The utilization of dental care services according to health insurance coverage in Catalonia (Spain)

Patterns, barriers, and utilization of oral healthcare provided at primary health centers (PHCs) and its association with oral health status among rural population in Rohtak district, Haryana: A household cross-sectional study

Introduction

Access to oral healthcare is limited in rural areas, resulting in disparities in oral health services. Primary health centers (PHCs) are essential for providing integrated oral healthcare to rural populations. This study examines the patterns, barriers, and utilization of oral healthcare at PHCs in Rohtak district, Haryana.

Materials and Methods

In this 6-month household cross-sectional study, data were collected from a sample of 600 participants residing in rural areas under the jurisdiction of three randomly selected PHCs in Rohtak district. The study employed multistage cluster systematic random sampling procedures. Data collection included structured questionnaires and clinical oral examinations following the type-III ADA classification. Participants' oral health status was evaluated using the WHO oral health assessment form for adults (2013). Descriptive and analytical statistics were used for data analysis.

Results and Discussion

Dental caries and periodontal diseases were more common in older age groups. Barriers to oral healthcare among the elderly include fear of dental procedures and low dental literacy. Proximity to PHCs influenced dental service utilization, with higher rates among participants living near a PHC, that is, within 5 km of a PHC.

Conclusion

Age, gender, proximity to PHCs, household size, and socioeconomic status play crucial roles in the utilization of oral health services among the rural population. Addressing these factors is essential for improving oral healthcare and overcoming barriers. It is crucial to enhance the accessibility, affordability, and availability of oral health services at PHCs to promote better oral health and overall well-being in rural areas.

Trends in Access to Oral Health Care among Adults from the N-E Region of Romania

Aims and Objectives: To investigate the trends in access to dental services among adults from the N-E region of Romania and to evaluate the factors that influence access to dental care. Material and Methods: A self-administered questionnaire was used to evaluate the access and utilization of dental care among a sample of adults. We collected data on their demographic characteristics, their type of medical insurance, their monthly income, the type of dental office they visited, their reasons for choosing a certain type of dentist office, and their oral hygiene habits. It was found that their financial status determined by the occupation of the individual, as well as their monthly income, influenced their access to medical services. Data were analyzed using SPSS 20.0. Results: Of a total of 696 participants, 55.6% were female, 83.3% were from urban areas, 42.1% were retired, 62.3% of the subjects utilized dental emergency services, and 67.9% of the subjects self-funded their treatment. The reasons for women not attending dental offices included costs (24.3%) and dental fear (9.8%), while men's reasons were high costs (26.4%) and lack of time (5.9%). Significant differences were recorded between gender and reasons for visiting the dentist (p = 0.018), payment for dental services (p = 0.009), and preferred clinic (p = 0.010). In relation to occupation, there were significant differences for most of the variables evaluated (reasons to visit a dentist, payment for dental services, preferred dental clinic, self-rated oral health, etc.). Conclusions: Gender, occupation, and monthly income levels were found to influence access to dental medicine services of Romanians in the N-E region. Dental services were frequently accessed for emergency reasons. Dental services were found to be paid for by state insurance for those with low monthly incomes and self-funded for those with higher monthly incomes.

"To enroll or not to enroll": a qualitative study on preferences for dental insurance in Iran

BACKGROUND

Oral public health services are included in primary healthcare. Although oral diseases are preventable, improving oral health has become a concern in many countries. Evidence shows that functioning insurance coverage can significantly increase the use of dental health services, improve quality of services, and reduce financial barriers to utilization. Little evidence exists on households' preferences for dental insurance in Iran. This study seeks to identify the households' preferences for dental insurance in Tehran-Iran.

METHOD

This is a qualitative study. We interviewed 84 participants who visited selected public and private dental clinics in Tehran-Iran, from October 2018 until January 2019. All interviews were recorded and transcribed verbatim. We used a mixed inductive/deductive approach for thematic analysis of the interviews.

RESULTS

We identified two main themes and 12 sub-themes: pecuniary attributes (insurance premium, coinsurance, insurance coverage granted, discounting option, reimbursement of expenses), and non-pecuniary attributes (notification status, ethical issues, benefits package, contract providers with health insurance, quality of service centers, administrative process, and dental insurance scheme).

