Chronic Periodontitis as a Risk Factor for Benign Prostatic Hyperplasia: A Cohort Study

Abstract

Objective: The association between periodontitis and benign prostatic hyperplasia (BPH) has been controversial. This study aimed to estimate the association between recurrent periodontitis episodes and the occurrence of BPH in an adult male population in Korea. Methods: This study analyzed data from 79,497 matched cases and controls to examine the relationship between periodontitis and BPH, using Korean National Health Insurance Service-Health Screening Cohort data. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for confounding factors. Results: The odds of BPH were significantly higher for participants with periodontitis ≥ 1 within 1 year (OR = 1.34, 95% CI = 1.31-1.37), particularly in low-income individuals (OR = 1.43, 95% CI = 1.38-1.48). Increased periodontitis frequency (≥2 or ≥3 within 1 year) and a CCI score ≥ 2 were associated with progressively higher odds of BPH, indicating that periodontitis may be a significant risk factor for BPH, with variations depending on socioeconomic and health status. Conclusions: The occurrence of BPH was higher in participants with a history of recurrent periodontitis episodes, with stronger associations observed in those with low income or multiple comorbidities. Clinicians should be aware of the potential risk of BPH in patients with recurrent periodontitis episodes. This study's retrospective design, reliance on ICD-10 codes without details on disease severity, and focus on Korean citizens over 40 limit its ability to establish causality and generalizability to other populations and age groups, which should be considered when interpreting the findings.

Keywords: benign prostatic hyperplasia; epidemiology; periodontitis; risk factors.

Figure 1

A schematic illustration of the participant selection process used in the present study. The flowchart outlines the inclusion and exclusion criteria at each step. BPH participants with a washout period of less than 2 years were excluded to ensure diagnostic accuracy, and control participants with a single BPH diagnosis were excluded to avoid potential misclassification. Participants with missing health data, including BMI, fasting blood glucose, blood pressure, or total cholesterol, were also removed. During the matching process, participants were excluded if they could not be matched due to demographic or clinical differences. Ultimately, of a total of 514,866 participants, 79,497 participants with BPH were matched with 79,497 control participants based on age, sex, income, and region of residence.

Figure 2

Forest plots illustrating the adjusted odds ratio and corresponding 95% confidence intervals (CIs) for demographic, lifestyle, and comorbid factors in relation to chronic periodontitis (CP) for incident benign prostatic hyperplasia (BPH) when participants are diagnosed with CP ≥ 2 within 1 year before the index date.

Figure 3

Forest plots illustrating the adjusted odds ratio and corresponding 95% confidence intervals (CIs) for demographic, lifestyle, and comorbid factors in relation to chronic periodontitis (CP) for incident benign prostatic hyperplasia (BPH) when participants are diagnosed with CP ≥ 3 within 1 year before the index date.

Figure 4

Forest plots illustrating the adjusted odds ratio and corresponding 95% confidence intervals (CIs) for demographic, lifestyle, and comorbid factors in relation to chronic periodontitis (CP) for incident benign prostatic hyperplasia (BPH) when participants are diagnosed with CP ≥ 1 within 2 years before the index date.