Relationship between periodontal status and blood count and anemia in adults: Based on the 5th Korea National Health and Nutrition Examination Survey

Min-Jeong Jo; Jae-Kyung Ma; Ah-Ra Shin; Fan Dong; Keun-Bae Song; Youn-Hee Choi; Hee-Kyung Lee

doi:10.11149/jkaoh.2015.39.2.152

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Jo, Ma, Shin, Dong, Song, Choi, and Lee: Relationship between periodontal status and blood count and anemia in adults: Based on the 5th Korea National Health and Nutrition Examination Survey

Original Article

J Korean Acad Oral Health 2015;39(2):152-157.

Published online: 12 June 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.2.152

Relationship between periodontal status and blood count and anemia in adults: Based on the 5th Korea National Health and Nutrition Examination Survey

Min-Jeong Jo¹, Jae-Kyung Ma², Ah-Ra Shin¹, Fan Dong³, Keun-Bae Song¹, Youn-Hee Choi¹, Hee-Kyung Lee³

¹Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea

²Doctor Hong Dental Clinic, Daegu, Korea

³Department of Dentistry, College of Medicine Yeungnam University, Daegu, Korea

Corresponding Author: Hee-Kyung Lee Department of Dentistry, College of Medicine Yeungnam University, 170 Hyunchung-ro, Nam-gu, Daegu 705-717, Korea Tel: +82-53-620-3731 Fax: +82-53-629-1772 E-mail: Ihk3731@yu.ac.kr

Received 18 May 2015 Revised 10 June 2015 Accepted 26 June 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Periodontal disease is an inflammatory disease fundamentally initiated by chronic bacterial infection. Just as the periodontal tissues mount an immune inflammatory response to bacteria and their products, systemic challenges owing to these inflammatory agents also induce a major vascular response. It is proposed that periodontitis also needs to be considered as a chronic disease that may decrease erythrocyte count and consequently lower hemoglobin concentration (Hb%). Therefore, the aim of this study was to elucidate the correlation between anemia and blood cell count according to periodontal state.

Methods

Data from the Fifth Korea National Health and Nutrition Examination Survey (KNHNES) were used to analyze the prevalence of anemia and blood cell counts according to the periodontal status. Complex logistic regression analysis was used to assess the relationship of anemia with periodontal status. The data were analyzed using t-test, ANOVA, and logistic regression using SPSS, and 95% confidence intervals were computed.

Results

A significant difference was observed for gingivitis (odds ratio [OR], 1.436 [95% confidence interval [CI], 1.072-1.924]) but not for periodontitis (OR, 1.353 (95% CI, 0.947-1.934).

Conclusions

The present study provides further evidence that gingivitis has systemic effects and may cause anemia. However, periodontitis was not significantly associated with anemia. Further, there was no significant difference in periodontal status after adjustment for age, gender, and other factors.

Keywords: Anemia, Blood cell, Periodontal disease

References

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Table 1.

Characteristics of the study subjects

	Variable	N (%) Total=4,882
Gender	Male	2,056 (50.5)
Gender	Female	2,826 (49.5)
Age	20-29	528 (18.0)
	30-39	889 (21.4)
	40-49	897 (22.8)
	50-59	986 (19.5)
	60-69	868 (10.5)
	≥70	714 (7.8)
Education	Lower middle school	1,686 (26.2)
	High school	1,650 (40.5)
	Higher college	1,546 (33.3)
Income	Low	814 (13.4)
	Middle-low	1,248 (26.3)
	Middle-high	1,343 (29.8)
	High	1,477 (30.5)
Drinking	Never	641 (9.6)
Drinking	Experienced	4,241 (90.4)
Smoking habits	Never	2,960 (54.0)
Smoking habits	Experienced	1,922 (46.0)
Anemia	No	4,493 (93.2)
Anemia	Yes	389 (6.8)
Periodontal status	Healty	1,333 (28.4)
	Gingivitis	2,303 (49.1)
	Periodontitis	1,246 (22.5)

The data were analysed by reflecting complex weighted sample design.

Table 2.

