Patterns of multimorbidity and their association with edentulism: is health literacy a moderator?

Abstract Background Multimorbidity impacts oral health, especially with limited health literacy (LHL/HL), though evidence is limited. Certain disease patterns, like diabetes and cardiovascular diseases, show stronger links with oral diseases, due to shared risk factors. Understanding these associations could support early detection and prevention of oral diseases. We therefore aimed to assess the association of multimorbidity and its patterns with oral health, measured as edentulism, and whether HL moderates this association. Methods We included 42,357 participants from the prospective multigenerational Dutch Lifelines Cohort Study. Oral health was measured as self-reported “edentulism”, and “multimorbidity” as having more than two disease domains (body systems) affected. Using latent class analysis, we identified five multimorbidity patterns-specific combinations of comorbid diseases. The most prevalent was a combination of endocrinological and cardiovascular diseases (pattern 2, 32.7%). Next, we assessed the association of edentulism and multimorbidity with edentulism, the presence of multimorbidity (yes/no) and per patterns, and whether HL modified this association. Preliminary results In the edentulous population (mean age: 58 years, 50% female), 36.7% had LHL, and 31.5% had multimorbidity overall. The odds of edentulism in case of multimorbidity were 2.81 times higher (CI: 2.49-3.81) than without multimorbidity. Regarding multimorbidity patterns, the odds of edentulism present in pattern 2, characterised by endocrinological and cardiovascular diseases, were 6.16 times higher (5.27-7.20) than if without multimorbidity. LHL did not significantly moderate the associations of overall multimorbidity with edentulism, and regarding patterns only for pattern 2. Conclusions Multimorbidity is strongly associated with edentulism, particularly patterns involving endocrinological and cardiovascular diseases. LHL increases the risk of edentulism within some multimorbidity patterns. Key messages • Multimorbidity, especially endocrinological and cardiovascular patterns, is associated to edentulism. • Health literacy influences the association between certain multimorbidity patterns and edentulism.