J Periodontal Implant Sci.  2018 Apr;48(2):92-102. 10.5051/jpis.2018.48.2.92.

Charlson comorbidity index as a predictor of periodontal disease in elderly participants

• Lee JH
• Choi JK
• Jeong SN
• Choi SH

• KMID: 2410688
• DOI: http://doi.org/10.5051/jpis.2018.48.2.92

Abstract

PURPOSE
This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period.
METHODS
Nationwide representative samples of 149,785 adults aged ≥60 years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD.
RESULTS
The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P < 0.001; grade ≥2: HR, 1.12, P < 0.001).
CONCLUSIONS
We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.

Keyword

Comorbidity; Periodontal disease; Risk factors

MeSH Terms

Adult
Aged*
Classification
Cohort Studies
Comorbidity*
Connective Tissue
Dementia
Diabetes Complications
Family Characteristics
Heart Failure
HIV
Humans
Insurance Coverage
Liver Diseases
Lung Diseases
Mortality
Myocardial Infarction
National Health Programs
Paraplegia
Peptic Ulcer
Periodontal Diseases*
Peripheral Vascular Diseases
Risk Factors

Figure

• 

  Figure 1 The cumulative incidence of PD in patients with CDs was estimated using the Kaplan-Meier method and compared using the log-rank test. A higher CCI was associated with a higher incidence of PD in elderly participants with comorbidities (P<0.001).PD: periodontal disease, CD: comorbid disease, CCI: Charlson comorbidity index.

• 

  Figure 2 Associations of comorbidities with PD in elderly participants in the multivariate regression analysis. The multivariate Cox proportional-hazards regression analysis adjusted for sex, age, household income, insurance status, residence area, health status, acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and HIV. Data are HRs with 95% CIs.PD: periodontal disease, HIV: human immunodeficiency virus, HR: hazard ratio, CI: confidence interval, MAP: Medical Aid Program, NHIS: National Health Insurance Service, CCI: Charlson comorbidity index.

Reference

1. Lee JH, Lee JS, Park JY, Choi JK, Kim DW, Kim YT, et al. Association of lifestyle-related comorbidities with periodontitis: a nationwide cohort study in Korea. Medicine (Baltimore). 2015; 94:e1567. PMID: 26376407.

2. Lee JH, Choi JK, Kim SH, Cho KH, Kim YT, Choi SH, et al. Association between periodontal flap surgery for periodontitis and vasculogenic erectile dysfunction in Koreans. J Periodontal Implant Sci. 2017; 47:96–105. PMID: 28462008.

3. Lee JH, Oh JY, Youk TM, Jeong SN, Kim YT, Choi SH. Association between periodontal disease and non-communicable diseases: a 12-year longitudinal health-examinee cohort study in South Korea. Medicine (Baltimore). 2017; 96:e7398. PMID: 28658175.

4. Choi JK, Kim YT, Kweon HI, Park EC, Choi SH, Lee JH. Effect of periodontitis on the development of osteoporosis: results from a nationwide population-based cohort study (2003–2013). BMC Womens Health. 2017; 17:77. PMID: 28893226.

5. Lee JH, Kweon HH, Choi JK, Kim YT, Choi SH. Association between periodontal disease and prostate cancer: results of a 12-year longitudinal cohort study in South Korea. J Cancer. 2017; 8:2959–2965. PMID: 28928887.

6. Seymour GJ. Relationship between periodontal infections and systemic disease - the oral systemic connection. Int J Antimicrob Agents. 2007; 29:S57–S58.

7. LaMonte MJ, Genco RJ, Hovey KM, Wallace RB, Freudenheim JL, Michaud DS, et al. History of periodontitis diagnosis and edentulism as predictors of cardiovascular disease, stroke, and mortality in postmenopausal women. J Am Heart Assoc. 2017; 6:e004518. PMID: 28356279.

8. Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple IL. Association between periodontitis and mortality in stages 3–5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol. 2016; 43:104–113. PMID: 26717883.

9. Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, et al. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005; 28:27–32. PMID: 15616229.

10. Melfi C, Holleman E, Arthur D, Katz B. Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data. J Clin Epidemiol. 1995; 48:917–926. PMID: 7782800.

