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    2020-08-14

    r> 3. Results
    The baseline characteristics of lung cancer cases and controls ADH1 presented in Table 1. The proportion of current smoking was much higher in cases than in controls (71.5% vs. 32.1%, respectively, P < 0.001). Among smokers, lung cancer cases also showed a much higher number of pack-years than controls (38.2 vs. 26.0 pack-years, respectively, P < 0.001). Lung cancer cases were more likely to be less educated, earn less income, have a history of COPD, be alcohol drin-kers, and have a lower BMI, compared with controls (all P < 0.05). Tooth loss was significantly associated with an increased risk of lung cancer (Table 2). Results were similar whether we used original data only or included imputed missing data; thus, we show only the results including imputed missing data in further analyses. Using no tooth loss as the reference, the OR (95% CI) for developing lung cancer gradually increased by greater numbers of tooth loss (P for trend < 0.001): 1.37 (0.85, 2.21) for 1–4 lost, 1.54 (0.95, 2.50) for 5–10 lost, and 3.33 (2.14,
    Table 1
    Baseline characteristics of study population, the Southern Community Cohort Study.
    Case Control P
    Household income, N (%)
    Table 2
    Association of oral health with lung cancer risk, the Southern Community Cohort Study.
    Case (%) Control (%) Original data†
    Missing data were imputed
    Crude
    Crude
    Adjusted‡
    Tooth loss
    P for trend
    Tooth decay
    P for trend
    Periodontal diseasea
    † Due to missing information on tooth loss, tooth decay, and periodontal disease, a total of 18 (tooth loss), 5 (tooth decay), and 35 (periodontal disease) were not included in the analyses.
    ‡ Adjusted for BMI, education, household income, COPD, alcohol drinking, smoking status, and pack-years; and missing data on oral health were imputed. a Ever diagnosed with periodontal diseases (gingivitis or periodontitis).
    Table 3
    Association of oral health with lung cancer risk by race, the Southern Community Cohort Study.
    African American
    European American
    P interaction
    Case Control OR† 95% CI
    Case Control OR† 95% CI
    Tooth loss
    P for trend
    Tooth decay
    P for trend
    Periodontal diseasea
    † Adjusted for BMI, education, household income, COPD, alcohol drinking, smoking status, pack-years; and missing data on oral health were imputed. a Ever diagnosed with periodontal diseases (gingivitis or periodontitis).
    As shown in Table 1, 93.8% of cases included in the study are current or former smokers. To evaluate whether the association be-tween oral health and lung cancer risk differed by smoking intensity, we performed analyses stratified by smoking pack-years. The associa-tion of oral health with lung cancer was more evident among those with
    a higher (≥ race-specific median) cumulative smoking exposure than those with a lower (< race-specific median) cumulative smoking (P for interaction < 0.001, < 0.001, and 0.03 for tooth loss, tooth decay and
    Table 4
    Association of oral health with lung cancer risk by pack-years, the Southern Community Cohort Study.
    Case Control OR† 95% CI
    Case Control OR† 95% CI
    Tooth loss
    P for trend
    Tooth decay
    P for trend
    Periodontal diseasea
    † Adjusted for age at baseline, race, smoking status, alcohol drinking, education, household income, COPD, and BMI; and missing data on oral health were imputed.
    a Ever diagnosed with periodontal disease (gingivitis or periodontitis).
    periodontal disease, respectively) (Table 4). Among heavy smokers, the ORs for developing lung cancer were 2.88 (95% CI: 1.12, 7.45) for those with more than 10 teeth lost compared to no tooth loss, 1.64 (95% CI: 0.99, 2.70) for those with 6 or more decayed teeth compared to no tooth decay, and 2.05 (95% CI: 1.38, 3.05) for those with a history of periodontal disease compared to those without a history of periodontal disease (Table 4). In addition, the risk increase associated with tooth loss or tooth decay was significant only among smokers who had more than the race-specific median pack-years.
    We also evaluated the association between oral health and lung cancer risk by lung cancer subtypes. The associations did not differ between adenocarcinoma and squamous cell carcinoma (data not shown). However, the sample size is not large in the subgroup analyses.
    4. Discussion
    In Hybrid-arrested translation population-based nested case-control study, we found that poor oral health, including tooth loss, ADH1 tooth decay, and a history of periodontal disease, was associated with an increased risk of lung cancer among the SCCS population. These positive associations were more evident among African Americans and heavy smokers.