Tooth Loss, Periodontal Disease, and Mild Cognitive Impairment Among Hispanic/Latino Immigrants: The Moderating Effects of Age at Immigration

Abstract

Background: The objectives were to assess (a) the association between poor oral health and mild cognitive impairment (MCI) in Hispanic/Latino immigrants and (b) potential modification effects on this association by age at immigration.

Methods: Data were from the Hispanic Community Health Study/Study of Latinos and its ancillary study-the Study of Latinos-Investigation of Neurocognitive Aging. MCI, a binary outcome variable, defined by the National Institute on Aging-Alzheimer's Association criteria. The main exposure was significant tooth loss (STL), defined as a loss of 8 or more teeth, and periodontitis, classified using the Centers for Disease Control and Prevention and American Academy of Periodontology case classification. Multiple logistic regression was used to assess the association between STL/periodontitis and MCI and test moderation effects of age at immigration. The analytical sample comprised 5 709 Hispanic/Latino adult immigrants.

Results: Hispanic/Latino immigrants with STL (adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI]: 1.01-1.85) were more likely to have MCI than those with greater tooth retention. Overall, migration to the United States after age 18 was associated with greater odds of MCI than migration at a younger age. A significant interaction effect between STL and age at immigration revealed that the effect of STL on MCI is even higher in those who immigrated to the United States at ages 35-49 years.

Conclusions: STL is a significant risk factor for MCI and age at immigration had a modification effect on the association between STL and MCI. Better access to dental care, health education on risk factors of MCI, and promotion of good oral health may mitigate the burden of cognitive impairment in Hispanics/Latinos.

Keywords: Hispanics/Latinos; Immigrants; Mild cognitive impairment; Periodontal disease; Tooth loss.

Figure 1.

A flow chart of sample selection. SOL-INCA = Study of Latinos – Investigation of Neurocognitive Aging.

Figure 2.

Predictive probability by Age at immigrantion × Significant tooth loss. Note: Results were generated from a logistic regression model (same as Model VI): MCI is the dependent variable; periodontal disease and tooth 
loss are the independent variables; covariates included. The independent variables significant tooth loss, periodontal disease, and covariates were age, sex, race, income, health insurance, time since visit 1, filed centers, body mass index, smoking status, alcohol use, dietary quality, depression, hypertension, stroke, myocardial infarction, diabetes, hs-CRP, age at immigration, and age at immigration by significant tooth loss interaction. hs-CRP = high-sensitivity C-reactive protein; MCI = mild cognitive impairment.