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Article

Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey

1
School of Dentistry, Autonomous University of Campeche, Campeche 24039, Mexico
2
Academic Area of Dentistry, Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca 42160, Mexico
3
Advanced Studies and Research Center in Dentistry “Dr. Keisaburo Miyata”, School of Dentistry, Autonomous University of State of Mexico, Toluca 50000, Mexico
4
Richard M. Fairbanks School of Public Health, Indiana University/Purdue University, Indianapolis, IN 46202, USA
5
Indiana University Network Science Institute, Bloomington, IN 47408, USA
*
Authors to whom correspondence should be addressed.
Healthcare 2021, 9(4), 404; https://doi.org/10.3390/healthcare9040404
Received: 17 February 2021 / Revised: 19 March 2021 / Accepted: 26 March 2021 / Published: 1 April 2021
(This article belongs to the Section Chronic Care)

Abstract

:
Objective: To determine the association of edentulism with different chronic diseases and mental disorders in Mexicans aged 60 years and over. Material and Methods: A cross-sectional study was carried out using data from the World Health Survey for Mexico, in a probabilistic, multi-stage cluster sampling framework. Data for self-report of chronic diseases (diabetes, arthritis, angina pectoris and asthma), mental disorders (depression and schizophrenia) and edentulism were analyzed. Edentulism data were available for 20 of the 32 States of Mexico. Statistical analysis was performed in Stata 14.0 using the svy module for complex sampling (Complex nature under which individuals are sampled). Results: In total 4213 subjects were included, representing a population of 7,576,057 individuals. Mean age was 70.13 ± 7.82 years (range 60 to 98); 56.2% were women. Chronic diseases’ prevalence and mental disorders prevalence were as follows: diabetes 15.0% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of edentulism was 26.3%, which pertained to 1,993,463 people aged 60 years and over. Angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001) were associated with higher prevalence of edentulism. Conclusions: There was generally sparse association between edentulism on chronic diseases and mental disorders included in the study, except for women aged 60 to 69 years for angina, and in men aged 70 and over, for depression. Although our findings are misaligned with previous reports, longitudinal studies are required to test causal and temporal relationships between edentulism with chronic diseases and mental disorders.

1. Introduction

Around the world, oral diseases such as dental caries in both dentitions, periodontitis and severe tooth loss are the main oral diseases/conditions [1,2,3]. These represent a public health problem since they have a high prevalence and incidence, and have a significant burden of the disease; they increased dramatically between 1990 and 2015 [1,2,3,4,5]. Unfortunately, it has been reported that oral health has not improved in the last three decades, and oral conditions continue to be a major challenge for health systems in many countries [2]. The number of people with untreated oral conditions is estimated to have increased from 2.5 billion in 1990 to 3.5 billion in 2015 [2]. Similarly, in Mexico, dental caries on primary [6,7,8,9,10] and permanent [8,9,10,11,12,13] dentitions as well as periodontal diseases [14,15,16,17] are presented as challenges to public health. In addition to this, a large percentage of the Mexican population has considerable unmet treatment needs; various studies indicate that they are concentrated in populations with the worst socioeconomic conditions [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. This situation generates a significant disease and economic burden for families and for the Mexican health system [9,10].
Tooth loss, partial or total, is a reflection of the history of dental diseases and treatments that people have undergone throughout their lives. This condition is modified by the attitudes of patients and the clinical decisions of dentists, the dentist-patient relationship, the availability and accessibility of dental services, as well as the treatment philosophies prevailing at the time of dental care delivery [3]. Tooth loss effects in terms of pain, suffering, functional deterioration and decreased quality of life are considerable and expensive. Losing multiple teeth has negative implications at the systemic level for chronic diseases [20,21]. For example, it has been associated to hypertension [22], diabetes [23], peripheral arterial disease [24], cardiovascular and brain disease [25], heart failure, stroke, and death [26], angina [27], overweight and obesity [28], renal disease [29], chronic obstructive pulmonary disease [30], dementia [31], depression [32], cognitive impairment [33], certain types of cancer such as liver cancer [34] and pancreas [35], risk of oral, upper gastrointestinal, pulmonary and pancreatic cancer [36,37] as well as with the presence of multimorbidity (+1 chronic disease) [38].
Population aging in Mexico is one of the most important challenges the country is facing. In a short time, the elderly population will increase relative to the other age groups. People over 65 years of age represented 6.3% in 2010 and 10.4% in 2015. However, by 2050, they are expected to represent 22.5% [39]. As the population of older adults in Mexico increases, interest in diseases likely to be associated with old age also grows. Age is a strong predictor for both tooth loss and edentulism, as well as for chronic diseases and mental disorders. From an epidemiological point of view, between 60% and 80% of the elderly population have at least one chronic disease. Therefore, poor oral health, aging and chronic diseases together represent some of the greatest challenges for health systems because they are highly prevalent in older adults and costly [40].
People are now living longer and the impact of poor oral health on the quality of life of older adults is an important public health issue. Efforts need to be strengthened in low- and middle-income countries where periodontal diseases and caries are often “solved” by dental extraction instead of dental conservation. Edentulism is a “final marker of disease burden for oral health” and an important indicator of dental caries and periodontal disease sequels [41,42]. While the prevalence of complete edentulism has reduced over the last decade, tooth loss remains a significant disease worldwide, mainly among the elderly population. However, complete edentulism prevalence varies from country to country and from region to region [42]. Edentulism is a highly prevalent condition globally, with an overall age- and sex-standardized prevalence of 7.6% ranging from as low as 1.4% in Bangladesh and Myanmar up to 15.2% in Brazil. Global prevalence figures among those <50 and ≥50 years were 2.8% and 14.0%, respectively. Age-sex standardized prevalence of edentulism was highest in middle-income countries (MICs) (10.9%), followed by high-income countries (HICs) (8.6%), and low-income countries (LICs) (4.4%). The overall prevalence of edentulism in individuals aged <50 years was 2.8% (LICs 1.6%; MICs 4.3%; HICs 3.5%) with the highest prevalence observed in Zimbabwe (14.5%), Nambia (13.2%), and South Africa (8.2%) [43].
Oral infections are believed to increase the risk of systemic disease [44,45]. Oral invasive pathogens appear to induce a systemic inflammatory response through mediators released by the cardiovascular system and liver, increasing the risk of developing systemic infections [44]. The precise relationship between chronic diseases and mental disorders with oral diseases has not been fully clarified, and several theories have been proposed. A possible biological mechanism that links periodontal disease, tooth loss and edentulism, with chronic diseases is the local and systemic inflammation (inflammaging) [45] due to endothelial dysfunction are involved, in addition to microvascular and macrovascular damage [46]. People with chronic systemic diseases/conditions also exhibit lowered immune systems [47,48]. Oral bacteria promote platelet aggregation, a key event in the development of thrombosis, in addition to worsening of atheromas when exposed to periodontal pathogens [49,50,51,52]. Periodontal disease is associated with higher levels of acute phase proteins, plasma antibody levels, coagulation factor, total white blood cell count, neutrophils, C reactive protein (CRP), and cytokines such as IFN-γ (interferon-gamma), TNF-α (Tumor Necrosis Factor-Alpha), IL (Interleukin)-1β, IL-2 and IL-6. [45,49,52]. Tooth loss is associated with non-invasive measures of atherosclerosis, such as thickening of the carotid wall, stenosis, and the presence of carotid plaque [20,49,53]. Taken in aggregate, such evidence may constitute an aggregate of chronic oral infection implicated with various chronic diseases [20,22,23,24,25,26,28,29,34,35,36,37,38,54,55,56], cognitive impairment and other mental issues [20,31,32,33] and death [21,26]. Based on this background, we set out to test the hypothesis that edentulism is associated with chronic diseases and mental disorders in the elderly. The objective of the present study was to determine the strength of association of edentulism with a limited array of chronic diseases and mental disorders in Mexican individuals aged 60 years and over.

