Concurrent Diabetes Mellitus and Periodontitis in U.S. Adults: Mortality Associations and Machine Learning Risk Prediction
- 1Section of Geriatric Dentistry and Perioperative Medicine in Dentistry, Division of Maxillofacial Diagnostic and Surgical Science, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
Abstract
Background/Objectives: We examined mortality associations by diabetes mellitus (DM)–periodontitis status and the incremental predictive value of composite inflammatory indices among adults with concurrent disease. Methods: We analyzed 10,632 adults from the National Health and Nutrition Examination Survey 2009–2014 linked to mortality data through 2019. Groups included neither DM nor periodontitis (NDM + NP), periodontitis alone (P), DM alone (DM), or concurrent DM and periodontitis (DM + P). Survey-weighted Cox and Fine–Gray models assessed all-cause and cardiovascular mortality. Among 978 participants with DM + P, nine survival models underwent five repeats of fivefold cross-validation to assess 5-year all-cause mortality prediction and the incremental value of eight composite inflammatory indices. Results: DM + P was associated with higher all-cause mortality than NDM + NP (HR, 1.51; 95% CI, 1.17–1.94) and P (HR, 1.31; 95% CI, 1.09–1.57). For cardiovascular mortality, DM + P was associated with higher mortality than NDM + NP (subdistribution hazard ratio [sHR], 1.51; 95% CI, 1.003–2.276), although the confidence interval only narrowly excluded 1.0. DM + P also had higher cardiovascular mortality than P (sHR, 1.55; 95% CI, 1.14–2.10). Neither outcome differed significantly between DM + P and DM. The Combined extreme gradient boosting Cox model had a concordance index and 5-year AUC of 0.754. Adding inflammatory indices did not significantly improve discrimination, prediction error, calibration, or net benefit. Observed 5-year mortality across predicted-risk tertiles was 3.7%, 7.4%, and 21.2%. Conclusions: Concurrent diabetes and periodontitis were associated with higher all-cause and cardiovascular mortality than periodontitis alone, but not with significantly higher mortality than diabetes alone. Composite inflammatory indices did not significantly improve prediction beyond clinical predictors.
Related
- Population-Level Associations of Diabetes Prevalence and Childhood Overweight with Kidney Cancer Mortality in Türkiye
- Joint associations of sitting time and depressive symptoms with all-cause and heart disease mortality among adults with diabetes or prediabetes
- Development and validation of a risk prediction model for preterm birth in women concurrent with Hepatitis B virus carrier status and gestational diabetes mellitus.
- Associations of a nutrition–inflammation index and vascular aging with mortality in adults with diabetes or prediabetes and cardiovascular disease
- A machine learning-driven and explainable prediction model for in-hospital mortality in patients with diabetes mellitus and congestive heart failure: integrating XGBoost and SHAP approaches.
BibTeX
@article{li2026concurrent,
title = {{Concurrent Diabetes Mellitus and Periodontitis in U.S. Adults: Mortality Associations and Machine Learning Risk Prediction}},
author = {Jincheng Li and Tian Zhu and Haruhiko Kashiwazaki},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208138},
url = {https://www.mdpi.com/2077-0383/15/20/8138},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Concurrent Diabetes Mellitus and Periodontitis in U.S. Adults: Mortality Associations and Machine Learning Risk Prediction
AU - Jincheng Li
AU - Tian Zhu
AU - Haruhiko Kashiwazaki
PY - 2026
DA - 2026/10/20
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208138
UR - https://www.mdpi.com/2077-0383/15/20/8138
AB - Background/Objectives: We examined mortality associations by diabetes mellitus (DM)–periodontitis status and the incremental predictive value of composite inflammatory indices among adults with concurrent disease. Methods: We analyzed 10,632 adults from the National Health and Nutrition Examination Survey 2009–2014 linked to mortality data through 2019. Groups included neither DM nor periodontitis (NDM + NP), periodontitis alone (P), DM alone (DM), or concurrent DM and periodontitis (DM + P). Survey-weighted Cox and Fine–Gray models assessed all-cause and cardiovascular mortality. Among 978 participants with DM + P, nine survival models underwent five repeats of fivefold cross-validation to assess 5-year all-cause mortality prediction and the incremental value of eight composite inflammatory indices. Results: DM + P was associated with higher all-cause mortality than NDM + NP (HR, 1.51; 95% CI, 1.17–1.94) and P (HR, 1.31; 95% CI, 1.09–1.57). For cardiovascular mortality, DM + P was associated with higher mortality than NDM + NP (subdistribution hazard ratio [sHR], 1.51; 95% CI, 1.003–2.276), although the confidence interval only narrowly excluded 1.0. DM + P also had higher cardiovascular mortality than P (sHR, 1.55; 95% CI, 1.14–2.10). Neither outcome differed significantly between DM + P and DM. The Combined extreme gradient boosting Cox model had a concordance index and 5-year AUC of 0.754. Adding inflammatory indices did not significantly improve discrimination, prediction error, calibration, or net benefit. Observed 5-year mortality across predicted-risk tertiles was 3.7%, 7.4%, and 21.2%. Conclusions: Concurrent diabetes and periodontitis were associated with higher all-cause and cardiovascular mortality than periodontitis alone, but not with significantly higher mortality than diabetes alone. Composite inflammatory indices did not significantly improve prediction beyond clinical predictors.
SN - 2077-0383
ER -