TY - JOUR
T1 - Causal Effect of Tooth Loss on Functional Capacity in Older Adults in England
T2 - A Natural Experiment
AU - Matsuyama, Yusuke
AU - Listl, Stefan
AU - Jürges, Hendrik
AU - Watt, Richard G.
AU - Aida, Jun
AU - Tsakos, Georgios
N1 - Funding Information:
These data were made available through the U.K. Data Archive (Colchester, United Kingdom). The English Longitudinal Study of Aging (ELSA) was developed by a team of researchers based at NatCen Social Research (London, United Kingdom), University College London (London, United Kingdom), and the Institute for Fiscal Studies (London, United Kingdom). The data were collected by NatCen Social Research. Funding for ELSA was provided by the National Institute on Aging and a consortium of United Kingdom government departments coordinated by the Office for National Statistics.
Funding Information:
This work was supported by the Grant‐in‐Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI Grant Number 19K19309) and the Grant for JSPS Research Fellow (17J05974).
Funding Information:
These data were made available through the U.K. Data Archive (Colchester, United Kingdom). The English Longitudinal Study of Aging (ELSA) was developed by a team of researchers based at NatCen Social Research (London, United Kingdom), University College London (London, United Kingdom), and the Institute for Fiscal Studies (London, United Kingdom). The data were collected by NatCen Social Research. Funding for ELSA was provided by the National Institute on Aging and a consortium of United Kingdom government departments coordinated by the Office for National Statistics. This work was supported by the Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS KAKENHI Grant Number 19K19309) and the Grant for JSPS Research Fellow (17J05974). Y.M.: study concept and design, analysis and interpretation of data, and writing the initial draft. S.L., H.J., R.G.W., J.A., and G.T.: study concept and design, interpretation of data, and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work. The authors have no potential conflicts of interest to declare regarding research, authorship, and/or publication of this article. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the manuscript. The developers and funders of ELSA and the UK Data Archive do not bear any responsibility for the analyses or interpretations presented here. Key Points Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on instrumental activity of daily living (IADL) by employing a natural variation in childhood exposure to water fluoride in the United Kingdom as an instrumental variable for tooth loss. The analysis showed that retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (95% CI = 0.2, 6.0 percentage points). Why Does this Paper Matter? The findings showed that tooth loss could be a relevant target for interventions to promote functional capacity and avoid or delay limitations in IADLs. Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on instrumental activity of daily living (IADL) by employing a natural variation in childhood exposure to water fluoride in the United Kingdom as an instrumental variable for tooth loss. The analysis showed that retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (95% CI = 0.2, 6.0 percentage points). The findings showed that tooth loss could be a relevant target for interventions to promote functional capacity and avoid or delay limitations in IADLs.
Publisher Copyright:
© 2021 The American Geriatrics Society
PY - 2021/5
Y1 - 2021/5
N2 - Background/Objectives: Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England. Design: Natural experiment study with instrumental variable analysis. Setting: The English Longitudinal Study of Aging (ELSA) combined with the participants' childhood exposure to water fluoride due to the community water fluoridation. Participants: Five thousand six hundred and thirty one adults in England born in 1945–1965 participated in the ELSA wave seven survey (conducted in 2014–2015; average age: 61.0 years, 44.6% men). Measurements: The number of natural teeth predicted by the exogenous geographical and historical variation in exposure to water fluoride from age 5 to 20 years old (instrumental variable) was used as an exposure variable. The outcome, having any limitations in IADL (preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money), was assessed by self-reported questionnaires. Results: Linear probability model with Two-Stage Least Squares estimation was fitted. Being exposed to fluoridated water was associated with having more natural teeth in later life (coefficient: 0.726; 95% confidence interval (CI) = 0.311, 1.142; F = 11.749). Retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (coefficient: −0.031; 95% CI = −0.060, −0.002). Conclusion: Preventing tooth loss maintains functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable. Further research on the mechanism of the observed causal relationship is needed.
AB - Background/Objectives: Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England. Design: Natural experiment study with instrumental variable analysis. Setting: The English Longitudinal Study of Aging (ELSA) combined with the participants' childhood exposure to water fluoride due to the community water fluoridation. Participants: Five thousand six hundred and thirty one adults in England born in 1945–1965 participated in the ELSA wave seven survey (conducted in 2014–2015; average age: 61.0 years, 44.6% men). Measurements: The number of natural teeth predicted by the exogenous geographical and historical variation in exposure to water fluoride from age 5 to 20 years old (instrumental variable) was used as an exposure variable. The outcome, having any limitations in IADL (preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money), was assessed by self-reported questionnaires. Results: Linear probability model with Two-Stage Least Squares estimation was fitted. Being exposed to fluoridated water was associated with having more natural teeth in later life (coefficient: 0.726; 95% confidence interval (CI) = 0.311, 1.142; F = 11.749). Retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (coefficient: −0.031; 95% CI = −0.060, −0.002). Conclusion: Preventing tooth loss maintains functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable. Further research on the mechanism of the observed causal relationship is needed.
KW - instrumental activity of daily living
KW - instrumental variable
KW - natural experiment
KW - oral health
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U2 - 10.1111/jgs.17021
DO - 10.1111/jgs.17021
M3 - Article
C2 - 33496349
AN - SCOPUS:85099773507
VL - 69
SP - 1319
EP - 1327
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 5
ER -