2. Materials and Methods

2.1. Study Design, Population and Sample

This cross-sectional study is a secondary analysis of the National Performance Evaluation Survey (ENED), which was part of the World Health Organization (WHO) Global Health Survey project. Survey methods have been described elsewhere [57] including some oral health results [58,59]. The original data collection instrument was provided by the WHO. For operational reasons, those people living in collective residential dwellings were excluded from the target population. The ENED sample design was probabilistic, multi-stage, stratified and by conglomerates. Three strata were considered: (a) Cities or metropolitan areas (locations with >100,000 inhabitants); (b) urban settings (locations from 2500 to 99,999 inhabitants), and (c) rural areas (locations with fewer than 2500 inhabitants). A sample size of approximately 1243 households was determined per state. The sample size for each stratum was designed proportionally to the number of inhabitants within the stratum to allow representation of both urban and rural areas. The complete WHS questionnaire was not administered to all states; the dental part of the survey was available only for 20 of the 32 states of Mexico (24,159 households). For this analysis, only adults aged 60 years and over were included, leading to a sample of 4213 people.

2.2. Variables and Data Collection

The questionnaires were administered by trained personnel at home. We included in the analysis conditions such as edentulism and five chronic systemic diseases and two mental disorders. The questions used to calculate the prevalence of chronic diseases and mental disorders were: Have you ever been diagnosed with arthritis (a disease of the joints)?, Has a doctor or other health professional ever told you that you have angina pectoris (heart disease)?, Have you ever been diagnosed with asthma (an allergic respiratory disease)?, Has a doctor or other health professional ever told you that you suffer from depression?, Have you ever been diagnosed with schizophrenia or psychosis?, Have you ever been diagnosed with diabetes (high blood sugar)? The independent variable was edentulism (absence of all-natural teeth in the mouth, collected through the question: Are you missing all your natural teeth? The variables age (0 = 60–69, 1 = 70 and over) and sex (0 = male, 1 = female) were also included in the stratified analysis.

2.3. Statistic Analysis

Due to the design used in the survey sampling, the svy module for complex sampling (Complex nature under which individuals are sampled) of the Stata 14.0® statistical package was used. First, a univariate analysis was carried out, reporting summary measures as appropriate. In the bivariate analysis, the X2 test was used. Pearson’s chi-square statistic was corrected by using Rao and Scott’s second-order correction and converted to an F statistic [60]. Since the bivariate analysis did not show an association between the events studied and edentulism, no multivariate models were reported.

2.4. Ethical Statement

Since public databases were used, the approval of the ethics and research committee was not required for this specific sub-analysis. The main study complied with the research and ethics guidelines established by the Helsinki principles and regulations in place for health research in Mexico.

3. Results

A total of 4213 participants were included, representing a population of 7,576,057 individuals. All data presented are weighted. Descriptive results are shown in Table 1. Mean age was 70.13 ± 7.82 years (range 60 to 98). Women represented 56.2%. Chronic diseases and mental disorders prevalence were: diabetes 15% (N = 1,132,693); arthritis 13.2% (N = 1,001,667); depression 5.5% (N = 414,912); angina pectoris 4.5% (344,315); asthma 3.6% (N = 269,287); and schizophrenia 2.2% (N = 16,988). The prevalence of multimorbidity was 7.6% (N = 572,659). Prevalence of complete edentulism was 26.3%, which represents 1,993,463 people aged 60 years and over.
Table 2 shows the results of the crude logistic regression analyses; the association with edentulism was significant for none of the chronic diseases and mental disorders. Analyses stratified by age and sex are shown in Table 3, Table 4 and Table 5: with the exception of angina in women aged 60 to 69 years (p < 0.05) and depression in men aged 70 years and over (p < 0.0001), no statistically significant differences were observed in edentulism through chronic diseases.

