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ORIGINAL RESEARCH article
Front. Oral. Health
Sec. Oral Epidemiology
Volume 6 - 2025 | doi: 10.3389/froh.2025.1542147
This article is part of the Research Topic The interplay between oral and systemic diseases: the mouth as biosignature source for control and monitoring View all 3 articles
Tooth Loss and Mortality Risk: The Mediating Role of hs-CRP in a Chinese Cohort
Provisionally accepted
Donglei Wu *
Mingxin Mao 
Wei Wang Henan Zheng Hongxia You Weixuan Chen Ziyang Xu Yuyan Zheng 
Yuan Li *- shenzhen people'hospital, Shenzhen, China
Objectives: This study aimed to evaluate the mediating effect of systemic condition on the relationship between tooth loss and mortality risk. Materials and methods: A 9-y follow-up prospective longitudinal study was conducted based on China Health and Retirement Longitudinal Study (CHARLS). The participants aged >45y at baseline and were followed up from 2011 to 2020. Cox proportional hazards models were utilized to assess the relationship between tooth loss and both all-cause mortality with hazard ratios (HRs) and 95% confidence intervals (CIs) reported with adjusted possible confounders. Systemic inflammation markers, including high-sensitivity C-reactive protein (hs-CRP) and white blood cell count (WBCs), were collected from CHARLS blood sample data. A mediation analysis was conducted to determine the role of hs-CRP and WBCs in the relationship between tooth loss and mortality. Results: A total of 13,201 participants met the inclusion criteria, of which 964 had tooth loss and 12,237 did not. During a median follow-up of 8.7 years, The multivariable-adjusted Cox regression models. The subgroup analysis indicated that the association was found to be stronger among older adults (≥80 years) (HR: 1.62, 95% CI: 1.09-2.41) and males (HR: 1.80, 95% CI: 1.34-2.40). Additionally, the mediation analysis result has showed that serum hs-CRP level rather WBC count mediated 3 % of this effect. Conclusions: Complete tooth loss is associated with higher mortality in the Chinese population, with systemic inflammation (hs-CRP) as a mediator.
Keywords: Tooth Loss, Mortality, c reactive protein, Mediation analysis, Retrospective cohort study
Received: 13 Dec 2024; Accepted: 07 Apr 2025.
Copyright: © 2025 Wu, Mao, Wang, Zheng, You, Chen, Xu, Zheng and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Donglei Wu, shenzhen people'hospital, Shenzhen, China
Yuan Li, shenzhen people'hospital, Shenzhen, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.