CONCLUSION

Our participants considered both pecuniary and non-pecuniary attributes for choosing a dental insurance package. Our findings could help, we envisage, policymakers understand Iranian households' preferences for a dental insurance scheme that they afford to buy.

Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession

BACKGROUND

Dental health is an important component of general health. Socioeconomic inequalities in unmet dental care needs have been identified in the literature, but some knowledge gaps persist. This paper tries to identify the determinants of income-related inequality in unmet need for dental care and the reasons for its recent evolution in Spain, and it inquires about the traces left by the Great Recession.

METHODS

Data from the EU-SILC forming a decade (2007-2017) were used. Income-related inequalities for three years were measured by calculating corrected concentration indices (CCI), which were further decomposed in order to compute the contribution of different factors to inequality. An Oaxaca-type decomposition approach was also used to analyze the origin of changes over time. Men and women were analyzed separately.

RESULTS

Pro-rich inequality in unmet dental care needs significantly increased over time (CCI 2007: - 0.0272 and - 0.0334 for males and females, respectively; CCI 2017: - 0.0704 and - 0.0776; p < 0.001). Inequality showed a clear "pro-cycle" pattern, growing during the Great Recession and starting to decrease just after the economic recovery began. Gender differences only were significant for 2009 (p = 0.004) and 2014 (p = 0.063). Income was the main determinant of inequality and of its variation along time -particularly for women-, followed by far by unemployment -particularly for men-; the contributions of both were mainly due to changes in elasticites.

CONCLUSIONS

The Great Recession left its trace in form of a higher inequality in the access to dental care. Also, unmet need for dental care, as well as its inequality, became more sensitive to the ability to pay and to unemployment along recent years. To broaden public coverage of dental care for vulnerable groups, such as low-income/unemployed people with high oral health needs, would help to prevent further growth of inequality.

The effect of pain intensity levels and clinical symptoms on the treatment preferences of patients with endodontically involved teeth: A preliminary cross-sectional study

Purpose:

This study aimed to evaluate the effect of pain intensity levels and clinical symptoms on the treatment preferences of patients with endodontically involved teeth in a local Turkish population.

Subjects and methods:

A total of 30 patients with symptomatic teeth requiring non-surgical root canal treatment were included in the study. The patients’ demographic (age, gender, and education level) and diagnostic data (tooth type, pain intensity, response to percussion and palpation, presence of referred pain, and diagnosis) were analyzed. Data on the patients’ explicit preferences (requested treatment, whether they are willing to accept a proposed extraction, choice of treatment if an anterior tooth was involved, and choice of treatment if the pain was not severe) as well as previous root canal treatment experiences were also analyzed. Pain intensity levels were evaluated using the Visual Analog Scale.

Results:

Pain intensity levels had a significant effect on the treatment requested by the patient (p=0.001). Among the patients who requested extraction upon referral to the clinic, the rate of those who reported that they would not accept extraction if the pain was located in an anterior tooth was significantly lower than that of patients stating that they would refuse (p=0.039). The presence of referred pain also had a significant effect on the requested treatment (p=0.001).

Conclusion:

The intensity of pain and the presence of referred pain influence patients’ treatment preferences.

Factors Affecting Dental Service Utilisation in Indonesia: A Population-Based Multilevel Analysis

This study aimed to examine the prevalence of dental service utilisation in Indonesia and its association with social determinants at individual and community levels. Cross-sectional data from the 2014 Indonesian Family Life Survey (IFLS-5) was analysed. Individual independent variables included age, sex, marital status, educational attainment, economic status, health insurance, dental pain, self-reported mouth ulcers, self-rated health status, unmet healthcare needs and smoking status, while community independent variables included cognitive, structural social capital and residential area. Multilevel logistic regressions were performed to explore the associations between independent variables at different levels and the outcome of dental service utilisation. Of the total sample of 16,860 adults aged 15 years or older in our study, around 86.4% never visited a dentist. Dental service utilisation was associated with older age, female, currently not married, higher education level and economic status, health insurance, dental pain, self-reported mouth ulcers, met healthcare needs, never smoking, living in urban areas and communities with high structural social capital. Both individual and broader social determinants influenced dental service utilisation in Indonesia. These factors should be considered in the formulation of oral health policies and programmes aiming to improve dental service utilisation in the country.

