口腔卫生行为与脑卒中发病的前瞻性队列研究

龙梦雅; 王惠群; 周婕; 吴延莉; 余丽莎; 刘涛

doi:10.16462/j.cnki.zhjbkz.2023.10.009

口腔卫生行为与脑卒中发病的前瞻性队列研究

doi: 10.16462/j.cnki.zhjbkz.2023.10.009

龙梦雅¹,
王惠群¹,
周婕²,
吴延莉²,
余丽莎²,
刘涛^{1, 2, ,}

1.
贵州医科大学公共卫生与健康学院，环境污染与疾病监控教育部重点实验室, 贵阳 550025
2.
贵州省疾病预防控制中心慢性病防治研究所, 贵阳 550004

基金项目:

贵州省科技计划项目 Supported by Qiankehe [2018] 2819

详细信息

通讯作者:
刘涛，E-mail：liutao9099@163.com

中图分类号: R195
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- 被引次数: 0
出版历程
- 收稿日期: 2022-10-18
- 修回日期: 2023-01-14
- 网络出版日期: 2023-10-23
- 刊出日期: 2023-10-10

A prospective cohort study on the association between oral hygiene behaviors and the incidence of stroke

LONG Mengya¹,
WANG Huiqun¹,
ZHOU Jie²,
WU Yanli²,
YU Lisha²,
LIU Tao^{1, 2
, ,}

1.
School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China
2.
Institute of Chronic Disease Prevention and Control, Guizhou Center for Disease Control and Prevention, Guiyang 550004, China

Funds:

Guizhou Provincial Science and Technology Plan Project Supported by Qiankehe [2018] 2819

More Information

Corresponding author: LIU Tao, E-mail: liutao9099@163.com

摘要

摘要: 目的探讨贵州省人群口腔卫生行为与脑卒中发病的关系，为脑卒中的预防控制提供参考依据。方法采用分层随机整群抽样方法，2010年对抽取的贵州省12个县(市、区)18岁及以上常住居民共9 280人进行基线调查，于2016―2020年对该队列所有人群进行随访。运用SPSS 21.0软件进行数据分析，计量资料以(x±s)表示，多组间比较采用单因素方差分析。计数资料以构成比和率表示，组间比较采用χ²检验。采用Cox比例风险回归模型分析口腔卫生行为与脑卒中发病的关系，用Graphpad Prism 10.0.2软件绘制脑卒中发病风险森林图。结果最终纳入分析人群共7 970人，脑卒中发病204人，发病密度为3.62/1 000人年，多因素Cox回归分析结果显示，与每天刷牙1次以下的人群相比，每天刷牙1次可以降低34.3%的脑卒中发病风险(HR=0.657, 95% CI: 0.459~0.941)，每天刷牙2次及以上可以降低50.8%的脑卒中发病风险(HR=0.492, 95% CI: 0.307~0.789)。每天刷牙2次及以上的人群缺血性脑卒中的发病风险是刷牙不足1次人群的0.515倍(HR=0.515, 95% CI: 0.298~0.891)，口腔卫生行为与出血性脑卒中的发病无相关性。结论刷牙是脑卒中发病的保护性因素，每天刷牙2次及以上可以有效降低缺血性脑卒中的发病风险。
- 口腔卫生行为 /
- 刷牙频率 /
- 脑卒中 /
- 队列研究
Abstract: Objective To explore the relationship between oral health behavior and the incidence of stroke in Guizhou Province, and to provide reference for the prevention and control of stroke. Methods A total of 9 280 permanent residents aged 18 years and above were selected using stratified random cluster sampling across 12 counties (cities and districts) in Guizhou Province in 2010. The cohort was followed up from 2016 to 2020. SPSS 21.0 software was used to analyze the data. The measured data were expressed as mean±standard deviation (x±s). One-way variance analysis was used for comparison among multiple groups. The count data were expressed as constituent ratio or rate. Chi-square test was used for comparison between groups. Cox proportional hazards regression model was used to analyze the relationship between oral hygiene behavior and stroke incidence. The Graphpad Prism 10.0.2 software was utilized for plotting stroke incidence risk. Results Of the 7 970 individuals included in the analysis, 204 experienced a stroke, with an incidence density of 3.62/1 000 person-years. The results of Cox regression analysis showed that compared with the individuals who brushed their teeth less than once a day, the risk of stroke decreased by 34.3% (HR=0.657, 95% CI: 0.459-0.941) for those brushing teeth once a day, and by 50.8% (HR=0.492, 95% CI: 0.307-0.789) for those brushing twice a day or more. The risk of ischemic stroke was 0.515-fold higher in those who brushed their teeth twice or more per day than in those who brushed less than once (HR=0.515, 95% CI: 0.298-0.891). However, no correlation was found between oral hygiene behavior and hemorrhagic stroke. Conclusions Brushing teeth is a protective factor for stroke. Brushing teeth twice or more every day can effectively reduce the risk of ischemic stroke.
- Oral hygiene behavior /
- Brushing frequency /
- Stroke /
- Cohort study

