1
|
Duvvuri VR, Abdelrehim M, Singhal S. Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged. BMC Public Health 2024; 24:1386. [PMID: 38783219 PMCID: PMC11112852 DOI: 10.1186/s12889-024-18868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable. METHODS This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)]. RESULTS Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care. CONCLUSION In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.
Collapse
Affiliation(s)
- Venkata R Duvvuri
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mona Abdelrehim
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
| | - Sonica Singhal
- Public Health Ontario, Toronto, ON, Canada
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Åstrøm AN, Mastrovito B, Sannevik J, Lie SA. Oral health inequalities in Swedish older adults over 25 years of follow-up. Gerodontology 2024; 41:17-27. [PMID: 36880598 DOI: 10.1111/ger.12680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75. MATERIALS AND METHODS In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time. RESULTS Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age. CONCLUSION Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.
Collapse
Affiliation(s)
| | | | - Josefine Sannevik
- Region Örebro län, Tandvårdsenheten, Örebro, Sweden
- Department of Dentistry, Region Örebro, Örebro, Sweden
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Allison PJ. Canada's oral health and dental care inequalities and the Canadian Dental Care Plan. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:530-533. [PMID: 37410362 PMCID: PMC10351248 DOI: 10.17269/s41997-023-00800-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Paul J Allison
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada.
| |
Collapse
|
4
|
Abdelrehim M, Ravaghi V, Quiñonez C, Singhal S. Trends in self-reported cost barriers to dental care in Ontario. PLoS One 2023; 18:e0280370. [PMID: 37418457 PMCID: PMC10328358 DOI: 10.1371/journal.pone.0280370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket. OBJECTIVES i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario. METHODS A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care. RESULTS In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income. CONCLUSION Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.
Collapse
Affiliation(s)
- Mona Abdelrehim
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| |
Collapse
|
5
|
Dixit A, Parekh NH, Anand R, Kamal N, Badiyani BK, Kumar A, Obulareddy VT. A Study to Assess the Awareness of Adults about Precancerous and Cancerous Lesions and the Associated Risk Factors. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S977-S980. [PMID: 37694066 PMCID: PMC10485476 DOI: 10.4103/jpbs.jpbs_260_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 09/12/2023] Open
Abstract
Aim The purpose of this study was to determine which factors contribute to the development of oral precancerous lesions and subsequent mouth cancer. Materials and Methods Throughout the trial, 450 patients agreed to participate in the investigation. The subjects comprised patients with squamous cell carcinoma (n = 79), oral submucous fibrosis (OSF) (n = 200), leukoplakia (n = 41), lichen planus (n = 10), and controls (n = 120). Statistical analysis of the data was carried out using the Chi-square and regression analysis. Results All oral precancerous lesions were shown to have a high prevalence of chewing, which was found to have a strong link with oral cancer. Oral precancerous lesions and cancer were also substantially connected with the length of time someone had the habit and how often they engaged in it. Conclusion Oral cancer and precancerous lesions were determined to be less of a worry when other risks such as drinking and smoking were taken into account.
