Modeling longitudinal oral health status and pneumonia risk: secondary data analyses of an integrated dental-medical cohort

Background: Mounting evidence indicates potential associations between poor oral health status (OHS) and increased pneumonia risk. Relative pneumonia risk was assessed in the context of longitudinally documented OHS. Methods: Electronic medical/dental patient data captured from 2007 through 2019 were retrieved from the integrated health records of Marshfield Clinic Health Systems. Participant eligibility initiated with an assessment of OHS, stratified into the best, moderate, or worst OHS groups, with the additional criterion of ‘no pneumonia diagnosis in the past 90 days’. Pneumonia incidence was longitudinally monitored for up to 1 year from each qualifying dental visit. Models were assessed, with and without adjustment for prior pneumonia incidence, adjusted for smoking and subjected to confounding mitigation attributable to known pneumonia risk factors by applying propensity score analysis. Time-to-event analysis and proportional hazard modeling were applied to investigate relative pneumonia risk over time among the OHS groups. Results: Modeling identified associations between any incident pneumonia subtype and ‘number of missing teeth’ (p < 0.001) and ‘clinically assessed periodontal status’ (p < 0.01), which remained significant following adjustment for prior pneumonia incidence and smoking. The hazard ratio (HR) for ‘any incident pneumonia’ in the best OHS group for ‘number of missing teeth’ was 0.65, 95% confidence interval (CI) [0.54 − 0.79] (unadjusted) and 0.744, 95% CI [0.61 − 0.91] (adjusted). The HR for ‘any incident pneumonia’ in the best ‘clinically assessed periodontal status’ group was 0.72, 95% CI [0.58 − 0.90] (unadjusted) and 0.78, 95% CI [0.62 − 0.97] (adjusted). Conclusion/clinical relevance: Poor OHS increased pneumonia risk. Proactive attention of medical providers to patient OHS and health literacy surrounding oral-systemic disease association is vital, especially in high-risk populations.