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图 1 敏感性分析

调整年龄、性别、城乡、民族、婚姻状态和文化程度、油盐摄入过量、BMI、身体活动、吸烟、饮酒、每日蔬果摄入不足、基线高血压、糖尿病和血脂异常。

Figure 1. Sensitivity analysis

Adjusted age, gender, urban and rural areas, ethnicity, marital status and education, excessive oil and salt intake, BMI, physical activity, smoking, drinking, insufficient daily vegetable and fruit intake, baseline hypertension, diabetes and dyslipidemia.

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表 1 基线情况

Table 1. Baseline characteristics

变量 Variable	刷牙频率^① Brushing frequency ^①				t/χ²值 value	P值 value
变量 Variable	合计 Total (n=7 970)	＜1次/d ＜once per day (n=1 032)	1次/d once per day (n=4 729)	≥2次/d ≥ two times per day (n=2 209)	t/χ²值 value	P值 value
年龄/岁 Age/years	44.50±15.15	55.86±15.01	44.02±14.15	40.23±14.66	420.105	＜0.001
性别 Gender					40.740	＜0.001
男 Male	3 791(47.57)	540(52.33)	2 322(49.10)	929(42.06)
女 Female	4 179(52.43)	492(47.67)	2 407(50.90)	1 280(57.94)
城乡 Urban and rural					185.443	＜0.001
城市 Urban	2 650(33.25)	270(26.16)	1 392(29.44)	988(44.73)
农村 Rural	5 320(66.75)	762(73.84)	3 337(70.56)	1 221(55.27)
民族 Ethnicity					41.339	＜0.001
少数民族 Ethnic minority	3 917(49.15)	559(54.17)	2 394(50.62)	964(43.64)
汉族 The Han nationality	4 053(50.85)	473(45.83)	2 335(49.38)	1 245(56.36)
婚姻状态 Marriage					93.949	＜0.001
未婚/丧偶/独居/离婚 Unmarried/Widowed/Living alone/Divorced	1 536(19.27)	192(18.60)	768(16.24)	576(26.08)
已婚/同居 Married/cohabitation	6 434(80.73)	840(81.40)	3 961(83.76)	1 633(73.92)
文化程度 Education					792.688	＜0.001
九年及以下≤9 years	6 924(86.88)	1 019(98.74)	4 358(92.15)	1547(70.03)
九年以上>9 years	1 046(13.12)	13(1.26)	371(7.85)	662(29.97)
油摄入过量 Excess oil intake					2.219	0.330
否 No	2 363(29.65)	303(29.36)	1 378(29.14)	682(30.87)
是 Yes	5 607(70.35)	729(70.64)	3 351(70.86)	1 527(69.13)
盐摄入过量 Excess salt intake					75.646	＜0.001
否 No	2 268(28.46)	214(20.74)	1 288(27.24)	766(34.68)