4. Discussion

The present study aimed to determine the association of edentulism with different chronic diseases and mental disorders in Mexican individuals aged 60 years and over. We observed that 1 in 4 (26.3%) adults were edentulous, but this feature was for the most part not significantly associated with chronic diseases and mental disorders. Chronic conditions often arise and develop in parallel with other diseases. Co-occurrence of chronic conditions and dental conditions have been reported in the literature [54]. It is not clear whether this is true causation or simply an association between oral infections and some other systemic conditions [55]. Methodologically speaking, a major consideration is that multiple studies have been observational and cross-sectional, confirming statistical associations [22,23,27,28,29] but not causal relationships between chronic conditions and edentulism. When large scale cohort studies (accruing more confidence in the suggestion of a causal relationship but not reaching the level of certainty) are examined, the association is maintained [24,26,30,31]. In a meta-analysis of cohort studies [25] it was a concluded that design and quality of studies—together with the number of cases and participants—support the association between tooth loss and both cardiovascular disease and cerebrovascular incidents. Other meta-analyses give credence to a link between death risk [21], obesity [28], dementia [61], depression [32], Alzheimer’s disease [62], asthma [63], different types of cancer [64,65] and metabolic syndrome [66] and oral health indicators. Oral diseases/infections as a risk factor for the development of various systemic conditions is a topic that has been widely investigated and debated. Although most of the evidence for this association consistently supports this notion, the need for further studies is apparent. In general, studies with larger populations and better designs corroborate the association of dental conditions with systemic conditions.
People with chronic conditions are more likely to have untreated dental disease, which can in turn lead to tooth loss [67]. The association under evaluation was not confirmed by our findings. One possible reason for not finding an association between chronic diseases and edentulism is that the present study included adults over 60 years of age: people in poorer health may be less than 60 years of age, thereby self-selecting them out of the pool of participants (Sixty years of age, and the selection of chronic conditions, were determined by the methods and priorities set in the national survey and derived from health policy guidelines in Mexico).
Among the study’s greatest strengths is the nationwide representativeness of the sample and strong methodological design. One of the limitations of the study is its cross-sectional design, which leads to temporal ambiguity through measuring cause and effect at the same time. The cross-sectional design precludes detecting trends in the disease patterns under evaluation. Self-report is an efficient and accepted approach to collecting data about salient health conditions; it is a standard feature of the Global Health Survey. However, there are risks of recall bias (perhaps more pronounced in older individuals) or misrepresentation of conditions believed to be present, but not based on a formal medical diagnosis. Finally, in the present study only edentulism was measured: data on the exact number of missing teeth were not measured for each individual—possibly diminishing precision of the variable [34].
Based on our findings, further research is necessary to examine data through a more finely grained set of strategies: e.g., adding other chronic diseases to the limited array included in the national survey; establishing levels of severity of disease, together with measures of how well controlled some diseases are (such as glycemic control in diabetics); incorporating other Latin American population groups besides Mexicans; and disaggregating the block of 60+ age group in various levels. Finally, longitudinal designs would be required to fully quantify causality between chronic diseases, mental disorders, and tooth loss and, separately, with edentulism (complete tooth loss).

5. Conclusions

Few associations were observed between edentulism and the chronic diseases and mental disorders included in the study. In the stratified analysis, edentulism was associated only with angina in women aged 60 to 69 years, and with depression in men aged 70 and over. More research is needed to clarify the association of edentulism with selected chronic diseases and mental disorders, and to characterize mechanisms for tooth loss.

Author Contributions

A.J.C.-R., J.F.C.-R., M.M.-S., C.E.M.-S., and G.M. conceptualized and designed the study. J.L.R.-M., J.A.C.-S., M.d.L.M.-C., A.P.P.-L., H.I.-G., M.M.-A., and S.M.-R., contributed to data analysis, interpretation of data, and writing the first draft. All authors contributed to a critical review of the manuscript and approved the final version. All authors have read and agreed to the published version of the manuscript.

Funding

Publication supported by the Ministry of Education, Mexican Federal Government, through of the Faculty Development Program (PRODEP).

Institutional Review Board Statement

This analysis was based on secondary data obtained from publicly available dataset.

Informed Consent Statement

Written consent was obtained from participants.

