STORMS checklist.docx

Increasing evidence suggests a potential link between oral microbiome diversity and the occurrence of multiple chronic extraoral diseases. However, evidence regarding oral microbiota diversity and long-term prognosis in the general population is limited. We included 8224 individuals with available oral microbiome diversity data by 16S rRNA gene sequencing of the oral rinse sample was collected from participants of ongoing National Health and Nutrition Examination Survey (2009–2012). The endpoint was all-cause mortality. Cox regression analysis was performed to identify the association between oral microbiome diversity and all-cause mortality. During a mean follow-up period of 8.9 years, 429 deaths occurred. After multivariate adjustment, a negative association was observed between oral microbiome α diversity and all-cause mortality (P <0.01). Significant differences in all-cause mortality risk were observed between the different clusters based on the oral microbiome β diversity (Log-rank P <0.001). Subgroup analyses revealed that oral microbiome diversity was independently associated with all-cause mortality in individuals with extraoral diseases, particularly those with diabetes mellitus and hypertension. A multivariate logistic regression model demonstrated that increased dietary fiber intake and reduced antibiotic use were significantly associated with higher oral microbiome α diversity. We showed that higher oral microbiome diversity was significantly associated with a lower risk of all-cause mortality in the general population and individuals with extraoral diseases, especially diabetes mellitus, and hypertension. In addition, reasonable restrictions on antibiotic use and high dietary fiber intake may increase oral microbiome diversity, thereby reducing the risk of all-cause mortality.