title: Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort.
abstract: BACKGROUND
  Tooth loss has previously been associated with a higher risk of cancer, heart disease, and stroke, but the role of confounding by smoking remains an issue.
  
  
  METHODS
  We conducted a cohort study including 29,584 healthy, rural Chinese adults who were participants in a chemoprevention trial from 1986 through 1991 and who have been followed-up through 2001. We categorized tooth loss for each subject as less than or equal to or greater than the median number of teeth lost for other subjects of the same age at baseline. Mortality outcomes were categorized as follows: total death (n = 9362), upper gastrointestinal (GI) cancer death (n = 2625), other cancer death (n = 514), heart disease death (n = 1932), and fatal stroke (n = 2866).
  
  
  RESULTS
  Individuals with greater than the age-specific median number of teeth lost had statistically significant 13% increased risk of total death [95% confidence interval (CI) 9-18%], 35% increased risk of upper GI cancer death (95% CI 14-59%), 28% increased risk of heart disease death (95% CI 17-40%), and 12% increased risk of stroke death (95% CI 2-23%), but no significantly increased risk of death from cancer at other sites. These elevated risks were present in male smokers, male non-smokers, and females, nearly all never-smokers.
  
  
  CONCLUSIONS
  In this Asian population, tooth loss significantly increased the risk of total death and death from upper GI cancer, heart disease, and stroke. These associations were not limited to tobacco smokers.
authors.affiliation: Cancer Prevention Studies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA. abnetc@mail.nih.gov
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.forename: Zhi-Wei
authors.initials: ZW
authors.lastname: Dong
authors.forename: Philip R
authors.initials: PR
authors.lastname: Taylor
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mark
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000150:complications / Q000401:mortality*; D002681:China / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality*; D005260:Female; D006306:Health Surveys; D006331:Heart Diseases / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D016388:Tooth Loss / Q000150:complications / Q000401:mortality*