ArticleFrontiers in public health2026
Long-term dental care utilization trajectories as behavioral markers of cognitive aging: a 14-year national cohort study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Dental care utilization may serve as a behavioral marker of healthy aging, but previous studies have largely relied on single-time-point measures. Whether long-term utilization patterns are associated with cognitive aging and through which functional pathways remains unclear. Methods: We analyzed eight biennial waves (2006-2020) of the Health and Retirement Study. Group-based trajectory modeling identified dental care utilization trajectories among 14,599 adults aged ≥50 years at baseline. Cognitive function was assessed using a 27-point summary score. Linear mixed-effects models estimated associations between trajectory and cognitive decline. Serial mediation analysis using empirical Bayes individual slope estimates examined mediation through longitudinal changes in self-rated health (SRH) and activities of daily living (ADL) limitations, with Persistent High as the reference. Results: Three trajectories were identified: Persistent High (53.3%), Decreasing (14.5%), and Persistent Low (32.2%). Compared with Persistent High, both suboptimal trajectories showed faster cognitive decline (Decreasing: Conclusion: Persistently low and declining dental care utilization were associated with similarly faster cognitive decline, with functional deterioration representing the principal mediating pathway. Long-term dental care utilization may be an accessible behavioral marker of broader functional vulnerability. Although modest, these associations may have public health relevance because utilization can be captured through surveys and administrative or claims data. Causal inference cannot be established from this observational study.
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