Data Availability Statement

The data sets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Marcenes, W.; Kassebaum, N.J.; Bernabé, E.; Flaxman, A.; Naghavi, M.; Lopez, A.; Murray, C.J.L. Global Burden of Oral Conditions in 1990–2010: A Systematic Analysis. J. Dent. Res. 2013, 92, 592–597. [Google Scholar] [CrossRef][Green Version]
  2. Kassebaum, N.J.; Smith, A.G.C.; Bernabé, E.; Fleming, T.D.; Reynolds, A.E.; Vos, T.; Murray, C.J.L.; Marcenes, W. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J. Dent. Res. 2017, 96, 380–387. [Google Scholar] [CrossRef]
  3. Kassebaum, N.J.; Bernabé, E.; Dahiya, M.; Bhandari, B.; Murray, C.J.; Marcenes, W. Global Burden of Severe Tooth Loss: A Systematic Review and Meta-Analysis. J. Dent. Res. 2014, 93, 7. [Google Scholar] [CrossRef][Green Version]
  4. Peres, M.A.; Macpherson, L.M.D.; Weyant, R.J.; Daly, B.; Venturelli, R.; Mathur, M.R.; Listl, S.; Celeste, R.K.; Guarnizo-Herreño, C.C.; Kearns, C.; et al. Oral Diseases: A Global Public Health Challenge. Lancet 2019, 394, 249–260. [Google Scholar] [CrossRef]
  5. Watt, R.G.; Daly, B.; Allison, P.; Macpherson, L.M.D.; Venturelli, R.; Listl, S.; Weyant, R.J.; Mathur, M.R.; Guarnizo-Herreño, C.C.; Celeste, R.K.; et al. Ending the Neglect of Global Oral Health: Time for Radical Action. Lancet 2019, 394, 261–272. [Google Scholar] [CrossRef]
  6. Vázquez-Nava, F.; Vázquez-Rodríguez, E.M.; Saldívar-González, A.H.; Lin-Ochoa, D.; Martinez-Perales, G.M.; Joffre-Velázquez, V.M. Association between Obesity and Dental Caries in a Group of Preschool Children in Mexico. J. Public Health Dent. 2010, 70, 124–130. [Google Scholar]
  7. Lucas-Rincón, S.E.; Robles-Bermeo, N.L.; Lara-Carrillo, E.; Scougall-Vilchis, R.J.; Pontigo-Loyola, A.P.; Rueda-Ibarra, V.; Loyola-Rodríguez, J.P.; Escoffié-Ramirez, M.; Medina-Solís, C.E. Interproximal Caries Lesions and Premature Loss of Teeth in the Primary Dentition as Risk Factors for Space Loss in the Posterior Sector: A Cross-Sectional Study. Medicine 2019, 98, 14875. [Google Scholar] [CrossRef]
  8. Pérez-Domínguez, J.; González-García, A.; Niebla-Fuentes, M.R.; Ascencio-Montiel, I.J. Encuesta de Prevalencia de Caries Dental En Niños y Adolescentes. Rev. Med. Inst. Mex. Seguro Soc. 2010, 48, 25–29. [Google Scholar] [PubMed]
  9. Medina-Solís, C.E.; Ávila-Burgos, L.; Márquez-Corona, M.L.; Medina-Solís, J.J.; Lucas-Rincón, S.E.; Borges-Yañez, S.A.; Fernández-Barrera, M.Á.; Pontigo-Loyola, A.P.; Maupomé, G. Out-of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting. Int. J. Environ. Res. Public Health 2019, 16, 1997. [Google Scholar] [CrossRef] [PubMed][Green Version]
  10. Medina-Solís, C.E.; Ávila-Burgos, L.; Borges-Yañez, S.A.; Irigoyen-Camacho, M.E.; Sánchez-Pérez, L.; Zepeda-Zepeda, M.A.; Salvador, E.L.R.; Medina, S.M.L.; Márquez, C. Horacio Islas-Granillo, Ecological Study on Needs and Cost of Treatment for Dental Caries in Schoolchildren Aged 6, 12 and 15 Years: Data from a National Survey in Mexico. Medicine 2020, 99, 19092. [Google Scholar] [CrossRef] [PubMed]
  11. Esquivel-Hernández, R.I.; Jiménez-Férez, J. Perfil Epidemiológico de Salud Bucodental de Estudiantes de la FES Iztacala. Rev. Odontol. Mex. 2007, 11, 46–52. [Google Scholar]
  12. De la Fuente-Hernández, J.; González de Cossío, M.; Ortega-Maldonado, M.; Sifuentes-Valenzuela, M.C. Dental Decay and Tooth Loss at the High School Level in Mexican Students. Salud. Publica Mex. 2008, 50, 235–240. [Google Scholar] [PubMed]
  13. Molina-Frechero, N.; Castañeda-Castaneira, E.; Marques-Dos-Santos, M.J.; Soria, H.A.; Bologna, M.R. Caries Dental y Factores de Riesgo en Adolescentes de Ecatepec, Estado de México. Rev. Investig. Clin. 2009, 61, 300–305. [Google Scholar]
  14. Borges-Yáñez, S.A.; Irigoyen-Camacho, M.E.; Maupomé, G. Risk Factors and Prevalence of Periodontitis in Community-Dwelling Elders in Mexico. J. Clin. Periodontol. 2006, 33, 184–194. [Google Scholar] [CrossRef] [PubMed]
  15. Juárez-López, M.L.A.; Murrieta-Pruneda, J.F.; Teodosio-Procopio, E. Prevalence and Risk Factors Periodontal Disease among Preeschool Children in Mexico City. Gac. Méd. Méx. 2005, 141, 185–189. [Google Scholar] [PubMed]
  16. García-Pérez, Á.; Borges-Yáñez, S.A.; Jiménez-Corona, A.; Jiménez-Corona, M.E.; Ponce-de-León, S. Self-Report of Gingival Problems and Periodontitis in Indigenous and Non-Indigenous Populations in Chiapas, Mexico. Int. Dent. J. 2016, 66, 105–112. [Google Scholar] [CrossRef] [PubMed]
  17. Romero-Castro, N.S.; Paredes-Solís, S.; Legorreta-Soberanis, J.; Reyes-Fernández, S.; Flores Moreno, M.; Andersson, N. Prevalencia de Gingivitis y Factores Asociados en Estudiantes de la Universidad Autónoma de Guerrero, México. Rev. Cubana Estomatol. 2016, 53, 9–16. [Google Scholar]