Socioeconomic-Related Inequalities in Dental Care Utilization in Northwestern Iran

INTRODUCTION

There have been multiple studies on socioeconomic-related inequalities in the use of dental services in Iran, but the evidence is still limited. This study measured inequality in dental care utilization by socioeconomic status and examined factors explaining this inequality among households in Ardabil, Iran in 2019.

METHODS

A total of 436 household heads participated in this cross-sectional study. Using a validated questionnaire, face-to-face interviews were conducted to collect data on dental care utilization, unmet needs, sociodemographic characteristics, economic status, health insurance, and oral health status of the participants. We used the concentration curve and relative concentration index (RCI) to visualize and quantify the level of inequality in dental care utilization by income. Regression-based decomposition was also applied to understand the causes of inequality.

RESULTS

About 59.2% (95% CI 54.4%-63.7%) and 14.7% (95% CI 11.6%-18.4%) of participants had visited a dentist for dental treatment in the previous 12 months and for 6-month dental checkups, respectively. The RCI for the probability of visiting a dentist in the last 12 months was 0.243 (95% CI 0.140-0.346). This suggests that dental care utilization was more concentrated among the rich. The RCI for unmet dental care needs was negative, which indicates more prevalence among the poor. Monthly household income (20.9%), self-rated oral health (6.9%), regular brushing (3.2%), and dental health insurance (2.5%) were the main factors in socioeconomic inequality in dental care utilization.

CONCLUSION

This study reveals that dental care-service utilization did not match the need for dental care, due to differences in socioeconomic status in Ardabil, Iran. Policies could be implemented to increase the coverage of dental care services among socioeconomically disadvantaged groups to tackle socioeconomic-related inequality in dental care utilization.

Oral health taking a back seat at primary health centers of Bangalore urban district, India - A situation analysis

BACKGROUND

Even though a dramatic change in pattern of oral diseases has been observed at a global level, oral health equality still remains as a dream to achieve. Studies have documented disparities in delivery and utilisation of oral health services among urban, suburban, and rural regions of India. Therefore, the aim of the present study was to conduct a situation analysis at PHCs to understand resource availability and oral health seeking behavior from perspective of medical officers of Bangalore City, India.

MATERIALS AND METHODS

A structured questionnaire was validated using Lawshe technique and was given across medical and dental officers present at 65 Primary Health Centers. Data collected was entered in Excel sheet and further subjected to Descriptive statistics using SPSS version 20.

RESULTS

Among 65 PHCs, about 18 PHCs had dental officers posted. In those 18 PHCs only 2 were maintained by the state government and others by Private dental college. In the 65 PHCs , only one PHC maintained a separate register for dental complaints, whereas 48 of them had maintained a combined register for both general and oral complaints. With regard to the management of tooth-related complaints, about 48 of medical officers reported that they dispense the patients affected by providing antibiotics and pain killers (analgesics) and recall, whereas 12 medical officers reported that they get the existing condition treated and refer and the rest refer the patients directly to hospitals. clinics.

CONCLUSION

The results highlight the challenges experienced by nondental primary-care providers and their views on access to oral health to be improved. It is high time that the state government should put oral health policies into practice by recruiting adequate dental officers and providing separate dental infrastructure at the urban PHCs for better utilisation of dental care services.