11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40:373–383. PMID: 3558716.

12. Jönsen A, Clarke AE, Joseph L, Belisle P, Bernatsky S, Nived O, et al. Association of the Charlson comorbidity index with mortality in systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2011; 63:1233–1237. PMID: 21618451.

13. Bar B, Hemphill JC 3rd. Charlson comorbidity index adjustment in intracerebral hemorrhage. Stroke. 2011; 42:2944–2946. PMID: 21799172.

14. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45:613–619. PMID: 1607900.

15. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004; 57:1288–1294. PMID: 15617955.

16. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999; 4:1–6. PMID: 10863370.

17. 1999 International International Workshop for a Classification of Periodontal Diseases and Conditions. Papers. Oak Brook, Illinois, October 30–November 2, 1999. Ann Periodontol. 1999; 4:1–112. PMID: 10863370.

18. Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G. In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care. 2006; 44:745–753. PMID: 16862036.

19. Shiau HJ, Reynolds MA. Sex differences in destructive periodontal disease: a systematic review. J Periodontol. 2010; 81:1379–1389. PMID: 20450376.

20. López R, Smith PC, Göstemeyer G, Schwendicke F. Ageing, dental caries and periodontal diseases. J Clin Periodontol. 2017; 44(Suppl 18):S145–S152. PMID: 28266118.

21. Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, et al. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017; 44(Suppl 18):S135–S144. PMID: 28266112.

22. Lee JH, Lee JS, Choi JK, Kweon HI, Kim YT, Choi SH. National dental policies and socio-demographic factors affecting changes in the incidence of periodontal treatments in Korean: A nationwide population-based retrospective cohort study from 2002-2013. BMC Oral Health. 2016; 16:118. PMID: 27814698.

23. Lee JH, Oh JY, Choi JK, Kim YT, Park YS, Jeong SN, et al. Trends in the incidence of tooth extraction due to periodontal disease: results of a 12-year longitudinal cohort study in South Korea. J Periodontal Implant Sci. 2017; 47:264–272. PMID: 29093985.

24. Freisinger E, Malyar NM, Reinecke H. Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting. Vasa. 2016; 45:169–174. PMID: 27058804.

25. Kaye EK, Valencia A, Baba N, Spiro A 3rd, Dietrich T, Garcia RI. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 2010; 58:713–718. PMID: 20398152.

26. Wang YH, Lv ZF, Zhong Y, Liu DS, Chen SP, Xie Y. The internalization of Helicobacter pylori plays a role in the failure of H. pylori eradication. Helicobacter. 2017; 22:e12324.

27. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009; 374:1449–1461. PMID: 19683340.

28. Anand PS, Nandakumar K, Shenoy KT. Are dental plaque, poor oral hygiene, and periodontal disease associated with Helicobacter pylori infection? J Periodontol. 2006; 77:692–698. PMID: 16584352.

29. Zarić S, Bojić B, Janković L, Dapčević B, Popović B, Čakić C, et al. Periodontal therapy improves gastric Helicobacter pylori eradication. J Dent Res. 2009; 88:946–950. PMID: 19783805.

30. Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Ann Periodontol. 2003; 8:54–69. PMID: 14971248.

31. Manger D, Walshaw M, Fitzgerald R, Doughty J, Wanyonyi KL, White S, et al. Evidence summary: the relationship between oral health and pulmonary disease. Br Dent J. 2017; 222:527–533. PMID: 28387268.

32. Sumi Y, Miura H, Michiwaki Y, Nagaosa S, Nagaya M. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr. 2007; 44:119–124. PMID: 16723159.

33. Larsson J, Itenov TS, Bestle MH. Risk prediction models for mortality in patients with ventilator-associated pneumonia: A systematic review and meta-analysis. J Crit Care. 2017; 37:112–118. PMID: 27676171.

34. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380:37–43. PMID: 22579043.

35. Laor A, Tal S, Guller V, Zbar AP, Mavor E. The Charlson comorbidity index (CCI) as a mortality predictor after surgery in elderly patients. Am Surg. 2016; 82:22–27. PMID: 26802847.

36. Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015; 10:461–467. PMID: 25709420.