Association of oral disease with cancer incidence and mortality among adults in South Korea: A nationwide retrospective cohort study

Abstract

Objectives: While studies have begun to suggest a potential link between periodontal disease and cancer, there remains a paucity of comprehensive investigations into its association with specific cancer incidence and mortality. This study aimed to analyze association between three oral diseases and site-specific cancer incidence and mortality. Methods: A retrospective cohort study was conducted on a population of 3,845,280, utilizing data sourced from the Korean National Health Insurance Database from 2006 to 2019, supplemented by National Statistics Data from 2010 to 2019. Cox proportional hazards models were applied to estimate the association between oral disease (dental caries, gingivitis, and tooth loss) and site-specific cancer risk of incidence and mortality. Results: After a median follow up of 10.11 years, we identified 181,754 new cancer cases and 37,135 deaths from cancer. Tooth loss was significantly associated with stomach cancer (adjusted hazard ratio (aHR): 1.08, 95% confidence interval (CI): 1.05-1.11), colorectal cancer (1.13, 1.09-1.16), liver cancer (1.09, 1.04-1.14), and lung cancer (1.04, 1.01-1.08) incidences. Tooth loss was significantly associated with mortality for total cancer (1.12, 1.09-1.14), stomach cancer (1.21, 1.12-1.31), colorectal cancer (1.14, 1.05-1.23), liver cancer (1.16, 1.09-1.23), lung cancer (1.08, 1.03-1.13), and prostate cancer (1.24, 1.04-1.47) mortality. Gingivitis was significantly associated with liver cancer incidence and mortality (1.08, 1.03-1.13; 1.11, 1.05-1.18). Conclusions: The results of this study showed that not only tooth loss but also gingivitis, an early stage of periodontal disease, may increase the risk of cancer incidence and mortality. Improving oral health can be prioritized to enhance overall public health, including reducing the risk of cancer.

Keywords: Tooth loss; cancer incidence; cancer mortality; gingivitis; oral disease.

Figure 1.

Study design and population (n = 3,845,280).

Figure 2.

Cumulative incidence of total cancer in with and without oral diseases (Log-rank P < 0.01).

Figure 3.

Association between tooth loss and total and site-specific cancer incidence according to age group (A), income level (B), and smoking (C). ^a Adjusted for sex, income, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^b Adjusted for age, sex, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^c Adjusted for age, sex, income, BMI, FBS CCI, alcohol, and physical activity (reference: no tooth loss). ^d n = number of cancer cases among individuals with tooth loss/total number of cancer cases. aHR: adjusted hazard ratio; BMI: body mass index; CCI: Charlson comorbidity index; CI: confidence intervals; FBS: fasting blood sugar.

Figure 3.

Association between tooth loss and total and site-specific cancer incidence according to age group (A), income level (B), and smoking (C). ^a Adjusted for sex, income, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^b Adjusted for age, sex, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^c Adjusted for age, sex, income, BMI, FBS CCI, alcohol, and physical activity (reference: no tooth loss). ^d n = number of cancer cases among individuals with tooth loss/total number of cancer cases. aHR: adjusted hazard ratio; BMI: body mass index; CCI: Charlson comorbidity index; CI: confidence intervals; FBS: fasting blood sugar.

Figure 3.

Association between tooth loss and total and site-specific cancer incidence according to age group (A), income level (B), and smoking (C). ^a Adjusted for sex, income, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^b Adjusted for age, sex, BMI, FBS, CCI, smoking, alcohol, and physical activity (reference: no tooth loss). ^c Adjusted for age, sex, income, BMI, FBS CCI, alcohol, and physical activity (reference: no tooth loss). ^d n = number of cancer cases among individuals with tooth loss/total number of cancer cases. aHR: adjusted hazard ratio; BMI: body mass index; CCI: Charlson comorbidity index; CI: confidence intervals; FBS: fasting blood sugar.