Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan

Figures & data

Figure 1 Selection of study patients.

Abbreviations: AMI, acute myocardial infarction; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; LHID, Longitudinal Health Insurance Database; NHIRD, National Health Insurance Research Database; PD, periodontal disease.

Table 1 Univariate analysis of factors affecting the incidence of acute myocardial infarction

Variables	Total (n)	AMI (n)	Follow-up (person-years)	IR (%/year)	χ^2 test (P-value)
Total	720,343	10,046	6,016,755	0.17
Age at baseline					<0.001
20–44 years	436,383	1,032	3,622,234	0.03
45–64 years	186,875	3,633	1,506,826	0.24
≥65 years	97,085	5,381	887,695	0.61
Sex					<0.001
Female	352,249	3,689	2,927,932	0.13
Male	368,094	6,357	3,088,823	0.21
Socioeconomic status					<0.001
<NT$20,000	194,532	1,743	1,777,477	0.10
NT$20,000–39,999	179,369	1,552	1,397,611	0.11
≥NT$40,000	128,113	1,463	1,020,913	0.14
Union/association member	103,075	2,813	870,662	0.32
Local government enrollees	115,254	2,475	950,093	0.26
Residential urbanicity					<0.001
Urban	434,975	5,308	3,594,699	0.15
Suburban	220,457	3,320	1,866,215	0.18
Rural	64,911	1,418	555,841	0.26
Periodontal disease					<0.001
No PD	208,713	4,327	2,248,618	0.19
Dental prophylaxis	344,228	2,952	2,807,865	0.11
Intensive treatment	121,827	2,233	789,518	0.28
PD without treatment	45,575	534	170,754	0.31
Comorbidity
Atrial fibrillation					<0.001
No	714,085	9,594	5,965,271	0.16
Yes	6,258	452	51,484	0.88
Diabetes					<0.001
No	638,060	6,406	5,355,794	0.12
Yes	82,283	3,640	660,962	0.55
Hypertension					<0.001
No	544,877	3,072	4,603,550	0.07
Yes	175,466	6,974	1,413,206	0.49
Dyslipidemia					<0.001
No	605,948	6,755	5,117,645	0.13
Yes	114,395	3,291	899,110	0.37
CKD					<0.001
No	708,023	9,158	5,914,168	0.15
Yes	12,320	888	102,587	0.87
PVD					<0.001
No	706,158	9,452	5,902,939	0.16
Yes	14,185	594	113,816	0.52

Note: US$1 is approximately worth NT$30.

Abbreviations: AMI, acute myocardial infarction; CKD, chronic kidney disease; IR, incidence rate; NT$, New Taiwan dollar; PD, periodontal disease; PVD, peripheral vascular disease.

Table 2 Acute myocardial infarction prevalence among study subjects by periodontal disease types

Variables	No PD			Periodontal disease
				Dental prophylaxis			Intensive treatment			PD without treatment			P-value for trend test
	AMI (n)	Person-years	IR (%/years)	AMI (n)	Person-years	IR (%/years)	AMI (n)	Person-years	IR (%/years)	AMI (n)	Person-years	IR (%/years)
Age at baseline (years)
20–44 years	263	1,163,439	0.02	496	2,024,810	0.02	229	350,200	0.07	44	83,785	0.05	<0.001
45–64 years	119	519,597	0.02	1,290	623,262	0.21	970	311,959	0.31	182	52,008	0.35	<0.001
≥65 years	2,873	565,581	0.51	1,166	159,793	0.73	1,034	127,359	0.81	308	34,962	0.88	<0.001
Sex
Female	1,787	951,092	0.19	1,087	1,546,539	0.07	597	349,999	0.17	218	80,303	0.27	<0.001
Male	2,510	1,297,526	0.19	1,865	1,261,326	0.15	1,636	439,520	0.37	316	90,451	0.35	<0.001
Socioeconomic status
<NT$20,000	743	798,879	0.09	541	767,126	0.07	388	175,166	0.22	71	36,306	0.20	<0.001
NT$20,000–39,999	531	376,425	0.14	567	784,967	0.07	378	195,361	0.19	76	40,858	0.19	<0.001
≥NT$40,000	453	237,493	0.19	581	599,525	0.10	357	160,270	0.22	72	23,626	0.30	<0.001
Union/association member	1,593	444,929	0.36	600	268,975	0.22	440	117,007	0.38	180	39,750	0.45	<0.001
Local government enrollees	1,007	390,892	0.26	663	387,272	0.17	670	141,715	0.47	135	30,214	0.45	<0.001
Residential urbanicity
Urban	1,976	1,164,514	0.17	1,751	1,847,309	0.09	1,317	493,400	0.27	264	89,476	0.30	<0.001
Suburban	1,564	794,253	0.20	912	787,166	0.12	675	227,180	0.30	169	57,616	0.29	<0.001
Rural	787	289,851	0.27	289	173,390	0.17	241	68,939	0.35	101	23,662	0.43	<0.001
Comorbidity
Atrial fibrillation	189	20,378	0.93	130	17,532	0.74	105	11,155	0.94	28	2,418	1.16	0.013
Diabetes	1,416	217,362	0.65	1,081	258,631	0.42	939	157,405	0.60	204	27,564	0.74	<0.001
Hypertension	2,853	486,339	0.59	2,071	571,649	0.36	1,652	294,169	0.56	398	61,048	0.65	<0.001
Dyslipidemia	980	211,397	0.46	1,192	454,098	0.26	937	201,900	0.46	182	31,715	0.57	<0.001
CKD	381	42,828	0.89	243	33,478	0.73	209	21,297	0.98	55	4,985	1.10	<0.001
PVD	211	35,872	0.59	181	47,045	0.38	162	25,388	0.64	40	5,511	0.73	<0.001

Note: US$1 is approximately worth NT$30.

Abbreviations: AMI, acute myocardial infarction; CKD, chronic kidney disease; IR, incidence rate; NT$, New Taiwan dollar; PD, periodontal disease; PVD, peripheral vascular disease.

Table 3 Results of Cox regression analysis conducted to identify predictors of acute myocardial infarction development

Variables	HR	95% CI
Age at baseline
20–44 years	1.00
45–64 years	4.72	4.39–5.08
≥65 years	9.93	9.21–10.71
Sex
Female	1.00
Male	1.66	1.59–1.73
Socioeconomic status
<NT$20,000	1.00
NT$20,000–39,999	0.97	0.91–1.04
≥NT$40,000	0.98	0.91–1.05
Union/association member	1.10	1.02–1.18
Local government enrollees	1.17	1.10–1.25
Residential urbanicity
Urban	1.00
Suburban	1.01	0.96–1.06
Rural	1.02	0.95–1.09
Periodontal disease
No PD	1.00
Dental prophylaxis	0.90	0.86–0.95
Intensive treatment	1.09	1.03–1.15
PD without treatment	1.23	1.13–1.35
Comorbidity
Atrial fibrillation	1.52	1.38–1.67
Diabetes	1.62	1.55–1.69
Hypertension	2.63	2.50–2.76
Dyslipidemia	1.09	1.04–1.14
CKD	1.60	1.49–1.72
PVD	1.01	0.93–1.10

Note: US$1 is approximately worth NT$30.

Abbreviations: CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; NT$, New Taiwan dollar; PD, periodontal disease; PVD, peripheral vascular disease.