Retirement and incident complete tooth loss in older adults: a multinational cohort study

Complete tooth loss remains a major public health burden among older adults, impairing nutrition, quality of life, and systemic health. Retirement is a near-universal life-course transition that may alter income, insurance coverage, daily routines, and oral hygiene behaviors, yet its association with complete tooth loss across populations with differing retirement and dental care systems remains unclear. We examined this association, and its effect modification by demographic and clinical characteristics, in three nationally representative aging cohorts. We analyzed prospective data from the China Health and Retirement Longitudinal Study (CHARLS; n = 11,035), the Health and Retirement Study (HRS; n = 9,584), and the English Longitudinal Study of Ageing (ELSA; n = 4,233), restricted to participants free of complete tooth loss at baseline. Retirement status (working vs. retired/partly retired) was ascertained using cohort-specific definitions. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for incident complete tooth loss, adjusting sequentially for sociodemographic, behavioral, and clinical covariates; prespecified subgroup analyses assessed effect modification. After full adjustment, retirement was associated with a significantly higher risk of incident complete tooth loss in all three cohorts: CHARLS, HR 1.28 (95% CI, 1.07–1.53; P = 0.008); HRS, HR 1.45 (95% CI, 1.14–1.84; P = 0.003); ELSA, HR 2.06 (95% CI, 1.25–3.40; P = 0.005). The association was significantly stronger among men and current drinkers in CHARLS (P for interaction < 0.05) but was consistent across subgroups in HRS and ELSA. Retirement was independently and consistently associated with a higher risk of incident complete tooth loss across three culturally and economically distinct populations, suggesting that the retirement transition may represent an underrecognized window for oral health surveillance and preventive intervention in aging populations.