Association of oral health with incident pancreatic cancer among individuals with atrial fibrillation: a population-based cohort study

Modifiable factors associated with pancreatic cancer risk in atrial fibrillation (AF) populations remain poorly defined. We aimed to evaluate the associations of oral health status and oral hygiene behaviors with incident pancreatic cancer in individuals with AF. Using the Korean National Health Insurance Service database, adults (≥ 40 years) with AF who received oral health screening were included. Exposures were periodontitis, toothbrushing frequency, tooth loss, dental visits, and dental scaling. The primary outcome was incident pancreatic cancer (≥ 2 claims for ICD-10 C25 plus V193). Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Propensity score matching (PSM; 1:4) was performed to balance baseline characteristics. Among 31,377 participants (mean age, 56.0 years; 64.0% men), 231 (0.74%) developed pancreatic cancer over a median 15.7-year follow-up. In multivariable analyses, periodontitis was associated with higher pancreatic cancer risk and remained significant after PSM (HR, 1.69; 95% CI, 1.08–2.63). Frequent toothbrushing (≥ 3 times/day) was linked to lower risk (HR, 0.84; 95% CI, 0.70–0.98). Tooth loss, dental visits, and dental scaling were not consistently associated after multivariable adjustment. In this population-based AF cohort, periodontitis was associated with higher pancreatic cancer incidence. Further studies are needed to determine whether these associations are causal and whether improving oral health can modify pancreatic cancer risk.