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Kim K, Rosenberg MA. The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries. J Public Health Dent 2024; 84:3-12. [PMID: 38031495 DOI: 10.1111/jphd.12592] [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: 08/08/2023] [Revised: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries. METHODS We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables. RESULTS For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth. CONCLUSIONS Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.
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Affiliation(s)
- Kyeonghee Kim
- Dr. William T. Hold/The National Alliance Program of Risk Management & Insurance, College of Business, Florida State University, Tallahassee, Florida, USA
| | - Marjorie A Rosenberg
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin, Madison, Wisconsin, USA
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da Silva-Sobrinho AR, Lima NLB, Ramos LFS, Jerônimo SF, da Costa Araújo FA, Sette-de-Souza PH. Access to dental services in an elder population of African descent in Brazil. Gerodontology 2024; 41:54-58. [PMID: 37948317 DOI: 10.1111/ger.12726] [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] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES We investigated access to dental services and associated factors in a community of Quilombola older people. BACKGROUND Quilombola populations are groups of individuals descended from black Africans subjected to slavery during part of Brazilian history. As marginalised and neglected individuals, they have high rates of negative indicators and require further attention to the social determinants that affect their health reality. MATERIALS AND METHODS A cross-sectional quantitative study was conducted in the Quilombola community of Castainho, in the Northeast region of Brazil. In this community, 34 older people aged between 65 and 74 resided. We collected self-report data on sociodemographic and economic characteristics, along with oral examinations by the researchers. The primary dependent variable was regular access to dental services. Statistical analysis used Fisher's exact test (P = .05). RESULTS Among the 32 participants in the final sample, 18.8% (n = 6) reported accessing dental services in the previous 6 months. Self-declared individuals of mixed race, with positive self-assessment of oral health, and those who did not self-perceive the need for treatment had lower rates of regular access to dental services (P < .05). CONCLUSION Use of dental services by older Quilombola people is low, and there are differences by ethnicity and individual perception of oral health.
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Affiliation(s)
| | - Nathália Larissa Bezerra Lima
- Graduate Program in Health and Socioambiental Development, Universidade de Pernambuco, Campus Garanhuns - Garanhuns, Pernambuco, Brazil
| | - Letícia Francine Silva Ramos
- Graduate Program in Health and Socioambiental Development, Universidade de Pernambuco, Campus Garanhuns - Garanhuns, Pernambuco, Brazil
| | - Stefania Ferreira Jerônimo
- Graduate Program in Health and Socioambiental Development, Universidade de Pernambuco, Campus Garanhuns - Garanhuns, Pernambuco, Brazil
- School of Dentistry, Universidade de Pernambuco, Campus Arcoverde - Arcoverde, Pernambuco, Brazil
| | | | - Pedro Henrique Sette-de-Souza
- Graduate Program in Health and Socioambiental Development, Universidade de Pernambuco, Campus Garanhuns - Garanhuns, Pernambuco, Brazil
- School of Dentistry, Universidade de Pernambuco, Campus Arcoverde - Arcoverde, Pernambuco, Brazil
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Pendleton M, Moss ME, Wu Q, Tempel R, Garcia R, Al-Dajani M. Payment Methods and Demographics Influence Patterns of Dental Service Utilization. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:929-935. [PMID: 37290126 PMCID: PMC10549891 DOI: 10.1097/phh.0000000000001774] [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] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the patterns of specific dental service utilization among the various sociodemographic groups in North Carolina served by the East Carolina University School of Dental Medicine (ECU SoDM). DESIGN This was a descriptive study utilizing self-reported patients' sociodemographic information, payment method history, and CDT codes of procedures performed. Deidentified clinical data recorded for 26 710 patients and 534 983 procedures from 2011 to 2020 were extracted from a centralized axiUm database. Data were analyzed using IBM SPSS Statistics, version 25.0. Cross-tabulations between dental service utilizations, patients' demographics, and payment method were performed using chi-square analysis. SETTING Nine dental clinic sites across the state of North Carolina. PARTICIPANTS In total, 26 710 adults 23 years to older than 65 years were included in the sample for this study. MAIN OUTCOME MEASURES In total, 534 983 procedure codes completed for the eligible patients were cross-tabulated with payment method. RESULTS Payment method was significantly related to individual characteristics including location of service, age, race, ethnicity, and untreated decay ( P < .001). Payment method is associated with the dental service type utilized by an individual ( P < .001). Patients who received Medicaid benefits were more likely to receive restorative procedures, removable prosthetics, or oral surgery. Despite NC Medicaid covering preventive procedures, patients who received Medicaid benefits showed lower utilization of preventive procedures than expected. Privately insured or self-paying individuals demonstrated a greater variety of service option utilization, as well as more frequent usage of more specialized procedure options such as endodontics, periodontics, fixed prosthodontics, and implants. CONCLUSIONS Payment method was found to be related to patients' demographics and type of dental service utilized. Adults older than 65 years demonstrated a higher proportion of self-payment for dental care, indicating a lack of payment options for this population. In the interest of providing care for underserved populations in North Carolina, policy makers should consider expanding dental coverage for adults older than 65 years.
