Frequent psychological distress and mortality among adults with all tooth loss across health-risk profiles

Health-risk profiles (HRPs) are associated with mortality among adults with all tooth loss (ATL). Frequent negative emotion (FNE), prevalent in various chronic diseases, may negatively affect health outcomes. This study aimed to explore the relationship between FNE and mortality among adults with ATL across different HRP groups. 571,938 adults (52,276 with ATL and 519,662 without ATL) from the National Health Interview Survey (1998–2018) were included, with mortality outcomes linked to the National Death Index through December 31, 2019. Logistic regression analyses were performed to assess the association between ATL and FNE. Latent class analysis (LCA) was performed to identify descriptive HRPs using baseline health-risk indicators. The association between HRPs and FNE was also examined. The associations of FNE with all-cause and cause-specific mortality across HRP groups were explored. Time-dependent receiver operating characteristic (ROC) curve analysis was conducted as an exploratory assessment of the discriminatory information provided by negative emotion frequency and HRPs for all-cause mortality. Population attributable fractions (PAFs) of FNE for all-cause mortality among adults with ATL were estimated. ATL was associated with a 45% higher likelihood of FNE. Age was positively associated with the negative emotion score before age 46 among adults with ATL. Compared with the low-risk HRP, the intermediate- and high-risk HRPs were associated with 49% and 118% higher likelihoods of FNE, respectively. FNE was associated with higher all-cause mortality across HRP groups during a median follow-up of 7 years. Cause-specific mortality patterns varied across HRP groups, with higher cancer mortality observed in the low-risk HRP + FNE group and higher cardiovascular and cancer mortality observed in the intermediate- and high-risk HRP + FNE groups. Exploratory discrimination and reclassification analyses showed only modest improvements after adding negative emotion frequency to the model, including HRPs, in relation to all-cause mortality. These findings should be interpreted cautiously and do not establish clinical prediction utility. Exploratory PAF estimates varied across age groups, with greater uncertainty among younger adults. Sensitivity analyses yielded similar results. Among US adults with ATL, intermediate- and high-risk HRPs were associated with a higher likelihood of FNE, and FNE was further associated with higher all-cause mortality. Cause-specific mortality patterns varied across HRP groups. Exploratory discrimination and reclassification analyses suggested that FNE provided only modest incremental information and did not establish clinical predictive utility.