Journal
JOURNAL OF DENTAL RESEARCH
Volume 82, Issue 5, Pages 345-349Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/154405910308200504
Keywords
periodontitis; smoking; systemic disease; confounding; NHANES III
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Funding
- NIDCR NIH HHS [R03-DE13861, P30 DE09743] Funding Source: Medline
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Non-causal associations between periodontitis and systemic diseases may be spuriously induced by smoking because of its strong relationship to both. The goal of this study was to evaluate whether adjustment for self-reported smoking removes tobacco-related confounding and eliminated such spurious confounding. Using NHANES III data, we evaluated associations between attachment loss and serum cotinine after adjustment by self-reported number of cigarettes smoked. Cotinine, a metabolite of, nicotine, should not be related to attachment loss, if self-reported smoking captures the effect of tobacco on attachment levels. Adjustment for self-reported cigarette smoking did not completely remove the correlation between attachment loss and serum-cotinine level (r = 0.075, n = 1507, p = 0.003). Simulation studies indicated similar results for time-to-event data. These findings demonstrate the difficulty in distinguishing the effects of periodontitis from those of smoking with respect to a smoking-related outcome. Future studies should report results of analyses on separate subcohorts of never-smokers and smokers.
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