Abstract
BACKGROUND: Poor oral health among older adults may contribute to cardiovascular and dementia risk via systemic inflammation and cardiometabolic comorbidities. Financial constraints are a major driver of unmet dental care needs for older individuals. This study investigates whether having dental care needs that were unmet due to cost is associated with subsequent incidence of cardiovascular disease (CVD) or dementia among adults aged 55 and older. METHODS: Participants in the All of Us cohort (N = 98 787) who responded to a survey question on dental care needs that were unmet due to cost were followed up to 5.3 years via electronic health records for onset of myocardial infarction (MI), stroke, heart failure (HF), or dementia. We estimated outcome-specific hazard ratios (HRs), using Cox proportional-hazards models, adjusting for demographic, behavioral, and clinical covariates. RESULTS: After adjustment for demographic factors, individuals who reported unmet dental needs due to cost had relatively higher incidence of HF (HR = 1.45; 95% CI, 1.30-1.63), MI (HR = 1.37; 95% CI, 1.17-1.61), stroke (HR = 1.45; 95% CI, 1.24-1.70), and dementia (HR = 1.37; 95% CI, 1.05-1.76). These associations were attenuated after further adjusting for socioeconomic, behavioral, and clinical factors. We did not observe differences by gender, racial and ethnic identity, or periodontitis diagnosis. The estimated population attributable fraction suggested that eliminating financial barriers to dental care could prevent 2%-4% of each outcome among older adults. CONCLUSION: Financial barriers to dental care may be an important determinant of CVD and dementia among aging populations.