Collapse
Affiliation(s)
- Arti Dixit
- Department of Public Health Dentistry, Vaidik Dental College and Research Centre, Daman (U.T.) India
| | - Nirav Hemant Parekh
- DDS MHA BDS, Owner and CEO of Smile Rite Dental Care, Connecticut USA, Graduated from NYU College of Dentistry, United States
| | - Rakesh Anand
- MDS Oral Medicine and Radiology Reader, Mata R Devi Dental Hospital, Sarjug Dental College, Darbhanga, Bihar, India
| | - Nitesh Kamal
- Department of Public Health and Dentistry, Mata R Devi Dental Hospital, Sarjug Dental College, Darbhanga, Bihar, India
| | - Bhumika K. Badiyani
- Department of Public Health Dentistry, Clinical Practitioner, Mumbai, Maharashtra, India
| | - Amit Kumar
- Associate Professor, Department of Public Health Dentistry, Clinical Practitioner, Mumbai, Maharashtra, India
| | | |
Collapse
|
6
|
The Impact of Dental Care Programs on Individuals and Their Families: A Scoping Review. Dent J (Basel) 2023; 11:dj11020033. [PMID: 36826178 PMCID: PMC9954911 DOI: 10.3390/dj11020033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite significant global improvements in oral health, inequities persist. Targeted dental care programs are perceived as a viable approach to both improving oral health and to address inequities. However, the impacts of dental care programs on individual and family oral health outcomes remain unclear. OBJECTIVES The purpose of this scoping review is to map the evidence on impacts of existing dental programs, specifically on individual and family level outcomes. METHODS We systematically searched four scientific databases, MEDLINE, EMBASE, CINAHL, and Sociological Abstracts for studies published in the English language between December 1999 and November 2021. Search terms were kept broad to capture a range of programs. Four reviewers (AG, VD, AE, and KKP) independently screened the abstracts and reviewed full-text articles and extracted the data. Cohen's kappa inter-rater reliability score was 0.875, indicating excellent agreement between the reviewers. Data were summarized according to the PRISMA statement. RESULTS The search yielded 65,887 studies, of which 76 were included in the data synthesis. All but one study assessed various individual-level outcomes (n = 75) and only five investigated family outcomes. The most common program interventions are diagnostic and preventive (n = 35, 46%) care, targeted children (n = 42, 55%), and delivered in school-based settings (n = 28, 37%). The majority of studies (n = 43, 57%) reported a significant improvement in one or more of their reported outcomes; the most assessed outcome was change in dental decay (n = 35). CONCLUSIONS Dental care programs demonstrated effectiveness in addressing individual oral health outcomes. However, evidence to show the impact on family-related outcomes remains limited and requires attention in future research.
Collapse
|
7
|
Levy BB, Goodman J, Eskander A. Oral healthcare disparities in Canada: filling in the gaps. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 114:139-145. [PMID: 36149572 PMCID: PMC9510506 DOI: 10.17269/s41997-022-00692-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023]
Abstract
As a key component of overall health and quality of life, oral health is recognized by public health organizations globally as a basic human right. Dentists are oral health experts involved in the primary prevention of oral injury and the detection and management of oral diseases. As regulated healthcare professionals, dentists identify and treat dental caries, gum disease, oral cancers, and edentulism, among other conditions. Oral diseases that go undetected and/or untreated burden patients with increased severity of disease and worse health outcomes. The Canadian Dental Association (CDA) recommends routinely scheduled reexamination and preventive care as an essential component of maintaining optimal oral health. Investments by the federal government into dental services for high-risk groups have failed to resolve pervasive oral health disparities among Canadians related to dental care affordability, accessibility, and availability. Vulnerable groups across Canada, including children, seniors in long-term care, Indigenous peoples, new immigrants with refugee status, people with special needs, and the low-income population, have been identified as having challenges accessing regular dental care. Herein, an equity-focused commentary on the current climate of oral healthcare in Canada is presented. We outline how addressing disparities in Canadian dental care will require the engagement of physicians on multiple levels of care, negotiation with both dentists and policymakers, as well as sustained oral health data collection to inform provincial and national decision-making/strategies.
