# The Burden of Dental Infections Among Hospitalized Patients With Rheumatoid Arthritis: A Cross-Sectional Analysis of the National Inpatient Sample Database

## TL;DR

This study finds that rheumatoid arthritis patients are more likely to be hospitalized for dental infections, highlighting the need for better dental care in this group.

## Contribution

The study identifies a novel association between rheumatoid arthritis and increased odds of oral infection-related hospitalizations after adjusting for multiple covariates.

## Key findings

- Patients with rheumatoid arthritis were 40% more likely to be hospitalized for oral infections compared to those without RA.
- Male sex, Black race, smoking, and longer hospital stays were significant predictors of oral infection-related hospitalizations.
- Older patients (65+) had a 75% lower risk of oral infection hospitalization compared to younger adults.

## Abstract

Background

Oral infections such as cellulitis and abscesses of the oral cavity present significant public health burdens, particularly when they result in hospitalization. Rheumatoid arthritis (RA) is a systemic autoimmune condition that presents with chronic inflammation and has been linked to poor oral health outcomes. The immunological pathway that RA shares with periodontal diseases explains its impact on oral health outcomes. This study investigates the association between RA and oral infection-related hospitalizations among U.S. adults, utilizing data from the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) from 2016 to 2022.

Methods

A cross-sectional, retrospective analysis was conducted on 14,975,196 adult inpatient records. This sample size was derived after filtering the total number of hospitalizations between 2016 and 2022 in the NIS dataset to include only adults (>18 years) with complete data for all the variables used in this analysis. The outcome variable was hospitalization for cellulitis or abscess of the mouth (CELL), identified using ICD-10-CM codes. The primary predictor was a diagnosis of RA. Covariates included age group, sex, race, length of hospital stays (LOS), smoking status (SMK), and the presence of systemic lupus erythematosus (SLE). Descriptive statistics, bivariate chi-square tests, and multivariate logistic regression were used to assess associations. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.

Results

Descriptive analysis indicated that only 10,710 (0.07%) of the total sample experienced oral infection-related hospitalizations. RA was present in 281,142 (1.88%) of patients. In bivariate analysis, RA was not significantly associated with CELL (p = 0.4306). However, when looking at multiple factors together, it was found that patients with RA were 40% more likely to be hospitalized for oral infections compared to those without RA. Other significant predictors included male sex (OR = 1.79), Black race (OR = 1.23), smoking (OR = 1.33), and longer LOS (OR = 1.44). Age was inversely related to oral infection risk, with patients aged 65 and older showing a 75% lower risk (OR = 0.25) compared to the 18-34-year-old reference group.

Conclusion

We found an independent link between RA and a higher likelihood of hospitalization for dental infections. This finding brings to light just how complex oral health disparities are driven not just by inflammation but also by factors like age, race, and health behaviors. These findings make a strong case for incorporating dental assessments into the routine care of RA patients and speak to the importance of focused prevention efforts. Future longitudinal research is recommended to establish causal relationships and to see how much of a difference approaches to collaborative care can make in cutting down hospitalizations related to oral infections.