Synergistic Effects of Social Determinants of Health and Periodontitis on Premature Cardiovascular Mortality: A Nationally Representative Cohort Study

BACKGROUND: Periodontitis, a prevalent chronic inflammatory disorder, is linked to an increased risk of cardiovascular disease (CVD). However, the impact of social determinants of health (SDoH) on premature CVD mortality in individuals with periodontitis remains poorly understood. METHODS: Data from 8277 US adults aged 30-74 years, collected from NHANES 2009-2014 with mortality follow-up through 2019, were analyzed. Periodontitis was defined according to CDC/AAP criteria, and premature CVD mortality was defined as death from CVD before age 75. A cumulative SDoH score was constructed based on eight indicators. Kaplan-Meier survival curves and log-rank tests compared survival probabilities across groups. Sensitivity analyses utilized Fine and Gray competing risk models. RESULTS: Periodontitis was independently associated with an elevated risk of premature CVD mortality (HR = 2.21; 95% CI = 1.01-4.86), particularly among those with multiple adverse SDoH. A significant dose-response relationship was observed between cumulative SDoH burden and premature CVD mortality in the periodontitis cohort (P for trend = 0.03), but not in those without periodontitis. Food insecurity emerged as the sole individual SDoH independently linked to increased mortality risk. Kaplan-Meier curves revealed significantly lower cumulative survival among adults with periodontitis burdened with high SDoH (p < 0.01). CONCLUSIONS: Periodontitis was associated with an increased risk of premature CVD mortality, especially in the presence of cumulative adverse SDoH, suggesting the need for integrated medical-dental care and broader strategies to address social inequities.