Collapse
Affiliation(s)
- Ben B. Levy
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Jade Goodman
- Faculty of Dentistry, University of Toronto, Toronto, Ontario Canada
| | - Antoine Eskander
- Department of Otolaryngology – Head & Neck Surgery, University of Toronto, Toronto, Ontario Canada ,Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
| |
Collapse
|
8
|
Badri P, Lai H, Ganatra S, Baracos V, Amin M. Factors Associated with Oral Cancerous and Precancerous Lesions in an Underserved Community: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031297. [PMID: 35162318 PMCID: PMC8835623 DOI: 10.3390/ijerph19031297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
Street-involved people with limited access to regular healthcare have an increased risk of developing oral cancer and a lower survival rate. The objective of this study was to measure the prevalence of oral cancerous/precancerous lesions and determine their associated risk factors in a high-risk, underserved population. In this cross-sectional study, English-speaking adults aged 18 years and older living in a marginalized community in Edmonton were recruited from four non-profit charitable organizations. Data were collected through visual oral examinations and a questionnaire. Descriptive statistics, chi-squared tests, and logistic regressions were applied. In total, 322 participants with a mean (SD) age of 49.3 (13.5) years completed the study. Among them, 71.1% were male, 48.1% were aboriginal, and 88.2% were single. The prevalence of oral cancerous lesions was 2.4%, which was higher than the recorded prevalence in Canada (0.014–1.42: 10,000) and in Alberta (0.011–1.13: 10,000). The clinical examinations indicated that 176 (54.7%) participants had clinical inflammatory changes in their oral mucosa. There was a significant association between clinical inflammatory oral lesions and oral cancerous/precancerous lesions (p < 0.001). Simple logistic regression showed that the risk of the presence of oral cancerous/precancerous lesions was two times higher in participants living in a shelter or on the street than in those living alone (OR = 2.06; 95% CI: 1.15–3.82; p-value: 0.021). In the multiple logistic regression analysis, the risk of oral cancerous/precancerous lesions was 1.68 times higher in participants living in a shelter or on the street vs. living alone after accounting for multiple predictors (OR = 1.67; 95% CI: 1.19–2.37; p-value: 0.022). The results demonstrated a high prevalence of cancerous/precancerous lesions among the study participants, which was significantly associated with clinical inflammatory oral lesions. The evidence supports the need for developing oral cancer screening and oral health promotion strategies in underserved communities.
Collapse
Affiliation(s)
- Parvaneh Badri
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (P.B.); (H.L.); (S.G.)
| | - Hollis Lai
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (P.B.); (H.L.); (S.G.)
| | - Seema Ganatra
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (P.B.); (H.L.); (S.G.)
| | - Vickie Baracos
- Department of Oncology, Cross Cancer Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Maryam Amin
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (P.B.); (H.L.); (S.G.)
- Correspondence:
| |
Collapse
|
9
|
Chari M, Ravaghi V, Sabbah W, Gomaa N, Singhal S, Quiñonez C. Comparing the magnitude of oral health inequality over time in Canada and the United States. J Public Health Dent 2021; 82:453-460. [PMID: 34821390 PMCID: PMC10078632 DOI: 10.1111/jphd.12486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. METHODS Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. RESULTS Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. CONCLUSIONS There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.
Collapse
Affiliation(s)
- Malini Chari
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Noha Gomaa
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Regional Disparities of Rehabilitation Resources for Persons with Disabilities in China: Data from 2014 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197319. [PMID: 33036409 PMCID: PMC7579471 DOI: 10.3390/ijerph17197319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
Although the United Nations’ Convention on the Rights of Persons with Disabilities enshrines the right to health for all persons with disabilities (PDs), PDs face health disparities in terms of access to rehabilitation resources, which is important for service supply. This study aimed to explore the trends and distribution of rehabilitation resources for PDs in China from 2014 to 2019, explore the main factors that influence equity, and provide suggestions for policymakers. Data were obtained from the annual China Statistical Bulletin on the Development of Disabled Persons and the database of the China Disabled Persons’ Federation. Six types of rehabilitation resources were chosen to measure the trends in allocation and equity. Data on disparities were analyzed based on western, central, and eastern regions. The Health Resource Density Index and Theil Index were calculated to determine the degree and density of unfairness. The findings show a steady increasing trend in the amount of rehabilitation resources in China from 2014 to 2019. The density and equity of allocation of rehabilitation resources have improved greatly in recent years. Regional disparities were principally caused by differences within the regions. Suggestions including expanding investment in rehabilitation resources and developing rehabilitation systems were put forward.
Collapse
|