PRP156: Risk of Periodontitis in invididuals with Multimorbidity
Marie Claire O'Dwyer, MBChB, MPH, NCMP; Allison Furgal, MS; Juana Nicoll Capizzano, MD; Manasi Ramakrishnan, MBBS; Melissa Plegue, MA; Wendy Furst, MA
Context: The triple aim of improved outcomes, improved quality and reduced healthcare costs is challenging in primary care. Multimorbidity, the presence of two or more unrelated chronic medical conditions, is a barrier to achieving this. Often misperceived as a dental disease, periodontitis is a systemic inflammatory disorder associated with chronic conditions such as diabetes and atherosclerosis. Treatment of periodontitis in chronic medical diseases is associated with reduced healthcare costs and hospitalizations. However, periodontitis is rarely included in studies quantifying multimorbidity and the relationship between periodontitis and multimorbidity is poorly understood. Objective: To determine if periodontitis is associated with multimorbidity. Study Design: Secondary data analysis of population based cross sectional survey. Dataset: NHANES 2011-2014 Population Studied: US adults aged 30 years or older who underwent a periodontal examination. Multimorbidity was defined as 2 or more chronic conditions using a validated multimorbidity tool and complex multimorbidity was defined as 3 or more chronic conditions in 3 more organ systems based on ICPC2 categories. Outcome Measures: Prevalence of periodontitis in individuals with and without multimorbidity and complex multimorbidity using likelihood estimates and adjusting for confounding (age, smoking history, socioeconomic status) with logistic regression models. Results: 6,961 had periodontal exams. 27.4% of all patients examined had periodontitis. 54% of those examined had multimorbidity and 23.7% of patients examined had complex multimorbidity. There was no difference between prevalence of periodontitis in individuals with and without multimorbidity (27.3% vs 27.5%, p=0.8922). There was no difference between prevalence of periodontitis in individuals with and without complex multimorbidity (26.8% vs 27.6% p=0.651). Diabetes, heart failure, obesity and depression were significantly associated with periodontitis. In adjusted analyses, the odds ratio for periodontitis in individuals with multimorbidity was 0.841(95% CI 0.714-0.992, p=0.04) and 0.822(95% CI 0.679-0.994) for those with complex multimorbidity, p=0.042. Conclusion: Multimorbidity is associated with a lower risk of periodontitis in our analysis. Given the known associations between periodontitis and chronic medical conditions, our novel finding of a reduced risk of periodontitis in multimorbidity is interesting and will require further study.