Concurrent Diabetes Mellitus and Periodontitis in U.S. Adults: Mortality Associations and Machine Learning Risk Prediction

Background/Objectives: We examined mortality associations by diabetes mellitus (DM)-periodontitis status and the incremental predictive value of composite inflammatory indices among adults with concurrent disease.

Methods

We analyzed 10,632 adults from the National Health and Nutrition Examination Survey 2009-2014 linked to mortality data through 2019. Groups included neither DM nor periodontitis (NDM + NP), periodontitis alone (P), DM alone (DM), or concurrent DM and periodontitis (DM + P). Survey-weighted Cox and Fine-Gray models assessed all-cause and cardiovascular mortality. Among 978 participants with DM + P, nine survival models underwent five repeats of fivefold cross-validation to assess 5-year all-cause mortality prediction and the incremental value of eight composite inflammatory indices.