Factores asociados a la utilización de servicios de salud odontológicos

Resumen El presente trabajo se propone analizar los factores asociados a la utilización de servicios de salud odontológicos (USSO) en individuos adultos de la Ciudad de Corrientes; Argentina. Se realizó un estudio transversal. A través de una encuesta domiciliaria se recolectó información de las variables de estudio. Se determinó el tamaño de la muestra estableciéndose un nivel de confianza del 95% (381 individuos). Se aplicó un diseño muestral aleatorio simple, que se complementó con un muestreo no probabilístico por cuotas. Se analizaron los datos con los programas SPSS 21.0. y Epidat 3.1. El nivel socioeconómico, la cobertura social odontológica, la percepción sobre la salud bucal, los conocimientos de salud bucal y los hábitos de higiene bucal se asociaron significativamente a la USSO en los últimos 12 meses. Los mismos factores, a excepción de la cobertura social odontológica y de los conocimientos de salud bucal, se asocian a la USSO por motivos de control/chequeo dental de rutina. Se deben implementar medidas tendientes a aumentar la USSO con fines de prevención en individuos de ambos sexos, de todos los niveles socioeconómicos, especialmente en aquellos menos favorecidos.

Dental health-care service utilisation and its determinants in West Iran: a cross-sectional study

BACKGROUND

Dental health care is not only an effective strategy for the prevention, early diagnosis and treatment of oral diseases but also contributes to the general health of communities. This study aimed to investigate the situation of dental health-care service utilisation and its determinants in Kermanshah city, western Iran, in 2015.

METHODS AND MATERIALS

A cross-sectional study on a total of 894 household heads was conducted. The participants were selected using a multistage sampling technique. A self-administered questionnaire was used to collect the data. Multiple logistic regression was performed to assess factors associated with utilisation of dental-care services and a negative binomial regression was carried out to identify the main factor associated with the frequency of visiting a dentist for dental health care. A statistically significant association was considered at a value of P < 0.05. All the analyses were performed using STATA version 12.

FINDING

Of the total household heads who participated in the study, 60.3% and 9.9% reported visiting a dentist for dental treatment in the past year and for 6-monthly dental check-ups, respectively. The average ± standard deviation number of visits by a respondent was 2.08 ± 2.97. Of the total number of respondents, 281 (31.4%) reported visiting a dentist once or twice in the last 12 months for dental health-care services, while 28.9% reported visiting a dentist more than twice in the same time period. Ageing, having dental insurance, higher income, being a university graduate, self-rated poor oral health and not regularly brushing own teeth were the main factors associated with utilisation of dental health-care services.

CONCLUSION

Our study indicates that dental health-care utilisation among households in the study area was influenced by a number of factors, including being socio-economically disadvantaged, self-rated poor oral health and not regularly brushing own teeth. Therefore, in this setting, dental-intervention programmes, including dental health insurance, should focus on mechanisms that can strengthen utilisation of preventive dental health-care services among disadvantaged households.

Transition in Dental Treatment Utilization in Jammu And Kashmir, India - A 10 Year Retrospective Study

BACKGROUND

Utilization of health services is the actual attendance by the members of the public at health care facilities to receive care. Utilization, serves as an important tool for oral health policy decision-making. The aim of the present study was to retrospectively gauge and assess the utilization pattern of the dental treatments which was given in hospital for last 10 years.

MATERIALS AND METHODS

This retrospective infirmary based study was carried out at Sheri Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India. The yearly outpatient department (OPD) records for the utilization of specific dental treatment of a total of 103963 patients were assessed retrospectively from 2014 to 2003. Trend analysis was used to assess the trend of utilization of each speciality with best fitted linear trend lines.

RESULTS

The pattern of new patients has also shown a constant rise during the study period except for 2008 and 2009. The utilization of oral surgery speciality has shown a tremendous fall from 2003 to 2014 whereas the number of patients coming to periodontics and conservative dentistry has shown an increasing pattern.

CONCLUSION

Utilization of oral health care has long been used as an indicator of oral health related behaviour of a population. In the present study it can be conclude that the outlook of the population under study has changed from blood and vulcanite dentistry outlook and is moving towards restorative dentistry. .

Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany

Background

In many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany.

Methods

Data from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen’s Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity.

Results

Migrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = −0.081 (95% CI = −0.093, −0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = −0.065 (95% CI = −0.076, −0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance.

Discussion

The study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention.

Dental care utilization in the west of Iran: a cross-sectional analysis of socioeconomic determinants

Purpose

Oral health is a major public health problem, both in developed and developing countries. The purpose of this paper is to examine the utilization of dental care and identify the main socioeconomic factors affecting the use of these services in the city of Sanandaj, west of Iran, in 2015.

