Dental status, quality of life, and mortality in an older community population: a multivariate approach

OBJECTIVE: To evaluate the relationships between a functional measure of dental status (FDS), several variables belonging to a quality of life (QOL) profile, and mortality in an older community population. DESIGN: Cross-sectional analysis for FDS and QOL; 10-year prospective study for mortality. SETTING: The historical and central district of the city of Brescia, northern Italy. PARTICIPANTS: The entire cohort of 70 to 75-year-old people living in the above-mentioned district (n = 1303): 1201 subjects were eligible for interview at baseline; 11 refused the physical examination; 52 were lost to follow-up; data are presented for the remaining sample of 1137 subjects. MEASUREMENTS: FDS examination was used to classify the subjects into three groups: naturally adequate (ADS) (25.2%), naturally inadequate (IDS) (14.3%) dental status, and denture wearers (DW) (60.4%). Various QOL domains were assessed: mood level, cognitive status, instrumental activities of daily living (IADL), social relationships, indexes of somatic health, and health behaviors. The demographic and socioeconomic parameters were used as covariates. RESULTS: Univariate analysis showed that both the ADS and the DW groups had a better QOL profile than the IDS group. Multiple logistic regression indicated that ADS and DW conditions were predicted independently by better educational and financial conditions, higher social relationships and a better IADL level in comparison with IDS. Moreover, compared with IDS, DS was a significant predictor of a better level at the SELF, IADL, and HCU scales whereas DW predicted only a better IADL level. Crude survival analysis showed that ADS was associated with a lower mortality risk compared with both DW and IDS, which did not differ from each other. FDS also remained a significant and independent predictor of mortality in a more general Cox's regression model. CONCLUSIONS: Within this cohort of 70 to 75-year-old urban residents, FDS is associated with several QOL domains and with long-term survival. A hierarchy of reciprocal relationships exists among these parameters. The present study provides a basis for encouraging more extensive use of dentures. Longitudinal studies using oral health outcomes are warranted before clinical recommendations can be made.