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Suboptimal oral health and the risk of cardiovascular disease in the presence of competing death: a data linkage analysis

The objective of this study is to simultaneously assess the associations between suboptimal oral health (SOH) and cardiovascular disease (CVD) and competing death (CD). Ontario residents aged 40 years and over who participated in the Canadian Community Health Survey 2003 and 2007–2008 were followed until December 31, 2016 for the incidence of CVD or CD. SOH was assessed based on self-rated oral health and inability to chew. Multivariable competing risk analysis was adjusted for socioeconomic characteristics, behavioural factors and intermediate health outcomes. The study sample included 36,176 participants. Over a median follow-up of 9.61 years, there were 2077 CVD events and 3180 CD events. The fully adjusted models indicate 35% (HR = 1.35, 95% CI: 1.12–1.64) increase in the risk of CVD and 57% (HR = 1.57, 95% CI: 1.33–1.85) increase in the risk of CD among those who reported poor oral health as compared to those who reported excellent oral health. The fully adjusted models also indicate 11% (HR = 1.11, 95% CI: 0.97–1.27) increase in the hazard of CVD and 37% (HR = 1.37, 95% CI: 1.24–1.52) increase in the hazard of CD among those who reported inability to chew. This study provides important information to contextualize CVD risk among those with SOH. The competing risk analysis indicates that those with SOH may benefit from additional interventions to prevent CVD and CD. Accordingly, managing the risk of CVD among those with SOH should fall under a more comprehensive approach that aims at improving their overall health and well-being.