Design/methodology/approach

A cross-sectional survey using multistage sampling was conducted to obtain information on the dental care visits of 520 head of households in Sanandaj. A self-administered questionnaire was used to collect data on the utilization of dental visits. Multivariable logistic regression was used to identify the main socioeconomic factors affecting the utilization of dental care in Sanandaj.

Findings

Results showed that 61.3 percent of the respondents visited a dentist at least once in the last year, of which 45 percent visited dentist for restoration, 27.9 percent had extraction and 10.3 percent had a dental checkup. The average number of dentist visits by respondents was 1.9. Regression results indicated a significant association between socioeconomic factors (e.g. income, educational level and employment status) and utilization of dental care.

Originality/value

This study suggested that dental care visit was influenced by socioeconomic status of households. Therefore, strategies aimed at improving dental care utilization for socioeconomically disadvantaged households (e.g. dental health insurance) are required to promote oral health among socioeconomically disadvantaged groups.

Self-Reported Obstacles to Regular Dental Care among Information Technology Professionals

INTRODUCTION

Good oral health is important for an individual as well as social well-being. Occupational stress and work exhaustion in Information Technology (IT) professionals may influence the oral health and oral health related quality of life.

AIM

To assess and compare self-reported obstacles for regular dental care and dental visits among IT professionals based on age, gender, dental insurance and working days per week.

MATERIALS AND METHODS

A cross-sectional study was conducted among 1,017 IT professionals to assess the self-reported obstacles to regular oral health care in Hyderabad city, Telangana, India. The Dental Rejection of Innovation Scale (DRI-S) was employed in this study. Comparison between means of DRI-S based on variables was done using t-test and ANOVA. The association between variables and DRI-S was determined using Chi-square test.

RESULTS

A total of 1017 participants comprising of 574 (56%) males and 443 (44%) females participated in the study. As age increased, a significant increase in mean DRI-S scores was seen for total and individual domains except for the "Situational" domain wherein higher mean score (9.42±2.5; p=0.0006) was observed among 30-39 years age group. Even though females reported higher mean scores for total and individual domains when compared to males, nevertheless significant difference was seen only for total (p=0.03) and "Lack of Knowledge" (p=0.001) domain.

CONCLUSION

Self-reported obstacles to regular dental care was more with increasing age, increased number of working days per week, irregular dental visits and absence of dental insurance facility.

Demand for Dental Services in Shiraz, Iran, 2013

This cross-sectional and descriptive-analytic study aimed to estimate the demands for the use of dental services by Shirazi inhabitants in Iran from June 2013 to October 2013. Six hundred eighty subjects older than 18 years were selected from among the people living in Shiraz, using a multistage sampling method. The collected data were analyzed using SPSS 16.0 and Stata 11.0. The results showed that the factors affecting the number of referrals to the dental services centers and the use of these services included the age groups of 28 to 37 and 38 to 47 years, household expenses per month, and having supplementary health insurance coverage (P < .05). According to the results, in order to improve access to dental services and increase the probability of utilizing such services by people in need, the researchers recommend that the authorities should design and develop basic and supplementary health insurance plans to cover different types of dental services, allocate subsidies to dental health services, and increase the knowledge of all the people in different age groups about adherence to dental health principles and prevention of oral and dental diseases.

Psychosocial determinants of dental service utilization among adults: Results from a population-based survey (Urban HEART-2) in Tehran, Iran

OBJECTIVES

To evaluate the association between dental service utilization and mental health in an adult population in the context of the socioeconomic status of the participants.

SUBJECTS AND METHODS

Multi-stage cluster random sampling was performed in Tehran, Iran, in 2011. Data were collected on dental service utilization, barriers of dental visit, self-perceived oral health, mental health, age, gender, education, and wealth status. The complex sample analysis method in SPSS and the survey data analysis menu in STATA were employed for statistical evaluation.

