歯周病と一般的な健康状態との関係についての横断的な研究。日立オーラルヘルスケア調査

A cross-sectional study of relationships between periodontal disease and general health: The Hitachi Oral Healthcare Survey.

抄録

背景:

本研究は，日本企業が毎年実施している健康診断に歯科検診を導入することで，歯周病と肥満，糖尿病，耐糖能異常（IGT），慢性閉塞性肺疾患（COPD），動脈硬化性心疾患（ASCVD）などの非感染性疾患（NCD）との関係を明らかにし，歯科医師と医療従事者をつなぐ医療体制の重要性を訴えることを目的とした横断的研究である．

BACKGROUND: This cross-sectional study performed to clarify the relationship between periodontal disease and non-communicable diseases (NCDs), such as obesity, diabetes mellitus, impaired glucose tolerance (IGT), chronic obstructive pulmonary disease (COPD), and atherosclerotic cardiovascular disease (ASCVD) by introducing dental examinations into the annual health examinations conducted by Japanese companies, and to highlights the importance of a medical system that connects dental and medical professionals.

調査方法:

日立製作所の従業員1.022名を対象とした横断的な研究。歯周健康指標、全身健康指標、咬合力に基づく層別化と多重ロジスティック回帰分析を用いて、従業員の歯と全身の健康の相関とオッズ比（OR）を検討した。

METHODS: A total of 1.022 Hitachi Ltd. employees were enrolled in this cross-sectional study. We examined correlations and odds ratios (ORs) between the dental and overall health of employees using stratification and multiple logistic regression analyses based on the periodontal health indicators, general health indicators, and occlusal force.

結果:

肥満(OR, 1.42; 95%信頼区間[CI], 1.09-1.84; p=0.009)、IGT(OR, 1.48; 95% CI, 1.00-2.20; p=0.049)、COPD(OR, 1.38; 95% CI, 1.02-1.88; p=0.038)のPPDの調整ORは有意に異なっていた。肥満度（OR）1.28、95％CI 1.15-1.42、p<0.001）、ヘモグロビンA1C（HbA1c）（OR）4.34、95％CI 1.89-9.98、p<0.001）、空腹時血糖（FBG）値（OR）1.08、95％CI 1.04-1.11、p<0.001）の調整後のORは有意に差があった。001），重度の歯周病に対しては，気管支拡張後の強制呼気1秒量／強制肺活量比（%FEV）（OR, 0.95; 95% CI 0.91-1.00; p=0.031），喫煙（OR, 2.32; 95% CI 1.62-3.33; p<0.001）にも有意な差が見られた。咬合力は、50-59歳の従業員が40-49歳の従業員に比べて有意に低下していた。中等度・重度歯周炎の従業員では，PPD，HbA1c，FBGのいずれも咬合力と有意に関連していた．中等度のCOPDおよびASCVDを有する従業員では、PPDが咬合力と有意に関連していた。IGTの従業員では、%FEVが咬合力と有意に関連していた。

RESULTS: The adjusted OR of PPD for obesity (OR, 1.42; 95% confidence interval [CI], 1.09-1.84; p = 0.009), IGT (OR, 1.48; 95% CI, 1.00-2.20; p = 0.049), and COPD (OR, 1.38; 95% CI, 1.02-1.88; p = 0.038) significantly differed. The adjusted OR of body mass index (OR, 1.28; 95% CI 1.15-1.42; p < 0.001), haemoglobin A1C (HbA1c) (OR, 4.34; 95% CI, 1.89-9.98; p < 0.001), fasting blood glucose (FBG) levels (OR, 1.08; 95% CI 1.04-1.11; p < 0.001), postbronchodilator forced expiratory volume in one second/forced vital capacity ratio (%FEV) (OR, 0.95; 95% CI 0.91-1.00; p = 0.031) and smoking (OR, 2.32; 95% CI 1.62-3.33; p < 0.001) for severe periodontal disease also significantly differed. Occlusal force was significantly reduced in employees aged 50-59 years compared to those aged 40-49 years. Both PPD, HbA1c, FBG levels were significantly associated with occlusal force among employees with moderate/severe periodontitis. PPD was significantly associated with occlusal force among employees with and moderate COPD, and ASCVD. %FEV was significantly associated with occlusal force among employees with IGT.

おわりに:

本研究では，日本の会社員における歯周病，NCDs，咬合力の相互関係を明らかにした．本研究により，職場での年1回の歯科・身体の総合検診を中心とした包括的な地域医療システムは，従業員に有益であり，企業の健康保険にもプラスの影響を与えることが示された．

CONCLUSIONS: This cross-sectional study revealed mutual relationships among periodontal disease, NCDs, and occlusal force on Japanese corporate workers. We demonstrated that a comprehensive, regional healthcare system centred on annual integrated dental and physical health examinations in the workplace will benefit employees and positively impact corporate health insurance.