是 Yes	5 702(71.54)	818(79.26)	3 441(72.76)	1 443(65.32)
BMI/(kg·m^-2)	22.89±3.36	22.31±3.24	22.90±3.35	23.11±3.41	20.322	＜0.001
总活动时间过少 Less total physical activity time					50.852	＜0.001
否 No	5 956(74.73)	773(74.90)	3 653(77.25)	1 530(69.26)
是 Yes	2 014(25.27)	259(25.10)	1 076(22.75)	679(30.74)
饮酒 Drinking					15.837	＜0.001
否 No	5 406(67.83)	652(63.18)	3 277(69.30)	1 477(66.86)
是 Yes	2 564(32.17)	380(36.82)	1 452(30.70)	732(33.14)
吸烟 Smoking					15.935	＜0.001
否 No	7 537(94.57)	1 002(97.09)	4 464(94.40)	2 071(93.75)
是 Yes	433(5.43)	30(2.91)	265(5.60)	138(6.25)
每日蔬果摄入不足 Insufficient daily intake of fruits and vegetables					103.871	＜0.001
否 No	3 889(48.97)	352(34.17)	2 418(51.34)	1 119(50.84)
是 Yes	4 052(51.03)	678(65.83)	2 292(48.66)	1 082(49.16)
高血压 Hypertension					53.603	＜0.001
否 No	5 890(73.90)	667(64.63)	3 545(74.96)	1 678(75.96)
是 Yes	2 080(26.10)	365(35.37)	1 184(25.04)	531(24.04)
糖尿病^② Diabetes ^②					10.683	0.005
否 No	6 535(82.17)	810(78.56)	3 896(82.58)	1 829(82.99)
是 Yes	1 418(17.83)	221(21.44)	822(17.42)	375(17.01)
血脂异常^② Dyslipidemia ^②					28.612	＜0.001
否 No	2 058(27.38)	312(31.87)	1 249(28.30)	497(23.41)
是 Yes	5 458(72.62)	667(68.13)	3 165(71.70)	1 626(76.59)
牙龈出血^② Gingival bleeding ^②					73.244	＜0.001
从无 Never	5 479(68.82)	808(78.37)	3 267(69.16)	1 404(63.64)
有时 Sometimes	2 240(28.14)	205(19.88)	1 319(27.92)	716(32.46)
总是 Always	242(3.04)	18(1.75)	138(2.92)	86(3.90)
因疾病拔牙^② Tooth extraction due to illness ^②					163.931	＜0.001
否 No	5 949(75.45)	596(59.24)	3 640(77.56)	1 713(78.36)
是 Yes	1 936(24.55)	410(40.76)	1 053(22.44)	473(21.64)
一年内看过牙^② Dental examination within a year ^②					54.897	＜0.001
否 No	7 610(95.59)	992(96.59)	4 570(96.66)	2 048(92.84)
是 Yes	351(4.41)	35(3.41)	158(3.34)	158(7.16)
注：BMI, 体质指数。 ① 以[人数(占比/%)]表示；② 表示该变量有缺失值 Note: BMI, body mass index. ① [Number of people (proportion/%)]; ② Indicates that the variable has a missing value.

