Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study

Eun Ae Kang; Jaeyoung Chun; Jee Hyun Kim; Kyungdo Han; Hosim Soh; Seona Park; Seung Wook Hong; Jung Min Moon; Jooyoung Lee; Hyun Jung Lee; Jun-Beom Park; Jong Pil Im; Joo Sung Kim

doi:10.3748/wjg.v26.i37.5661

Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study

World J Gastroenterol. 2020 Oct 7;26(37):5661-5672. doi: 10.3748/wjg.v26.i37.5661.

Authors

Eun Ae Kang¹, Jaeyoung Chun², Jee Hyun Kim³, Kyungdo Han⁴, Hosim Soh⁵, Seona Park⁵, Seung Wook Hong⁵, Jung Min Moon⁵, Jooyoung Lee⁵, Hyun Jung Lee⁵, Jun-Beom Park⁶, Jong Pil Im⁵, Joo Sung Kim⁵

Affiliations

¹ Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 03722, South Korea.
² Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, South Korea. chunjmd@yuhs.ac.
³ Department of Internal Medicine, Bundang CHA Medical Center, CHA University School of Medicine, Seoul 13496, South Korea.
⁴ Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea.
⁵ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, South Korea.
⁶ Department of Periodontics, the Catholic University of Korea College of Medicine, Seoul 06591, South Korea.

Abstract

Background: Periodontitis is a chronic inflammation of periodontal tissues. The effect of periodontitis on the development of inflammatory bowel disease (IBD) remains unclear.

Aim: To assessed the risk of IBD among patients with periodontitis, and the risk factors for IBD related to periodontitis.

Methods: A nationwide population-based cohort study was performed using claims data from the Korean National Healthcare Insurance Service. In total, 9950548 individuals aged ≥ 20 years who underwent national health screening in 2009 were included. Newly diagnosed IBD [Crohn's disease (CD), ulcerative colitis (UC)] using the International Classification of Disease 10^th revision and rare intractable disease codes, was compared between the periodontitis and non-periodontitis groups until 2017.

Results: A total of 1092825 individuals (11.0%) had periodontitis. Periodontitis was significantly associated with older age, male gender, higher body mass index, quitting smoking, not drinking alcohol, and regular exercise. The mean age was 51.4 ± 12.9 years in the periodontitis group and 46.6 ± 14.2 years in the non-periodontitis group (P < 0.01), respectively. The mean body mass index was 23.9 ± 3.1 and 23.7 ± 3.2 in the periodontitis and non-periodontitis groups, respectively (P < 0.01). Men were 604307 (55.3%) and 4844383 (54.7%) in the periodontitis and non-periodontitis groups, respectively. The mean follow-up duration was 7.26 years. Individuals with periodontitis had a significantly higher risk of UC than those without periodontitis [adjusted hazard ratio: 1.091; 95% confidence interval (CI): 1.008-1.182], but not CD (adjusted hazard ratio: 0.879; 95% confidence interval: 0.731-1.057). The risks for UC were significant in the subgroups of age ≥ 65 years, male gender, alcohol drinker, current smoker, and reduced physical activity. Current smokers aged ≥ 65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers aged ≥ 65 years without periodontitis.

Conclusion: Periodontitis was significantly associated with the risk of developing UC, but not CD, particularly in current smokers aged ≥ 65 years.

Keywords: Crohn’s disease; Inflammatory bowel disease; Periodontitis; Smoking; Ulcerative colitis.

MeSH terms

Adult
Aged
Cohort Studies
Colitis, Ulcerative* / diagnosis
Colitis, Ulcerative* / epidemiology
Crohn Disease*
Humans
Male
Middle Aged
Periodontitis* / epidemiology
Risk Factors
Smoking / adverse effects