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Affiliation(s)
- Matthew Pendleton
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Mark E. Moss
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Qiang Wu
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Rob Tempel
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Raul Garcia
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
| | - Mahmoud Al-Dajani
- School of Dental Medicine (Mr Pendleton, and Drs Moss, Tempel, and Al-Dajani) and Department of Public Health (Dr Wu), East Carolina University, Greenville, North Carolina; and Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts (Dr Garcia)
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Heaton B, Bond JC, Bae J, Cozier Y. Perceived experiences of racism linked to dental fear and anxiety among Black women. Community Dent Oral Epidemiol 2023; 51:896-907. [PMID: 35964228 PMCID: PMC9925613 DOI: 10.1111/cdoe.12782] [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: 03/29/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Dental fear and anxiety are known determinants of delaying or avoiding dental care and vary considerably based on factors such as age and gender. However, little is known about dental fear and anxiety in racial/ethnic minority populations, which bear a disproportionate burden of poor oral health outcomes. Structural and social pathways responsible for producing these disparities are also understudied. Experiences of racism over the lifecourse may contribute to poor oral health outcomes through a pathway of dental fear and anxiety. This paper aimed to evaluate perceived experiences with racism, dental fear and anxiety, and the utilization of dental services, in the Black Women's Health Study (BWHS), a United States-based prospective cohort. METHODS Analysis of prospective data obtained from a geographic subset of participants in the BWHS was conducted. In 2014, BWHS participants residing in Massachusetts responded to a mailed oral health questionnaire that included the Index of Dental Anxiety and Fear (IDAF-4C+) instrument (N = 484; 69% response rate). Previously collected demographic and health information, along with reported experiences of everyday and lifetime racism, obtained from national BWHS questionnaires between 1995 and 2009, were merged with the Massachusetts-based sub-sample. Associations between high dental anxiety (HDA) (mean IDAF-4C+ score ≥2.5 on the dental fear and anxiety module) and oral health outcomes and perceived racism and HDA were explored via prevalence ratios (PR) calculated using log-binomial regression models, including adjustment for potential confounders. RESULTS Reported exposures to everyday racism occurred weekly on average for the top 25% of the sample, while 13% of participants reported exposure to multiple (n = 3) experiences of unfair treatment due to their race over their lifetime. HDA was prevalent among 17.8% of the sample and was significantly associated with indicators of poor oral health status. High exposures to everyday and lifetime experiences of racism were positively associated with HDA (PR = 1.08; 95% CI: 0.90, 1.58 and PR = 1.72; 95% CI: 1.03, 2.88, respectively). CONCLUSIONS Significant associations between racism and HDA, and between HDA and poor oral health and reduced utilization of dental care were observed. Dental anxiety may be a pathway through which perceived experiences with racism may impact oral health outcomes.
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Affiliation(s)
- Brenda Heaton
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
| | - Julia C. Bond
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
| | - Jaeyoung Bae
- Department of Health Policy & Health, Services Research, Boston University, Henry M. Goldman School of Dental, Medicine, Boston, Massachusetts, USA
| | - Yvette Cozier
- Department of Epidemiology, Boston, University School of Public Health, Boston, Massachusetts, USA
- Slone Epidemiology Center, Boston, University, Boston, Massachusetts, USA
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Tu RY, Liang P, Tan AJM, Tran DHG, He AM, Je H, Kroon J. Factors associated with regular dental attendance by aged adults: A systematic review. Gerodontology 2023; 40:277-287. [PMID: 36271656 DOI: 10.1111/ger.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model. BACKGROUND Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases. MATERIALS AND METHODS An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related). RESULTS Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance. CONCLUSIONS This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.