RESULTS

Of 20,320 participants, 25-36% suffered from disorders in at least one of the domains of somatization, anxiety, social dysfunction, and depression. Only 56% of the participants visited a dentist at least once during the last year. The main barriers to a dental visit were "no perceived need" and "high costs." Females, the richest participants, subjects aged 25-64-year-old, and those with poor self-perceived oral health, mental health disorders, and higher education had more visits. The participants who perceived the need but did not visit a dentist due to some reasons mostly comprised females, those aged 25-44-year-old, those with a poor perceived oral health, disordered people in all domains of mental health, and poorer participants.

CONCLUSION

Dental service utilization was influenced by socioeconomic factors and the mental health status of the adult population after controlling for multiple confounders. Reducing financial hardship and providing health education on the importance of preventive visits may decrease barriers to regular visits in countries with developing oral health systems.

Barriers of access to oral health care among university students in southern Colombia, 2011. A multivariate analysis

<p>Background. The right to health is considered to be a fundamental human right. Therefore, it is a starting point from which to combat unjust and immoral inequalities. It is essential to study the process through which a need for attention is completely satisfied.</p><p><br />Objective. To analyze determinants of access to oral health<br />care among university students in municipality of Pasto.</p><p><br />Materials and methods. A sample of 338 university students<br />answered a confidential survey that was based upon previous<br />studies using a health care services utilization behavioral model.</p><p><br />Results. In terms of enabling factors, the students that responded as ‘having a bad health state’ were those that used oral health care services the most in last year, while those students that responded as “being dissatisfied with the appearance of their teeth’ used oral health care services less. In relation to need factors, the students whose quality of life was not affected by physical impairment and physical pain used oral health care services less. Predisposing factors were not statistically significant.</p><p><br />Conclusions. This study found that enabling and need factors<br />were associated with recent dental consultations by university<br />students in the municipality of Pasto.</p>

Changes in socioeconomic inequalities in the use of dental care following major healthcare reform in Chile, 2004-2009

The study examines changes in the distribution and socioeconomic inequalities of dental care utilization among adults after the major healthcare reform in Chile, 2004-2009. We evaluated the proportion of people who visited the dentist at least once in the previous two years, and the mean number of visits. These outcome variables were stratified by sex, age (20-39, 40-59, 60-63; ≥64 years), educational level (primary, secondary, higher), type of health insurance (public, private, uninsured), and socioeconomic status (quintiles of an asset-index). We also used the concentration index (CIndex) to assess the extent of socioeconomic inequalities in the use of dental care, stratified by age and sex as a proxy for dental care needs. The use of dental care significantly increased between 2004 and 2009, especially in those with public health insurance, with lower educational level and lower socioeconomic status. The CIndex for the total population significantly decreased both for the proportion who used dental care, and also the mean number of visits. Findings suggest that the use of dental care increased and socioeconomic-related inequalities in the utilization of dental care declined after a Major Health Reform, which included universal coverage for some dental cares in Chile. However, efforts to ameliorate these inequalities require an approach that moves beyond a sole focus on rectifying health coverage.

Early life-course socioeconomic position, adult work-related factors and oral health disparities: cross-sectional analysis of the J-SHINE study

OBJECTIVES

We examined the association between socioeconomic position (SEP) and oral health, and the associations of economic difficulties in childhood and workplace-related factors on these parameters.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 3201 workers aged 25-50 years, living in and around Tokyo, Japan, from the J-SHINE (Japanese study of Stratification, Health, Income, and Neighborhood) study. The response rate was 31.6%.

OUTCOME MEASURES

Self-rated oral health (SROH)-A logistic regression model was used to estimate ORs for the association between poor SROH and each indicator of SEP (annual household income, wealth, educational attainment, occupation and economic situation in childhood). Multiple imputation was used to address missing values.

RESULTS

Each indicator of SEP, including childhood SEP, was significantly inversely associated with SROH, and all of the workplace-related factors (social support in the workplace, job stress, working hours and type of employment) were also significantly associated with SROH. Compared with professionals, blue-collar workers had a significantly higher OR of poor SROH and the association was substantially explained by the workplace-related factors; ORs ranged from 1.44 in the age-adjusted and sex-adjusted model to 1.18 in the multivariate model. Poverty during childhood at age 5 and at age 15 was associated with poorer SROH, and these two factors seemed to be independently associated with SROH.