  18. Medina-Solís, C.E.; Pontigo-Loyola, A.P.; Mendoza-Rodríguez, M.; Lucas-Rincón, S.E.; Márquez-Rodríguez, S.; Navarrete-Hernández, J.J.; Maupomé, G. Treatment Needs for Dental Caries, Restorative Care Index, and Index of Extractions in Adolescents 12 to 15 Years Old. West Indian Med. J. 2013, 62, 636–641. [Google Scholar]
  19. Islas-Granillo, H.; Borges-Yañez, S.A.; Medina-Solis, C.E.; Márquez-Rodríguez, S.; Lucas-Rincón, S.E.; Fernández-Barrera, M.A.; Arturo, A.V.; Veras-Hernández, M.A. Dental Prosthetic Treatment Needs in Mexican Elders: Influence of Socioeconomic Position. Dent. Med. Probl. 2017, 54, 383–387. [Google Scholar] [CrossRef][Green Version]
  20. Holmstrup, P.; Damgaard, C.; Olsen, I.; Björn, K.; Allan, F.; Claus, H.; Nielsen, P.; Riis, H. Comorbidity of Periodontal Disease: Two Sides of the Same Coin? An Introduction for the Clinician. J. Oral Microbiol. 2017, 9, 1332710. [Google Scholar] [CrossRef]
  21. Romandini, M.; Baima, G.; Antonoglou, G.; Bueno, J.; Figuero, E.; Sanz, M. Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-Analyses. J. Dent. Res. 2021, 100, 37–49. [Google Scholar] [CrossRef] [PubMed]
  22. Singh, A.; Gupta, A.; Peres, M.A.; Watt, R.G.; Tsakos, G.; Mathur, M.R. Association Between Tooth Loss and Hypertension Among a Primarily Rural Middle Aged and Older Indian Adult Population. J. Public Health Dent. 2016, 76, 198–205. [Google Scholar] [CrossRef]
  23. Taboza, Z.A.; Costa, K.L.; Silveira, V.R.; Furlaneto, F.A.; Montenegro, R., Jr.; Russell, S.; Dasanayake, A.; Rego, R.O. Periodontitis, Edentulismo and Glycemic Control in Patients with Type 2 Diabetes: A Cross-Sectional Study. BMJ Open Diabetes Res. Care 2018, 6, 000453. [Google Scholar] [CrossRef][Green Version]
  24. Muñoz-Torres, F.J.; Mukamal, K.J.; Pai, J.K.; Willett, W.; Joshipura, K.J. Relationship between Tooth Loss and Peripheral Arterial Disease among Women. J. Clin. Periodontol. 2017, 44, 989–995. [Google Scholar] [CrossRef] [PubMed]
  25. Cheng, F.; Zhang, M.; Wang, Q.; Xu, H.; Dong, X.; Gao, Z.; Chen, J.; Wei, Y.; Qin, F. Tooth Loss and Risk of Cardiovascular Disease and Stroke: A Dose-Response Meta Analysis of Prospective Cohort Studies. PLoS ONE 2018, 13, e0194563. [Google Scholar] [CrossRef][Green Version]
  26. Lee, H.J.; Choi, E.K.; Park, J.B.; Han, K.D.; Oh, S. Tooth Loss Predicts Myocardial Infarction, Heart Failure, Stroke, and Death. J. Dent. Res. 2019, 98, 164–170. [Google Scholar] [CrossRef] [PubMed]
  27. Goteiner, D.; Craig, R.G.; Ashmen, R.; Janal, M.N.; Eskin, B.; Lehrman, N. Endotoxin Levels are Associated with High-Density Lipoprotein, Triglycerides, and Troponin in Patients with Acute Coronary Syndrome and Angina: Possible Contributions from Periodontal Sources. J. Periodontol. 2008, 79, 2331–2339. [Google Scholar] [CrossRef][Green Version]
  28. Nascimento, G.G.; Leite, F.R.; Conceição, D.A.; Ferrúa, C.P.; Singh, A.; Demarco, F.F. Is there a Relationship between Obesity and Tooth Loss and Edentulism? A Systematic Review and Meta-Analysis. Obes. Rev. 2016, 17, 587–598. [Google Scholar] [CrossRef] [PubMed]
  29. Choi, H.M.; Han, K.; Park, Y.G.; Park, J.B. Associations between the Number of Natural Teeth and Renal Dysfunction. Medicine 2016, 95, 4681. [Google Scholar] [CrossRef] [PubMed]
  30. Barros, S.P.; Suruki, R.; Loewy, Z.G.; Beck, J.D.; Offenbacher, S. A Cohort Study of the Impact of Tooth Loss and Periodontal Disease on Respiratory Events among COPD Subjects: Modulatory Role of Systemic Biomarkers of Inflammation. PLoS ONE 2013, 8, e68592. [Google Scholar] [CrossRef]
  31. Yoo, J.J.; Yoon, J.H.; Kang, M.J.; Kim, M.; Oh, N. The Effect of Missing Teeth on Dementia in Older People: A Nationwide Population-Based Cohort Study in South Korea. BMC Oral Health 2019, 19, 61. [Google Scholar] [CrossRef][Green Version]
  32. Cademartori, M.G.; Gastal, M.T.; Nascimento, G.G.; Demarco, F.F.; Corrêa, M.B. Is Depression Associated with Oral Health Outcomes in Adults and Elders? A Systematic Review and Meta-Analysis. Clin. Oral Investig. 2018, 22, 2685–2702. [Google Scholar] [CrossRef]
  33. Saito, S.; Ohi, T.; Murakami, T.; Komiyama, T.; Miyoshi, Y.; Endo, K.; Satoh, M.; Asayama, K.; Inoue, R.; Kikuya, M.; et al. Association Between Tooth Loss and Cognitive Impairment in Community-Dwelling Older Japanese Adults: A 4-Year Prospective Cohort Study from the Ohasama Study. BMC Oral Health 2018, 18, 142. [Google Scholar] [CrossRef] [PubMed]
  34. Yang, B.; Petrick, J.L.; Abnet, C.C.; Graubard, B.I.; Murphy, G.; Weinstein, S.J.; Männistö, S.; Albanes, D.; McGlynn, K.A. Tooth Loss and Liver Cancer Incidence in a Finnish Cohort. Cancer Causes Control 2017, 28, 899–904. [Google Scholar] [CrossRef] [PubMed]