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Affiliation(s)
- Raychel Yap Tu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Phoebe Liang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Alan Jia-Ming Tan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel Hien Gia Tran
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Antonio Menglong He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Heidi Je
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Anticona C, Lif Holgerson P, Gustafsson PE. Assessing inequities in unmet oral care needs among adults in Sweden: An intersectional approach. Community Dent Oral Epidemiol 2022; 51:428-435. [PMID: 36583509 DOI: 10.1111/cdoe.12836] [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: 06/17/2022] [Revised: 10/23/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The goal of the Swedish oral healthcare system is to achieve good oral health and equitable access to care for the entire population. However, considerable inequities in oral health and care are evident and occur across a range of social dimensions. This study uses an intersectional approach to examine complex inequities in unmet oral care needs among adults in Sweden over the period 2004-2021. METHODS Data were obtained from 14 Health on Equal Terms surveys conducted during 2004-2021. The final sample was 129 473 individuals aged 26-84 years. Applying intersectional analysis of individual heterogeneity and discriminatory accuracy, inequities in unmet oral care needs were estimated across 48 intersectional strata defined by gender, age, educational level, individual disposable income and immigrant status. RESULTS A high risk of unmet oral care needs was found among strata consisting of immigrants and those with low income. However, being an immigrant and/or having a low income did not universally entail a high risk but varied by the social position along other axes, particularly age and education. The discriminatory accuracy was moderate. CONCLUSION Groups with certain social disadvantages are highly heterogeneous themselves. An intersectionality approach is important to prevent the risk of stigmatizing large heterogenous groups while failing to identify the most vulnerable strata. The discriminatory accuracy analysis suggested that further policy and/or interventions may be the most effective if approaching the whole population, combined with selected targeted interventions directed at the most disadvantaged social strata.
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Affiliation(s)
| | | | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Ramos-Gomez F, Kinsler JJ. Addressing social determinants of oral health, structural racism and discrimination and intersectionality among immigrant and non-English speaking Hispanics in the United States. J Public Health Dent 2022; 82 Suppl 1:133-139. [PMID: 35726467 PMCID: PMC9540311 DOI: 10.1111/jphd.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Background The Hispanic population is the largest (18.5%) and fastest growing non‐majority ethnic group in the United States (US), about half of whom are non‐US born, and bears one of the highest oral disease burdens. Most current knowledge around oral health disparities in Hispanic populations examine the individual factors of culture, acculturation, and socioeconomic status. However, the root causes of this inequity; oral health literacy (OHL), social determinants of health (SDOH), structural racism and discrimination (SRD) and the intersectionality among the three, have not been well‐studied. Addressing this critical gap will be central to advancing health equity and reducing oral health‐related disparities in the Hispanic population, especially among immigrant and non‐English speaking Hispanics. Results Recommendations for future OHL/SDOH/SRD‐related research in oral health targeting Hispanic populations should include: (1) examining the direct and indirect effects of OHL/SDOH/SRD‐related factors and intersectionality, (2) assessing the impact of SRD on oral health using zip‐code level measures, (3) examining the role of OHL and SDOH as potential effect modifiers on the relationship between SRD and oral health outcomes, (4) conducting secondary data analysis to identify demographic, social and structural‐level variables and correlations between and among variables to predict oral health outcomes, and (5) obtaining a deeper understanding of how OHL/SDOH and SRD factors are experienced among Hispanic immigrant and migrant populations. Conclusion It is hoped these recommendations will lead to a better understanding of the mechanisms through which OHL, SDOH and SRD impact oral health outcomes among the largest minority population in the US so they can be addressed.
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Affiliation(s)
- Francisco Ramos-Gomez
- Division of Growth & Development, Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, California, USA
| | - Janni J Kinsler
- Section of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, California, USA
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Mulcahy A, Streed CG, Wallisch AM, Batza K, Kurth N, Hall JP, McMaughan DJ. Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052588. [PMID: 35270279 PMCID: PMC8909748 DOI: 10.3390/ijerph19052588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 12/10/2022]
Abstract
Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities. The rates of disability type were similar between transgender and cisgender participants with two significant differences. Fewer transgender participants identified physical or mobility disability as their main disability compared to cisgender participants (12.31%/8 vs. 27.68/581, p < 0.01), and more transgender participants selected developmental disability as their main disability compared to cisgender participants (13.85%/9 vs. 3.67%/77, p < 0.001). After adjusting for sociodemographic characteristics, the odds of disabled transgender participants reporting an unmet need were higher for every unmet need except for preventative services.
