ORIGINAL RESEARCH
Marie Claire O’Dwyer; Allison Furgal; Wendy Furst; Manasi Ramakrishnan; Nicoll Capizzano; Ananda Sen; Michael Klinkman
Corresponding Author: Marie Claire O’Dwyer; Dept. of Family Medicine - University of Michigan Medical School.Email: marieclo@med.umich.eduDOI: 10.3122/jabfm.2022.220207R1Keywords: Cross-Sectional Studies, Logistic Regression, Multimorbidity, Nutrition Surveys, PeriodontitisDates: Submitted: 06-09-2022; Revised: 11-21-2022; Accepted: 11-28-2022Status: In production for ahead of print.
BACKGROUND: Often misperceived as solely a dental disease, periodontitis is a chronic condition characterized by inflammation of the support structures of the tooth and associated with chronic systemic inflammation and endothelial dysfunction. Despite affecting almost 40% of US adults ≥ 30 years of age, periodontitis is rarely considered when quantifying multimorbidity (the presence of two or more chronic conditions in an individual) burden for our patients. Multimorbidity represents a major challenge for primary care and is associated with increasing healthcare expenditure and increased hospitalizations. We hypothesized that periodontitis was associated with multimorbidity.
METHODS: To interrogate our hypothesis, we performed a secondary data analysis of a population-based cross-sectional survey, the NHANES 2011-2014 dataset. The study population included US adults aged 30 years or older who underwent a periodontal examination. Prevalence of periodontitis in individuals with and without multimorbidity was calculated using likelihood estimates and adjusting for confounding variables with logistic regression models.
RESULTS: Individuals with multimorbidity were more likely than the general population and individuals without multimorbidity to have periodontitis. However, in adjusted analyses, there was no independent association between periodontitis and multimorbidity. Given the absence of an association, we included periodontitis as a qualifying condition for the diagnosis of multimorbidity. As a result, the prevalence of multimorbidity in US adults 30 years and older increased from 54.1% to 65.8%.
DISCUSSION: Periodontitis is a highly prevalent, preventable chronic inflammatory condition. It shares many common risk factors with multimorbidity but was not independently associated with multimorbidity in our study. Further research is required to understand these observations and whether treating periodontitis in patients with multimorbidity may improve healthcare outcomes.