老年人口腔健康多维状况与衰弱：一项按性别分层的横断面研究

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中文摘要

背景： 老年人衰弱是一个重要的公共卫生问题，与发病率、残疾和医疗利用增加相关。尽管全身健康和社会经济因素是衰弱的公认决定因素，但口腔健康的多维性质在既往研究中受到的关注相对有限。本研究旨在探讨社区居住老年人的一般特征、健康相关因素、口腔健康因素与衰弱之间的关联，并识别衰弱中的性别差异。
方法： 本横断面研究使用2022年韩国老龄化纵向研究（KLoSA）的数据，纳入3,729名65岁及以上个体。衰弱采用为韩国老年人开发的衰弱工具分为健壮、衰弱前期或衰弱。一般特征、健康相关因素和口腔健康相关因素（结构性、行为性和主观性）通过结构化问卷进行评估。采用三步分层logistic回归分析以识别与衰弱相关的因素。
结果： 参与者中，16.0%为衰弱，84.0%为非衰弱（31.5%为衰弱前期，52.5%为健壮）。按性别分层的分析还显示，结构性口腔健康因素在两种性别中均与衰弱关联最强。无义齿使用的无牙状态在女性（OR = 3.76，95% CI = 3.72-3.80）和男性（OR = 2.95，95% CI = 2.91-2.98）中均与最高的衰弱比值比相关。相比之下，某些主观口腔健康因素存在性别差异：牙齿敏感在女性中与较高的衰弱比值比相关（OR = 1.82，95% CI = 1.80-1.84），但在男性中与较低的比值比相关（OR = 0.85，95% CI = 0.84-0.86）。
结论： 口腔健康状况，包括未治疗的牙齿缺失、咀嚼或吞咽困难以及口腔疼痛，与衰弱显著相关。这些发现提示，口腔健康可能是社区居住老年人衰弱相关的重要考虑因素。

英文摘要

BACKGROUND: Frailty in older adults is a critical public health concern associated with increased morbidity, disability, and healthcare utilization. Although systemic health and socioeconomic factors are well-established determinants of frailty, the multidimensional nature of oral health has received relatively limited attention in previous research. The aim of this study was to examine the associations between general characteristics, health-related factors, oral health factors, and frailty among community-dwelling older adults, and to identify sex differences in frailty.
METHODS: This cross-sectional study used data from the 2022 Korean Longitudinal Study of Aging (KLoSA) and included 3,729 individuals aged 65 years and older. Frailty was categorized as robust, pre-frail, or frail using the Frailty Instrument developed for older Korean adults. General characteristics, health-related factors, and oral health-related factors (structural, behavioral, and subjective) were assessed through structured questionnaires. Hierarchical logistic regression analysis was performed in three steps to identify factors associated with frailty.
RESULTS: Of the participants, 16.0% were frail and 84.0% were non-frail (31.5% pre-frail and 52.5% robust). Sex-stratified analyses also showed that structural oral health factors were most strongly associated with frailty in both sexes. Edentulous status without denture use was associated with the highest odds of frailty in both women (OR = 3.76, 95% CI = 3.72-3.80) and men (OR = 2.95, 95% CI = 2.91-2.98). In contrast, sex differences were observed for some subjective oral health factors: tooth sensitivity was associated with higher odds of frailty in women (OR = 1.82, 95% CI = 1.80-1.84) but lower odds in men (OR = 0.85, 95% CI = 0.84-0.86).
CONCLUSIONS: Oral health conditions, including untreated tooth loss, difficulty in chewing or swallowing, and oral pain, were significantly associated with frailty. These findings suggest that oral health may be an important factor to consider in relation to frailty among community-dwelling older adults.