Combined influence of oral health behaviors and nutritional and inflammatory status on risk of all-cause mortality among US population, NHANES 2011-2018

Abstract Background: Oral health and inflammation and nutritional status are interconnected, each bearing significant correlation with long-term prognoses in populations. We investigated the interactions and correlations among nutritional and inflammatory indictors, oral health, and all-cause mortality. Methods: A nationally representative prospective cohort sample was recruited from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States from 2011 to 2018, selecting individuals aged 40 or above (n=10573; weighted population: 7229522) with comprehensive oral health assessments and related biomarkers. Oral health was quantified using multiple indicators to construct an Oral Health Index (OHI), and the Prognostic Nutritional Index (PNI) was employed to reflect general inflammatory and nutritional status. The independent effects of OHI and PNI on all-cause mortality were examined across the population, alongside their interactive prognostic implications. Results: The study included 10573 participants with complete oral health and related data. Adjusted models revealed that better self- assessed oral health (HR=0.80; 95%CI: 0.67-0.96) and more frequent use of dental floss (HR=0.94; 95%CI: 0.91-0.98) were associated with lower all-cause mortality rates. Conversely, individuals with dental visits exceeding five years (HR=1.35; 95%CI: 1.13-1.62), occupational oral health hazards (HR=1.33; 95%CI: 1.00-1.76), or no history of periodontal cleaning or treatment (HR=1.37; 95%CI: 1.09-1.73) faced higher mortality rates. A higher PNI indicated a lower all-cause mortality risk (HR=0.9; p<0.001). The correlation between the constructed OHI and all-cause mortality was confirmed (HR=0.99, P<0.001), with interaction analysis showing a significantly increased impact of OHI on prognosis at lower PNI levels. Conclusion: This cohort study observed the effects of oral health and nutritional/inflammatory statuses on all-cause mortality, identifying the lowest risk of mortality among populations with high OHI and PNI levels.