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表 2 口腔卫生行为与脑卒中发病的Cox回归分析

Table 2. Cox regression analysis of oral hygiene behavior and stroke incidence

特征 Characteristics	发病人数/调查人数 Number of patients/survey Total	发病密度 (1 000人年) Incidence density (1 000PYs)	未调整模型 Unadjusted model		模型1 ^① Model 1^①		模型2 ^② Model 2 ^②		模型3 ^③ Model 3 ^③
特征 Characteristics	发病人数/调查人数 Number of patients/survey Total	发病密度 (1 000人年) Incidence density (1 000PYs)	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value
刷牙频率 Brushing frequency
＜1次/d＜Once per day	51/1 032	7.41	1.000		1.000		1.000		1.000
1次/d Once per day	112/4 729	3.35	0.430 (0.308~0.599)	＜0.001	0.697 (0.491~0.989)	0.043	0.683 (0.478~0.975)	0.036	0.657 (0.459~0.941)	0.022
≥2次/d ≥Two times per day	41/2 209	2.56	0.319 (0.211~0.482)	＜0.001	0.547 (0.345~0.868)	0.010	0.559 (0.351~0.891)	0.014	0.492 (0.307~0.789)	0.003
P_趋势值P_trend value			＜0.001		0.010		0.014		0.003
牙龈出血 Gingival bleeding
从无 Never	147/5 479	3.83	1.000		1.000		1.000		1.000
有时 Sometimes	49/2 240	3.03	0.795 (0.576~1.099)	0.166	0.964 (0.695~1.337)	0.826	0.971 (0.700~1.347)	0.861	0.971 (0.697~1.352)	0.860
总是 Always	8/242	4.71	1.218 (0.598~2.482)	0.587	1.470 (0.717~3.010)	0.293	1.444 (0.705~2.960)	0.315	1.256 (0.585~2.696)	0.559
P_趋势值P_trend value			0.445		0.679		0.670		0.847
因疾病拔牙 Tooth extraction due to illness
否 No	126/5 949	2.96	1.000		1.000		1.000		1.000
是 Yes	75/1 936	5.67	1.960 (1.472~2.609)	＜0.001	1.227 (0.907~1.660)	0.184	1.195 (0.882~1.619)	0.251	1.207 (0.888~1.640)	0.229
P_趋势值P_trend value			＜0.001		0.184		0.251		0.229
一年内看过牙 Dental examination within a year
否 No	188/7 610	3.49	1.000		1.000		1.000		1.000
是 Yes	15/351	6.23	1.778 (1.051~3.009)	0.032	1.473 (0.864~2.509)	0.154	1.391 (0.815~2.373)	0.226	1.365 (0.798~2.335)	0.255
P_趋势值P_trend value			0.032		0.154		0.226		0.255
注：①调整年龄、性别、城乡、民族、婚姻状态和文化程度。②在模型1基础上调整油盐摄入过量、BMI、身体活动、吸烟、饮酒、每日蔬果摄入不足。③在模型2基础上调整基线高血压、糖尿病和血脂异常。 Note: ① Adjust age, gender, urban and rural areas, ethnicity, marital status and educational level. ② Regulating excessive oil and salt intake, BMI, physical activity, smoking, drinking and insufficient daily vegetable and fruit intake on the basis of model 1. ③ Adjust baseline hypertension, diabetes and dyslipemia on the basis of model 2.

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表 3 口腔卫生行为与脑卒中亚型发病的Cox回归分析

Table 3. Cox regression analysis of oral hygiene behavior and incidence of stroke subtype

