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. 2025 Jul 1;15(1):20761.
doi: 10.1038/s41598-025-06852-7.

Denture use and all-cause mortality risk in Chinese edentulous elderly: a follow-up study

Hong Tang  1 , Gang Sun  2 , Deping Sun  3
Affiliations

Denture use and all-cause mortality risk in Chinese edentulous elderly: a follow-up study

Hong Tang et al. Sci Rep. .

Abstract

This study examines the association between denture use and all-cause mortality risk among Chinese edentulous elderly, using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2008-2014 waves). A cohort of 8444 adults aged [Formula: see text] with complete tooth loss was analyzed, with denture use recorded as a binary variable (yes/no) and mortality verified via follow-up linkages. Missing data were handled via multiple imputation (MICE), and propensity score matching (PSM) balanced covariates between denture users and non-users. Kaplan-Meier survival analysis demonstrated significantly improved survival probabilities among denture users compared to non-users (log-rank p = 0.0033). Multivariate Cox proportional hazards models, after full adjustment for potential confounders, consistently revealed that denture non-users faced a 15.8% higher mortality risk (HR = 1.158, 95% CI 1.082-1.239, P < 0.001). Mediation analyses elucidated potential pathways, identifying BMI as a significant partial mediator (indirect effect = - 0.010, P < 0.001) in the denture-mortality relationship. In contrast, neither dietary diversity (DDS: p = 0.105) nor daily staple food intake (DSFA: p = 0.190) demonstrated significant mediating effects. The robustness of these findings was confirmed through comprehensive sensitivity analyses, including complete-case analysis and evaluation of pre-propensity score matched cohorts, with all approaches yielding consistent results. This study provides robust evidence that denture use is significantly associated with reduced all-cause mortality among edentulous elderly adults, with BMI serving as a key mediating factor in this protective relationship.

Keywords: All-cause mortality; Denture use; Edentulism; Elderly; Longitudinal cohort study; Mediation analysis.

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Conflict of interest statement

Declarations. Competing interests: All of the authors have confirmed that this work does not have any competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier Estimates of Survival Probability by denture use. Note: (A) All edentulous participants. (B) Edentulous participants aged > 90 years. (C) Edentulous participants aged formula image years. (D) male. (E) female. (F) higher income edentulous participants. (G) Middle income group. (H) lower income group. (I) without marry. (J) marry. (K) Illiterate. (L) Literate.
Fig. 2
Fig. 2
Restricted Cubic Spline (RCS) analysis of DDS, DSFA, and BMI with all-cause mortality. Note: DDs: Dietary Diversity Score. DSFA: Daily Staple Food Amount. BMI: Body Mass Index.
Fig. 3
Fig. 3
Mediation analysis of denture use, BMI, DDS, and DSFA on all-cause mortality. Note: DDs: Dietary Diversity Score. DSFA: Daily Staple Food Amount. BMI: Body Mass Index.c’: direct effect. c: total effect..
Fig. 4
Fig. 4
Subgroup mediation analysis of denture use, BMI, DDS, and DSFA on all-cause mortality. Note: (A, B) Edentulous participants aged formula image years. (C, D) Edentulous participants aged > 90 years. (E, F) male. (G, H) female. DDs: Dietary Diversity Score. DSFA: Daily Staple Food Amount. BMI: Body Mass Index.c’: direct effect. c: total effect..
Fig. 5
Fig. 5
Participant selection flow diagram.
See this image and copyright information in PMC

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