SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk

Jiayun Lu; Ina Zaimi; John R. Barber; Corinne E. Joshu; Anna E. Prizment; James D. Beck; Elizabeth A. Platz; Dominique S. Michaud

doi:10.1016/j.annepidem.2019.08.005

SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk

Jiayun Lu, Ina Zaimi, John R. Barber, Corinne E. Joshu, Anna E. Prizment, James D. Beck, Elizabeth A. Platz, Dominique S. Michaud

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Purpose: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. Methods: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. Results: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07–1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05–1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. Conclusions: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

Original language	English (US)
Pages (from-to)	35-41
Number of pages	7
Journal	Annals of epidemiology
Volume	38
DOIs	https://doi.org/10.1016/j.annepidem.2019.08.005
State	Published - Oct 2019

Bibliographical note

Funding Information:
Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data.

Funding Information:
The authors thank the staff and participants of the ARIC study for their important contributions. Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data. Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110. The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, United States, National Institutes of Health, United States, and Department of Health and Human Services, under the following contract numbers: HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN268201700002I. Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI (U01 CA164975). The ARIC Dental Study was funded by NIH NIDCR, United States R01-DE021418 and R01-DE021986. This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110 . The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute , United States, National Institutes of Health , United States, and Department of Health and Human Services , under the following contract numbers: HHSN268201700001I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I , HHSN268201700002I . Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI ( U01 CA164975 ). The ARIC Dental Study was funded by NIH NIDCR , United States R01-DE021418 and R01-DE021986 . This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2019 Elsevier Inc.

Keywords

Cancer
Confounding
Edentulism
Gum disease
Periodontal disease
SES

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.annepidem.2019.08.005

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@article{7542294f74ab49c688929788698661a7,

title = "SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk",

abstract = "Purpose: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. Methods: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. Results: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07–1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05–1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. Conclusions: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.",

keywords = "Cancer, Confounding, Edentulism, Gum disease, Periodontal disease, SES",

author = "Jiayun Lu and Ina Zaimi and Barber, {John R.} and Joshu, {Corinne E.} and Prizment, {Anna E.} and Beck, {James D.} and Platz, {Elizabeth A.} and Michaud, {Dominique S.}",

note = "Funding Information: Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data. Funding Information: The authors thank the staff and participants of the ARIC study for their important contributions. Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data. Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110. The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, United States, National Institutes of Health, United States, and Department of Health and Human Services, under the following contract numbers: HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN268201700002I. Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI (U01 CA164975). The ARIC Dental Study was funded by NIH NIDCR, United States R01-DE021418 and R01-DE021986. This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110 . The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute , United States, National Institutes of Health , United States, and Department of Health and Human Services , under the following contract numbers: HHSN268201700001I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I , HHSN268201700002I . Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI ( U01 CA164975 ). The ARIC Dental Study was funded by NIH NIDCR , United States R01-DE021418 and R01-DE021986 . This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = oct,

doi = "10.1016/j.annepidem.2019.08.005",

language = "English (US)",

volume = "38",

pages = "35--41",

journal = "Annals of epidemiology",

issn = "1047-2797",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk

AU - Lu, Jiayun

AU - Zaimi, Ina

AU - Barber, John R.

AU - Joshu, Corinne E.

AU - Prizment, Anna E.

AU - Beck, James D.

AU - Platz, Elizabeth A.

AU - Michaud, Dominique S.

N1 - Funding Information: Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data. Funding Information: The authors thank the staff and participants of the ARIC study for their important contributions. Cancer incidence data have been provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Maryland Department of Health, 201 W. Preston Street, Room 400, Baltimore, MD 21201. The authors acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the National Program of Cancer Registries of the Centers for Disease Control and Prevention for the funds that helped support the availability of the cancer registry data. Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110. The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, United States, National Institutes of Health, United States, and Department of Health and Human Services, under the following contract numbers: HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, HHSN268201700002I. Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI (U01 CA164975). The ARIC Dental Study was funded by NIH NIDCR, United States R01-DE021418 and R01-DE021986. This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: Dr. Michaud's pancreatic cancer research is supported by NCI R01 CA207110 . The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute , United States, National Institutes of Health , United States, and Department of Health and Human Services , under the following contract numbers: HHSN268201700001I , HHSN268201700003I , HHSN268201700005I , HHSN268201700004I , HHSN268201700002I . Studies on cancer in the Atherosclerosis Risk in Communities (ARIC) study are also supported by the NCI ( U01 CA164975 ). The ARIC Dental Study was funded by NIH NIDCR , United States R01-DE021418 and R01-DE021986 . This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973). The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2019 Elsevier Inc.

PY - 2019/10

Y1 - 2019/10

N2 - Purpose: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. Methods: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. Results: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07–1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05–1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. Conclusions: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

AB - Purpose: Severe periodontal disease and edentulism have been previously reported to be significantly associated with cancer risk and mortality, including in the Atherosclerosis Risk in Communities study (2018); however, complex sources of confounding by socioeconomic status (SES), and characteristics correlated with SES, could have been present in earlier analyses. Methods: To capture life course SES and its correlates, we generated a propensity score and included it, along with other potential confounders such as smoking and obesity, into a Cox regression model to examine the association between periodontal disease and cancer risk. In addition, we stratified the model with the propensity score by low and high SES. All statistical tests were two-sided. Results: Compared with our previous study, the associations for severe periodontitis and cancer incidence remained comparable after weighting by the propensity score (e.g., for total cancer: before weighting, hazard ratio = 1.24, 95% confidence interval = 1.07–1.42 vs. after weighting, hazard ratio = 1.23, 95% confidence interval = 1.05–1.44 when comparing severe periodontitis to no or mild periodontitis). Associations were comparable in low and high SES strata and statistically significant among participants with high SES. Conclusions: Complex sources of confounding by SES and its correlates are unlikely to fully account for the positive associations observed for periodontal disease and edentulism and cancer risk.

KW - Cancer

KW - Confounding

KW - Edentulism

KW - Gum disease

KW - Periodontal disease

KW - SES

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SES and correlated factors do not explain the association between periodontal disease, edentulism, and cancer risk

Abstract

Bibliographical note

Keywords

UN SDGs

Publisher link

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