特征 Characteristics	发病人数 Number of patients	发病密度 (1 000人年) Incidence density (1 000PYs)	未调整模型 Unadjusted model		模型1 ^① Model 1^①		模型2 ^② Model 2 ^②		模型3 ^③ Model 3 ^③
特征 Characteristics	发病人数 Number of patients	发病密度 (1 000人年) Incidence density (1 000PYs)	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value	HR值 value (95% CI)	P值 value
出血性脑卒中 Hemorrhagic stroke
刷牙频率 Brushing frequency
＜1次/d＜Once per day	15	2.18	1.000		1.000		1.000		1.000
1次/d Once per day	30	0.90	0.389 (0.209~0.725)	0.003	0.672 (0.350~1.292)	0.233	0.688 (0.355~1.330)	0.266	0.625 (0.319~1.224)	0.171
≥2次/d ≥Two times per day	14	0.87	0.362 (0.174~0.753)	0.007	0.777 (0.348~1.732)	0.537	0.809 (0.358~1.825)	0.609	0.658 (0.285~1.519)	0.327
P_趋势值P_trend value			0.014		0.548		0.617		0.327
牙龈出血 Gingival bleeding
从无 Never	41	1.07	1.000		1.000		1.000		1.000
有时 Sometimes	14	0.86	0.816 (0.445~1.498)	0.513	0.981 (0.532~1.812)	0.952	1.007 (0.545~1.862)	0.982	1.012 (0.535~1.915)	0.971
总是 Always	4	2.35	2.172 (0.778~6.065)	0.139	2.953 (1.043~8.358)	0.041	3.018 (1.065~8.553)	0.038	2.348 (0.714~7.715)	0.160
P_趋势值P_trend value			0.713		0.276		0.239		0.420
因疾病拔牙 Tooth extraction due to illness
否 No	36	0.85	1.000		1.000		1.000		1.000
是 Yes	21	1.59	1.908 (1.113~3.269)	0.019	1.210 (0.687~2.131)	0.508	1.218 (0.688~2.156)	0.499	1.284 (0.717~2.299)	0.400
P_趋势值P_trend value			0.019		0.508		0.499		0.400
一年内看过牙 Dental examination within a year
否 No	56	1.04	1.000		1.000		1.000		1.000
是 Yes	3	1.25	1.184 (0.371~3.783)	0.776	1.083 (0.335~3.506)	0.894	1.085 (0.334~3.522)	0.892	1.096 (0.336~3.577)	0.880
P_趋势值P_trend value			0.776		0.894		0.892		0.880
缺血性脑卒中 Ischemic stroke
刷牙频率 Brushing frequency
＜1次/d＜Once per day	36	5.24	1.000		1.000		1.000		1.000
1次/d Once per day	85	2.54	0.463 (0.314~0.685)	＜0.001	0.755 (0.500~1.139)	0.180	0.724 (0.476~1.102)	0.132	0.712 (0.467~1.086)	0.115
≥2次/d ≥Two times per day	31	1.94	0.345 (0.213~0.558)	＜0.001	0.564 (0.328~0.968)	0.038	0.561 (0.325~0.968)	0.038	0.515 (0.298~0.891)	0.018
P_趋势值P_trend value			＜0.001		0.037		0.038		0.018
牙龈出血 Gingival bleeding
从无 Never	108	2.82	1.000		1.000		1.000		1.000
有时 Sometimes	38	2.35	0.841 (0.581~1.218)	0.360	1.029 (0.708~1.495)	0.882	1.020 (0.702~1.482)	0.918	1.027 (0.706~1.495)	0.889
总是 Always	6	3.53	1.247 (0.548~2.836)	0.599	1.448 (0.632~3.316)	0.381	1.405 (0.613~3.218)	0.422	1.389 (0.606~3.180)	0.437
P_趋势值P_trend value			0.682		0.546		0.596		0.585
因疾病拔牙 Tooth extraction due to illness
否 No	96	2.26	1.000		1.000		1.000		1.000
是 Yes	54	4.08	1.853 (1.327~2.587)	＜0.001	1.130 (0.794~1.607)	0.497	1.091 (0.767~1.554)	0.627	1.083 (0.759~1.546)	0.659
P_趋势值P_trend value			＜0.001		0.497		0.627		0.659
一年内看过牙 Dental examination within a year
否 No	138	2.56	1.000		1.000		1.000		1.000
是 Yes	13	5.40	2.103 (1.191~3.714)	0.010	1.668 (0.937~2.969)	0.082	1.534 (0.860~2.736)	0.147	1.490 (0.833~2.664)	0.179
P_趋势值P_trend value			0.010		0.082		0.147		0.179
注：①调整年龄、性别、城乡、民族、婚姻状态和文化程度。②在模型1基础上调整油盐摄入过量、BMI、身体活动、吸烟、饮酒、每日蔬果摄入不足。③在模型2基础上调整基线高血压、糖尿病和血脂异常。 Note: ① Adjust age, gender, urban and rural areas, ethnicity, marital status and educational level. ② Regulating excessive oil and salt intake, BMI, physical activity, smoking, drinking and insufficient daily vegetable and fruit intake on the basis of model 1. ③ Adjust baseline hypertension, diabetes and dyslipemia on the basis of model 2.

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