Investigating the Association Between Complex Multimorbidity and Periodontal Disease: An Analysis of the National Health and Nutrition Examination Survey

Abstract

ABSTRACT

Periodontal disease (PD) is a chronic multifactorial inflammatory disease associated with bacterial plaque and destroys the periodontal structure. Previous studies on the association between PD and chronic conditions do not account for the co-occurring of chronic and other conditions, thus underestimating their cumulative impact on PD. To address the gaps in the literature, we adopted an expanded approach by examining PD in relation to Complex multimorbidity (MM), defined as the occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Complex MM is associated with several adverse health outcomes, including self-reported fair/poor health. In addition, people with complex MM are more likely to experience difficulty performing their daily self-care tasks or activities, including maintaining oral hygiene. Hence, in the following chapters, we tested the hypotheses that the co-occurrence of chronic conditions would be associated with the presence and severity of PD (Aim 1) and Complex MM would be associated with PD and its severity (Aim 2). In addition, we hypothesized that the presence of PD would moderate the association between Complex MM and self-reported poor health (Aim 3). In addition, for both Aims 1 and 2, we used a machine learning approach, Classification and Regression Tree (CART) analysis, to identify the specific combinations of conditions associated with the outcomes of interest. Results from Study 1 showed that sociodemographic and behavioral factors, rather than chronic conditions were the most important predictors for the presence and severity of PD. Findings from Study 2 showed that PD was associated with sociodemographic factors and functional limitations rather than chronic conditions or geriatric syndromes. Finally, our results from Study 3 showed that PD did not moderate the association between complex MM and fair/poor general health. The overarching conclusion of studies is that the presence and severity of PD are highly associated with combinations of sociodemographic and behavioral factors and with conditions constituting Complex MM. However, PD did not strengthen the association between Complex MM and fair/poor general health. Therefore, accounting for the common co-occurrence of sociodemographic factors and functional limitations will be more informative than only chronic conditions for identifying people most likely vulnerable to the development of PD.