  35. Maisonneuve, P.; Amar, S.; Lowenfels, A.B. Periodontal Disease, Edentulism, and Pancreatic Cancer: A Meta-Analysis. Ann. Oncol. 2017, 28, 985–995. [Google Scholar] [CrossRef]
  36. Meyer, M.S.; Joshipura, K.; Giovannucci, E.; Michaud, D.S. A Review of the Relationship between Tooth Loss, Periodontal Disease, and Cancer. Cancer Causes Control 2008, 19, 895–907. [Google Scholar] [CrossRef] [PubMed][Green Version]
  37. Michaud, D.S.; Fu, Z.; Shi, J.; Chung, M. Periodontal Disease, Tooth Loss, and Cancer Risk. Epidemiol. Rev. 2017, 39, 49–58. [Google Scholar] [CrossRef][Green Version]
  38. Islas-Granillo, H.; Borges-Yañez, S.A.; Navarrete-Hernández, J.J.; Veras-Hernández, M.A.; Casanova-Rosado, J.F.; Minaya-Sánchez, M.; Casanova-Rosado, A.J.; Fernández-Barrera, M.Á.; Medina-Solís, C.E. Indicators of Oral Health in Older Adults with and Without the Presence of Multimorbidity: A Cross-Sectional Study. Clin. Inter. Aging. 2019, 14, 219–224. [Google Scholar] [CrossRef][Green Version]
  39. Consejo Nacional de Población. Socio-Demographic Diagnosis of Aging in Mexico; Technical Documents Series; Conapo: Mexico City, Mexico, 2011.
  40. Islas-Granillo, H.; Medina-Solís, C.E.; Márquez-Corona, M.L.; de la Rosa-Santillana, R.; Fernández-Barrera, M.A.; Villalobos-Rodelo, J.J.; Hernández-Martínez, C.T.; Navarrete-Hernández, J.J.; Mendoza-Rodríguez, M. Prevalence of Multimorbidity in Institutionalized Subjects Aged 60 and Over in a Developing Country. Clin. Inter. Aging 2018, 13, 1129–1133. [Google Scholar] [CrossRef][Green Version]
  41. Kailembo, A.; Preet, R.; Stewart Williams, J. Common Risk Factors and Edentulism in Adults, Aged 50 years and over, in China, Ghana, India and South Africa: Results from the WHO Study on Global AGEing and Adult Health (SAGE). BMC Oral Health 2016, 17, 29. [Google Scholar] [CrossRef][Green Version]
  42. Al-Rafee, M.A. The Epidemiology of Edentulism and the Associated Factors: A Literature Review. J. Fam. Med. Prim. Care 2020, 9, 1841–1843. [Google Scholar] [CrossRef]
  43. Tyrovolas, S.; Koyanagi, A.; Panagiotakos, D.B.; Haro, J.M.; Kassebaum, N.J.; Chrepa, V.; Kotsakis, G.A. Population Prevalence of Edentulism and its Association with Depression and Self-Rated Health. Sci. Rep. 2016, 6, 37083. [Google Scholar] [CrossRef][Green Version]
  44. Gacon, I.; Wieczorek, A. Coexistence of Lack of Clinical Manifestation of Oral Mycosis and Systemic Diseases in Edentulous Patients Using Removable Prosthetic Restorations. Int. J. Environ. Res. Public Health 2020, 17, 6348. [Google Scholar] [CrossRef] [PubMed]
  45. Ebersole, J.L.; Graves, C.L.; Gonzalez, O.A.; Dawson, D., 3rd; Morford, L.A.; Huja, P.E.; Hartsfield, J.K., Jr.; Huja, S.S.; Pandruvada, S.; Wallet, S.M. Aging, Inflammation, Immunity and Periodontal Disease. Periodontology 2000, 2016, 54–75. [Google Scholar] [CrossRef] [PubMed]
  46. D’Aiuto, F.; Graziani, F.; Tetè, S.; Gabriele, M.; Tonetti, M.S. Periodontitis: From Local Infection to Systemic Diseases. Int. J. Immunopathol. Pharmacol. 2005, 18, 1–11. [Google Scholar]
  47. Fisher, M.A.; Taylor, G.W.; West, B.T.; McCarthy, E.T. Bidirectional Relationship between Chronic Kidney and Periodontal Disease: A Study Using Structural Equation Modeling. Kidney Int. 2011, 79, 347–355. [Google Scholar] [CrossRef] [PubMed][Green Version]
  48. Bagatini, M.D.; Cardoso, A.M.; Reschke, C.R.; Carvalho, F.B. Immune System and Chronic Diseases 2018. J. Immunol. Res. 2018, 2018, 8653572. [Google Scholar] [CrossRef][Green Version]
  49. You, Z.; Cushman, M.; Jenny, N.S.; Howard, G. Regards, Tooth Loss, Systemic Inflammation, and Prevalent Stroke among Participants in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) Study. Atherosclerosis 2009, 203, 615–619. [Google Scholar] [CrossRef] [PubMed][Green Version]
  50. Tu, Y.; Chen, Y.; Zheng, C.; Chen, H. Platelet Aggregation Promoted by Biofilms of Oral Bacteria and the Effect of Mouth Rinses in Vitro. J. Infect. Dev. Ctries 2016, 10, 704–711. [Google Scholar] [CrossRef][Green Version]
  51. Rath, S.; Mukherjee, M.; Kaushik, R.; Sen, S.; Kumar, M. Periodontal Pathogens in Atheromatous Plaque. Indian J. Pathol. Microbiol. 2014, 57, 259. [Google Scholar] [CrossRef]
  52. Schenkein, H.A.; Papapanou, P.N.; Genco, R.; Sanz, M. Mechanisms Underlying the Association Between Periodontitis and Ath-Erosclerotic Disease. Periodontology 2000, 83, 90–106. [Google Scholar] [CrossRef]
  53. Yu, H.; Qi, L.T.; Liu, L.S.; Wang, X.Y.; Zhang, Y.; Huo, Y.; Luan, Q.X. Association of Carotid Intima-media Thickness and Athero-sclerotic Plaque with Periodontal Status. J. Dent. Res. 2014, 93, 744–751. [Google Scholar] [CrossRef][Green Version]
