThis 9‐year‐follow‐up prospective cohort study targeted adults aged ≥65 years. Dementia incidence during 2013–2019, smoking status (never, past/current) in 2010 and the number of remaining teeth (≤19, ≥20) in 2013 were the outcome, exposure and mediator, respectively. We used causal mediation analysis to fit the Cox proportional hazards model and estimated the hazard ratio (HR) and 95% confidence interval (CI) of the natural indirect effect (NIE) of smoking on dementia incidence through tooth loss and their mediated proportions.ResultsAmong 32,986 participants (mean age 72.6 years [1 SD = 5.4]; men 48.4%), the dementia incidence during follow‐up was 2.11/100 person‐years. Tooth loss significantly mediated the association between past/current smoking and dementia incidence; the NIE of fewer remaining teeth for past/current smokers compared to never smokers was HR = 1.03 (95% CI: 1.02–1.05), and the mediated proportion was 18.0%.ConclusionsTooth loss significantly mediates the association between past/current smoking and an increased risk of dementia among older adults.

Funder

Japan Society for the Promotion of Science

Ministry of Health, Labour and Welfare

Japan Agency for Medical Research and Development

Japan Science and Technology Agency

Sasakawa Sports Foundation

Japan Health Promotion and Fitness Foundation

Chiba Foundation for Health Promotion and Disease Prevention

Niimi University

Publisher

Wiley

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