Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

Objective
To investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.
Methods
We used the 1999–2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999–2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.
Results
We enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06–1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25–1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.
Conclusion
The present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.

### 研究目的
研究牙周炎（periodontitis, PD）患者相较于非牙周炎个体发生心房颤动或心房扑动的风险。

### 研究方法
本研究采用1999-2010年台湾国民健康保险研究数据库，以2000年确诊的牙周炎患者作为病例组，按照性别与年龄1:1匹配1999-2000年间的非牙周炎个体作为对照组。通过Cox比例风险回归分析校正潜在混杂因素，包括基线年龄、性别、合并症，以及随访期间年均门诊就诊次数与牙科洁牙频率，最终估算风险比（hazard ratio, HR）及95%置信区间（confidence interval, CI），以比较牙周炎患者与对照组发生心房颤动或心房扑动的风险。此外，按年龄、性别或合并症开展亚组分析，以探究该关联的稳健性及潜在交互效应。

### 研究结果
本研究共纳入393745名牙周炎患者与393745名非牙周炎个体。牙周炎组心房颤动或心房扑动的发病率为每10万人年200例，非牙周炎组为每10万人年181例（发病比为1.10；95%CI：1.06~1.14）。校正潜在混杂因素后，牙周炎组发生心房颤动或心房扑动的风险显著高于非牙周炎组（HR=1.31；95%CI：1.25~1.36）。除甲状腺功能亢进症与睡眠呼吸暂停综合征亚组外，牙周炎组的心房颤动或心房扑动高风险在所有疾病亚组中均具有统计学显著性。

### 研究结论
本研究结果显示，牙周炎患者发生心房颤动或心房扑动的风险升高。本研究的主要局限性在于缺乏个体饮酒、肥胖与吸烟相关信息。