  54. Seitz, M.W.; Listl, S.; Bartols, A.; Schubert, I.; Blaschke, K.; Haux, C.; Van Der Zande, M.M. Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review. Prev. Chronic Dis. 2019, 16, 132. [Google Scholar] [CrossRef] [PubMed][Green Version]
  55. Kane, S.F. The Effects of Oral Health on Systemic Health. Gen. Dent. 2017, 65, 30–34. [Google Scholar] [PubMed]
  56. Kim, J.; Amar, S. Periodontal Disease and Systemic Conditions: A Bidirectional Relationship. Odontology 2006, 94, 10–21. [Google Scholar] [CrossRef][Green Version]
  57. Palma-Coca, O.; Olaiz-Fernández, G. Metodología de la Encuesta Nacional de Evaluación del Desempeño. Salud Pub. Mex. 2005, 47, 66–74. [Google Scholar]
  58. Medina-Solís, C.E.; Pontigo-Loyola, A.P.; Pérez-Campos, E.; Hernández-Cruz, P.; Avila-Burgos, L.; Mendoza-Rodríguez, M.; Maupomé, G. Edentulism and other Variables Associated with Self-Reported Health Status in Mexican Adults. Med. Sci. Monit. 2014, 20, 843–852. [Google Scholar] [PubMed][Green Version]
  59. Medina-Solís, C.E.; Pontigo-Loyola, A.P.; Pérez-Campos, E.; Hernández-Cruz, P.; Avila-Burgos, L.; Kowolik, M.J.; Gerardo, M. Association Between Edentulism and Angina Pectoris in Mexican Adults 35 Years of Age and Older: A Multivariate Analysis of a Population-Based Survey. J. Periodontol. 2014, 85, 406–416. [Google Scholar] [CrossRef]
  60. Rao, J.N.K.; Scott, A.J. On Chi-Squared Tests for Multi-Way Contingency Tables with Cell Proportions Estimated from Survey Data. Ann. Stat. 1984, 12, 46–60. [Google Scholar] [CrossRef]
  61. Gusman, D.J.R.; Mello-Neto, J.M.; Alves, B.E.S.; Matheus, H.R.; Ervolino, E.; Theodoro, L.H.; de Almeida, J.M. Periodontal Disease Severity in Subjects with Dementia: A Systematic Review and Meta-Analysis. Arch. Gerontol. Geriatr. 2018, 76, 147–159. [Google Scholar] [CrossRef][Green Version]
  62. Leira, Y.; Domínguez, C.; Seoane, J.; Seoane-Romero, J.; Pías-Peleteiro, J.M.; Takkouche, B.; Blanco, J.; Aldrey, J.M. Is Periodontal Disease Associated with Alzheimer’s disease? A Systematic Review with Meta-Analysis. Neuroepidemiology 2017, 48, 21–31. [Google Scholar] [CrossRef]
  63. Ferreira, M.K.M.; Ferreira, R.O.; Castro, M.M.L.; Magno, M.B.; Almeida, A.P.C.P.S.C.; Fagundes, N.C.F.; Maia, L.C.; Lima, R.R. Is there an Association Between Asthma and Periodontal Disease Among Adults? Systematic Review and Meta-Analysis. Life Sci. 2019, 223, 74–87. [Google Scholar] [CrossRef]
  64. Wang, J.; Yang, X.; Zou, X.; Zhang, Y.; Wang, J.; Wang, Y. Relationship between Periodontal Disease and Lung Cancer: A Systematic Review and Meta-Analysis. J. Periodontal. Res. 2020, 55, 581–593. [Google Scholar] [CrossRef] [PubMed]
  65. Xuan, K.; Jha, A.R.; Zhao, T.; Uy, J.P.; Sun, C. Is Periodontal Disease Associated with Increased Risk of Colorectal Cancer? A Meta-Analysis. Int. J. Dent. Hyg. 2021, 19, 50–61. [Google Scholar] [CrossRef]
  66. Daudt, L.D.; Musskopf, M.L.; Mendez, M.; Remonti, L.L.R.; Leitão, C.B.; Gross, J.L.; Weidlich, P.; Oppermann, R.V. Association Between Metabolic Syndrome and Periodontitis: A Systematic Review and Meta-Analysis. Braz. Oral Res. 2018, 32, 35. [Google Scholar] [CrossRef] [PubMed][Green Version]
  67. Parker, M.L.; Thornton-Evans, G.; Wei, L.; Griffin, S.O. Prevalence of and Changes in Tooth Loss among Adults Aged ≥50 Years with Selected Chronic Conditions-United States, 1999–2004 and 2011–2016. MMWR Morb. Mortal Wkly. Rep. 2020, 69, 641–646. [Google Scholar] [CrossRef] [PubMed]
Table 1. Variables from Mexican subjects aged 60 and older.
Table 1. Variables from Mexican subjects aged 60 and older.
VariableFrequencyN% Weighted
Age
60–6922274,194,88555.4
70 and older19863,381,17244.6
Gender
Female23644,259,13556.2
Male18493,316,92243.8
Edentulism
No30535,582,59473.7
Yes11601,993,46326.3
Diabetes
No36406,443,36485.0
Yes5731,132,69315.0
Arthritis
No37096,574,39086.8
Yes5041,001,66713.2
Depression
No40117,161,14594.5
Yes202414,9125.5
Angina pectoris
No39907,231,74295.5
Yes223344,3154.5
Asthma
No40627,306,77096.4
Yes151269,2873.6
Schizophrenia
No41997,559,06999.8
Yes1416,9882.2
Multimorbidity
No39227,003,39892.4
Yes291572,6597.6
Table 2. Crude estimates (Odds ratio= OR, 95% confidence interval=95% CI) of the different chronic diseases, mental disorders and multimorbidity (2 or more chronic diseases at the same time) and edentulism in Mexican older adults.
Table 2. Crude estimates (Odds ratio= OR, 95% confidence interval=95% CI) of the different chronic diseases, mental disorders and multimorbidity (2 or more chronic diseases at the same time) and edentulism in Mexican older adults.
DiabetesValue pArthritisValue pDepressionValue p
Edentulism
No1 * 1 * 1 *
Yes0.94 (0.64–1.37)0.7671.23 (0.90–1.68)0.1751.22 (0.83–1.78)0.297
AnginaValue pAsthmaValue pSchizophreniaValue p
