Caries Is the Hub of a Complex Network of Chronic Diseases across the Life Decades

Caries precedes periodontitis; both may predict fatal noncommunicable diseases (NCDs) decades in advance. However, the complex network of relationships between these and other NCDs remains unclear. Understanding the intricate nonlinear connections among NCDs from the early life stages holds profound significance for public health management strategies to prevent NCDs. Accordingly, we modeled the connections among NCDs and identified the underlying patterns in the US population from childhood to elderhood. Indicators of metabolic risks, diabetes, and cancer, as well as cardiovascular, autoimmune, mental, respiratory, and oral diseases, were collected from National Health and Nutrition Examination Survey data (2011-2012 and 2013-2014 cycles), encompassing 4 age groups of Americans aged 1 to ≥60 y. Diseases were represented as nodes in the complex network analysis, and edges indicated their co-occurrences. To characterize the networks, we computed degree, betweenness, eigenvector, local transitivity, assortative mixing, Shannon entropy, and cluster coefficients. Caries was the central hub in all models. Caries and obesity were linked since the first years of life, and with age, new diseases became connected, increasing network complexity with Shannon entropy from -2.79 to -4.07. Depression plays an essential role in adult life; however, episodes of forgetting and mental confusion surpass depression's significance in elderhood. The centrality of diabetes, cardiovascular disease, and cancer increases with age, peaking at ≥60 y, with diabetes being the most prominent. All groups had coefficients indicating that NCDs were highly connected, with cluster coefficients of 0.85 to 0.98 and assortativity mixing of -0.23 to -0.06. Caries was the central element over the decades, with the other diseases orbiting around it. It was mainly linked to overweight/obesity from early childhood. Integrated strategies targeting shared risk factors for caries and obesity can boost childhood health and potentially affect the development of other NCDs later.