CONCLUSIONS

We found oral health disparity across SEP among workers in Japan. Approximately 60% of the association between occupation and SROH was explained by job-related factors. Economic difficulties during childhood appear to affect SROH in adulthood separately from sex, age and the current workplace-related factors.

Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children

BACKGROUND

Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents' socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children's use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1-5 years.

METHODS

Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children's Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals.

RESULTS

Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as "poor" used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child's oral health as "fair/poor" were less likely to have visited the dentist for preventive care.

CONCLUSION

This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.

Health insurance, socio-economic position and racial disparities in preventive dental visits in South Africa

This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.

Utilization of services rendered in dental outreach programs in rural areas of Haryana

Background:

The availability of oral health services are very scarce in rural India; therefore the unmet treatment needs of rural population are very high. Hence, a retrospective study was conducted to evaluate the types of patients, disease pattern, and services rendered in outreach programs in rural areas of Haryana.

Materials and Methods:

A The data were obtained from records of outreach programs conducted, in last 3 months, by Swami Devi Dyal Hospital and Dental College. The data from were analyzed using descriptive statistics.

Results:

A total of 1371 individuals in the age group of 4--70 years (56.8% males and 43.2% females) attended the outreach program seeking the treatment. Dental caries (43.7%), gingivitis (27.2%), and periodontitis (22.9%) were commonly observed dental diseases. The services provided were oral prophylaxis (51.2%), restoration (22.9%), referral (20%), and extractions (8.8%).

Conclusion:

The attendance and utilization of dental services in the out reach programs seem to be influenced by sociodemographic characteristics of the population.

Predictors of the use of healthcare services in children and adolescents in Spain

OBJECTIVE

To assess medium to long term predictors of healthcare services use in a population-based sample of children/adolescents in Spain.

METHODS

A sample of children and adolescents aged 8-18 and their parents were evaluated at baseline (2003) and follow-up (2006). Total use of healthcare services and visits to specialist and dentists at the follow-up were analyzed.

RESULTS

Four hundred fifty-four children/adolescents completed baseline and follow-up assessments (response rate 54 %). 90 % of respondents reported at least one visit during the 12 months previous to the follow-up. Low socioeconomic status (beta coefficient = 0.30; 95 % CI = 0.02-0.57), double healthcare coverage (0.41; 0.17-0.66), parental use of services, poor mental health and activity limitation were associated to the total number of visits. Access to specialist was associated to double healthcare coverage (OR = 1.77; 1.01-3.07) and parental primary level of education (OR = 0.51; 0.32-0.81). Age and low family affluence predicted visits to dentists (OR = 0.38; 0.19-0.73).

CONCLUSION

No barriers to healthcare services use were found. Family level of education, family affluence and double healthcare coverage predicted the use of specialists and dentists.

Trends in socioeconomic disparities in the utilization of dental care in Brazil and Sweden

AIMS

To describe trends in socioeconomic disparities in utilization of dental care.

METHODS

We obtained cross-sectional data from Sweden in the period 1968-2000 and from Brazil in 1986 and 2002 for 16 state capitals. The outcome was the percentage of people who reported that they had visited the dentist in the last 12 months, calculated for a higher and a lower income group and stratified by sex, age (two groups: young and adults) and dental status. Adjusted prevalence differences and prevalence ratios were produced using Poisson regression.

RESULTS

In Brazil, there was a decline in use of dental care among the 15-19 year olds in the period 1986-2002, but not among the 35-44 year olds. In Sweden, there was a decline among the young and adults between 1991 and 2000. Overall, socioeconomic disparities in use of dental services between the higher and the lower economic groups showed a decline in both countries. The reduction in disparities among young Brazilians was 1.1 percentage points per year (p < 0.01), but among the other age groups the decline was not significant (p>0.01). In the last surveys, the gap remained in both countries and age groups (p < 0.01).

CONCLUSIONS

The recent decline in utilization of dental care and in the socioeconomic gap may mirror improvements in oral health. However, there are still relevant and persistent disparities in utilization of dental care in both countries, with a higher proportion of people of higher socioeconomic status visiting the dentist.