Edentulism
No1 * 1 * 1 *
Yes1.30 (0.77–2.19)0.3170.68 (0.35–1.30)0.2431.81 (0.44–7.43)0.408
At least oneValue pMultimorbidityValue p
Edentulism
No1 * 1 *
Yes1.10 (0.84–1.43)0.4631.09 (0.80–1.50)0.560
At least one = Refers to any chronic disease or mental disorders present among those included in the study. * Reference category.
Table 3. Distribution of edentulism due to diabetes and arthritis stratified by age group and sex (estimated population N = 7,576,057).
Table 3. Distribution of edentulism due to diabetes and arthritis stratified by age group and sex (estimated population N = 7,576,057).
VariablesDiabetesArthritis
FemalesNoYesNoYes
Edentulism (60–69)
No1,489,447 (82.0)327,475 (18.0)1,570,035 (86.4)246,887 (13.6)
Yes450,061 (87.0)67,488 (13.0)435,048 (84.1)82,501 (15.9)
X2 testp = 0.1675p = 0.4519
Edentulism (70 and older)
No1,001,633 (85.7)166,973 (14.3)951,499 (81.4)217,107 (18.6)
Yes637,792 (84.4)118,266 (15.6)607,583 (80.4)148,475 (19.6)
X2 testp = 0.7314p = 0.7498
MalesNoYesNoYes
Edentulism (60–69)
No1,398,600 (87.6)198,512 (12.4)1,467,854 (91.9)129,258 (8.1)
Yes214,843 (81.6)48,459 (18.4)236,482 (89.8)26,820 (10.2)
X2 testp = 0.2983p = 0.6737
Edentulism (70 and older)
No847,797 (84.8)152,157 (15.2)892,262 (89.2)107,692 (10.8)
Yes403,191 (88.3)53,363 (11.7)413,627 (90.6)42,927 (9.4)
X2 testp = 0.4677p = 0.7077
Table 4. Distribution of edentulism due to depression and angina stratified by age group and sex (estimated population N = 7,576,057).
Table 4. Distribution of edentulism due to depression and angina stratified by age group and sex (estimated population N = 7,576,057).
VariablesDepressionAngina
FemalesNoYesNoYes
Edentulism (60–69)
No1,714,925 (94.4)101,997 (5.6)1,762,043 (97.0)54,879 (3.0)
Yes463,873 (89.6)53,676 (10.4)478,668 (92.5)38,881 (7.5)
X2 testp = 0.0743p = 0.0499
Edentulism (70 and older)
No1,051,633 (90.0)116,973 (10.0)1,102,916 (94.4)65,690 (5.6)
Yes715,033 (94.6)41,025 (5.4)708,310 (93.7)47,748 (6.3)
X2 testp = 0.0768p = 0.8001
MalesNoYesNoYes
Edentulism (60–69)
No1,529,155 (95.7)67,957 (4.3)1,546,560 (96.8)50,552 (3.2)
Yes251,548 (95.5)11,754 (4.5)259,392 (98.5)3910 (1.5)
X2 testp = 0.9388p = 0.2960
Edentulism (70 and older)
No997,062 (99.7)2892 (0.03)935,229 (93.5)64,725 (6.5)
Yes437,916 (95.9)18,638 (4.1)438,624 (96.1)17,930 (3.9)
X2 testp = 0.0000p = 0.2651
Table 5. Distribution of edentulism due to asthma and schizophrenia stratified by age group and sex (estimated population N = 7,576,057).
Table 5. Distribution of edentulism due to asthma and schizophrenia stratified by age group and sex (estimated population N = 7,576,057).
VariablesAsthmaSchizophrenia
FemalesNoYesNoYes
Edentulismo (60–69)
No1,728,845 (95.2)88,077 (4.8)1,812,928 (99.8)3994 (0.2)
Yes507,448 (98.0)10,101 (2.0)514,678 (99.4)2871 (0.6)
X2 testp = 0.1611p = 0.3980
Edentulism (70 and older)
No1,107,494 (94.8)61,112 (5.2)1,167,502 (99.9)1104 (0.1)
Yes727,897 (96.3)28,161 (3.7)755,017 (99.9)1041 (0.1)
X2 testp = 0.4259p = 0.2747
MalesNoYesNoYes
Edentulism (60–69)
No1,561,253 (97.8)35,859 (2.2)1,595,130 (99.9)1982 (0.1)
Yes260,033 (98.8)3269 (1.2)263,098 (99.9)204 (0.1)
X2 testp = 0.3461p = 0.7095
Edentulism (70 and older)
No968,950 (96.9)31,004 (3.3)996,710 (99.7)3244 (0.3)
Yes444,850 (97.4)11,704 (2.6)454,006 (99.4)2548 (0.6)
X2 testp = 0.7353p = 0.6960
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Casanova-Rosado, A.J.; Casanova-Rosado, J.F.; Minaya-Sánchez, M.; Robles-Minaya, J.L.; Casanova-Sarmiento, J.A.; Márquez-Corona, M.d.L.; Pontigo-Loyola, A.P.; Isla-Granillo, H.; Mora-Acosta, M.; Márquez-Rodríguez, S.; Medina-Solís, C.E.; Maupomé, G. Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey. Healthcare 2021, 9, 404. https://doi.org/10.3390/healthcare9040404

AMA Style

Casanova-Rosado AJ, Casanova-Rosado JF, Minaya-Sánchez M, Robles-Minaya JL, Casanova-Sarmiento JA, Márquez-Corona MdL, Pontigo-Loyola AP, Isla-Granillo H, Mora-Acosta M, Márquez-Rodríguez S, Medina-Solís CE, Maupomé G. Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey. Healthcare. 2021; 9(4):404. https://doi.org/10.3390/healthcare9040404

Chicago/Turabian Style

Casanova-Rosado, Alejandro José, Juan Fernando Casanova-Rosado, Mirna Minaya-Sánchez, José Luís Robles-Minaya, Juan Alejandro Casanova-Sarmiento, María de Lourdes Márquez-Corona, América Patricia Pontigo-Loyola, Horacio Isla-Granillo, Mariana Mora-Acosta, Sonia Márquez-Rodríguez, Carlo Eduardo Medina-Solís, and Gerardo Maupomé. 2021. "Association of Edentulism with Various Chronic Diseases in Mexican Elders 60+ Years: Results of a Population-Based Survey" Healthcare 9, no. 4: 404. https://doi.org/10.3390/healthcare9040404

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