Characteristics of the study subjects according to periodontal status

Variable	Periodontal status (N/%)			P-value*
Variable	Healty	Gingivitis	Periodontitis	P-value*
Gender				<0.001
Male	446 (41.5)	962 (51.2)	648 (60.6)
Female	887 (58.5)	1,341 (48.8)	598 (39.4)
Age				<0.001
20-29	252 (27.6)	262 (19.8)	14 (1.8)
30-39	316 (26.5)	487 (23.6)	86 (10.4)
40-49	251 (19.9)	445 (22.6)	201 (26.7)
50-59	212 (14.3)	439 (17.7)	335 (29.9)
60-69	180 (7.0)	377 (9.8)	311 (16.3)
≥70	122 (4.7)	293 (6.5)	299 (14.9)
Education				<0.001
Lower middle school	271 (14.7)	719 (23.3)	696 (47.2)
High school	478 (39.5)	836 (44.2)	336 (33.4)
Higher college	584 (45.8)	748 (32.5)	214 (19.4)
Income				<0.001
Low	139 (9.3)	347 (12.5)	328 (20.7)
Middle-low	305 (23.7)	593 (26.6)	350 (28.7)
Middle-high	395 (30.4)	651 (30.9)	297 (26.5)
High	494 (36.6)	712 (30.0)	271 (24.1)
Drinking				<0.0001
Never	138 (7.7)	288 (8.9)	215 (13.7)
Experienced	1,195 (92.3)	2,015 (91.1)	1,031 (86.3)
Smoking habits				<0.001
Never	901 (61.3)	1,430 (54.8)	629 (43.1)
Experienced	432 (38.7)	873 (45.2)	617 (56.9)

The data were analysed by reflecting complex weighted sample design. *Chi-square test.

Table 3.

Characteristics of the study subjects according to anemia

Variable	Anemia (N/%)		P-value*
Variable	Yes	No	P-value*
Gender			<0.001
Male	73 (17.2)	1,983 (53.0)
Female	316 (82.8)	2,510 (47.0)
Age			<0.001
20-29	26 (9.1)	502 (18.6)
30-39	79 (22.3)	810 (21.3)
40-49	95 (30.2)	802 (22.3)
50-59	43 (11.3)	943 (20.1)
60-69	46 (9.9)	822 (10.5)
≥70	100 (17.2)	614 (7.2)
Education			0.170
Lower middle school	144 (30.9)	1,542 (25.9)
High school	124 (37.3)	1,526 (40.7)
Higher college	121 (31.8)	1,425 (33.4)
Income			0.005
Low	96 (20.4)	718 (12.9)
Middle-low	93 (25.8)	1,155 (26.3)
Middle-high	104 (28.2)	1,239 (29.9)
High	96 (25.6)	1,381 (30.9)
Drinking			0.001
Never	69 (15.0)	572 (9.3)
Experienced	320 (85.0)	3,921 (90.7)
Smoking habits			<0.001
Never	309 (79.7)	2,651 (52.2)
Experienced	80 (20.3)	1,842 (47.8)
Periodontal status			0.034
Healthy	118 (35.3)	1,215 (27.9)
Gingivitis	178 (43.6)	2,125 (49.5)
Periodontitis	93 (21.1)	1,153 (22.6)

The data were analysed by reflecting complex weighted sample design. *Chi-square test.

Table 4.

The change of blood components related to anemia according to periodontal status

Viriable	Periodontal status			P-value*
Viriable	Healthy	Gingivitis	Periodontitis	P-value*
		Mean±SD
Haemoglobin	14.01±0.06^a	14.34±0.08^a	14.38±0.09^b	<0.001
Hematocrit	41.67±0.17^a	42.58±0.22^a	42.65±0.23^b	<0.001
White blood cell	5.82±0.06^a	5.98±0.07^b	6.28±0.08^c	<0.001
Red blood cell	4.57±0.02^a	4.65±0.03^a	4.61±0.03^b	0.005

The data were analysed by reflecting complex weighted sample design. *P-value are determined from complex samples general linear model.

^a ,b,cDifferent letters denote there are significant difference by Bonferroni test.

Table 5.

Results of logistic regression analysis for association between periodontal status and anemia

Variable	Model 1		Model 2		Model 3
Variable	OR	95%CI	OR	95% CI	OR	95% CI
Periodontal ststus
Healthy	ref.		ref.		ref.
Gingivitis	1.436*	1.072-1.924	1.357	0.996-1.849	1.356	0.996-1.846
Periodontitis	1.353	0.947-1.934	1.244	0.846-1.828	1.207	0.812-1.792

CI: Confidence interval; OR: Odds ratio, Model 1: Unadjusted model, Model 2: Adjusted for age & sex model, Model 3: Adjusted for age, sex and other potential confounders model. The data were analysed by reflecting complex weighted sample design. *P-value<0.05.

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