Association between a history of periodontitis and the risk of systemic lupus erythematosus in Taiwan: A nationwide, population-based, case-control study

Objective To examine the association between a history of periodontitis (PD) and incident systemic lupus erythematosus (SLE) Methods We used 2003-2012 claims data from the Taiwanese National Health Insurance Database to identify 7,204 incident SLE patients during 2007-2012 as the study group, along with randomly selecting 72,040 non-SLE patients matched (1: 10) for age, gender, and first diagnosis date (index date) as the control group. The correlation between PD and SLE risk was estimated using conditional logistic regression analysis, after making adjustments for confounders (including a history of diabetes and number of non-PD related dental visits before the index date). To evaluate the effects of PD severity and the lag time which occurred since the last PD visit on SLE development, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for subgroups of patients with PD according to their number of visits, cumulative cost and also the time gaps between their last PD-related visit and the index date. Results A statistically significant association between a history of PD and newly diagnosed SLE was observed (OR, 1.21; 95% CI, 1.14-1.28; p-value, < 0.001). The association was both dose and time-dependent and was found to be strongest when the interval between the last PD-related visit and the index date was less than three months (OR, 1.83; 95% CI, 1.61-2.09; p-value, <0.001). The association between PD exposure and SLE risk was consistently significant among subgroups stratified based on age, gender, or DM status. Conclusions The results of this nationwide, population-based, case-control study suggest that there is a significant association between a history of PD and incident SLE in Taiwan. This weak association is limited to lack of information on individual smoking status in the database.