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Affiliation(s)
- Abigail Mulcahy
- Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, OR 97239, USA
- Correspondence:
| | - Carl G. Streed
- Section of General Internal Medicine, Boston University School of Medicine, Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, MA 02118, USA;
| | - Anna Marie Wallisch
- Juniper Gardens Children’s Project, University of Kansas, Lawrence, KS 66045, USA;
| | - Katie Batza
- Women, Gender, and Sexuality Studies, University of Kansas, Lawrence, KS 66045, USA;
| | - Noelle Kurth
- Institute for Health and Disability Policy Studies, Life Span Institute, University of Kansas, Lawrence, KS 66045, USA;
| | - Jean P. Hall
- Research and Training Center on Independent Living and The Institute for Health and Disability Policy Studies, Lawrence, KS 66045, USA;
| | - Darcy Jones McMaughan
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK 74078, USA;
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Yu YH, Cheung WS, Steffensen B, Miller DR. Number of teeth is associated with all-cause and disease-specific mortality. BMC Oral Health 2021; 21:568. [PMID: 34749715 PMCID: PMC8574051 DOI: 10.1186/s12903-021-01934-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tooth loss has been shown to correlate with multiple systemic comorbidities. However, the associations between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored extensively. We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of NoT (20-28,10-19, and 0-9), edentulism and without functional dentition (NoT < 19). METHODS The National Health and Nutrition Examination Survey in the United States (NHANES) (1999-2014) conducted dental examinations and provided linkage of mortality data. NHANES participants aged 20 years and older, without missing information of dental examination, age, gender, race, education, income, body-mass-index, smoking, physical activities, and existing systemic conditions [hypertension, total cardiovascular disease, diabetes, and stroke (N = 33,071; death = 3978), or with femoral neck bone mineral density measurement (N = 13,131; death = 1091)] were analyzed. Cox proportional hazard survival analyses were used to investigate risks of all-cause, heart disease, diabetes and cancer mortality associated with NoT in 3 groups, edentulism, or without functional dentition. RESULTS Participants having fewer number of teeth had higher all-cause and disease-specific mortality. In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%CI) = 1.46(1.25-1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33-2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05-2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34-2.43); p < .001]. Risks for all-cause mortality were also higher among the edentulous [HR(95%CI) = 1.35(1.17-1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17-1.55); p < .001]. CONCLUSIONS Having fewer NoT were associated with higher risks for all-cause mortality. More research is needed to explore possible biological implications and validate our findings.
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Affiliation(s)
- Yau-Hua Yu
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA.
| | - Wai S Cheung
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA
| | - Bjorn Steffensen
- Department of Periodontology, Tufts University School of Dental Medicine, One Kneeland Street, Boston, MA, 02111, USA
| | - Donald R Miller
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, VA Bedford Health Care System, Bedford, MA, USA
- School of Public Health, Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
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Aldosari M, Mendes SDR, Aldosari A, Aldosari A, de Abreu MHNG. Factors associated with oral pain and oral health-related productivity loss in the USA, National Health and Nutrition Examination Surveys (NHANES), 2015-2018. PLoS One 2021; 16:e0258268. [PMID: 34634083 PMCID: PMC8504739 DOI: 10.1371/journal.pone.0258268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Our aim was to identify clinical and sociodemographic factors associated with oral pain and oral health-related productivity loss among US adults. Methods We included adults aged ≥30 years who completed the dental examination, had at least one natural tooth, and provided an answer about their oral pain experience or oral health-related productivity loss in the 2015–2018 National Health and Nutrition and Examination Survey (NHANES). We performed descriptive analyses and multivariable binary logistic regression analyses on weighted data. Results One out of four adults had oral pain and 4% reported oral health-related productivity loss occasionally or often within the last year of the survey. The odds of oral pain were higher among non-Hispanic black (OR = 1.35; 95%CI = 1.08–1.62) and non-Hispanic Asian individuals (OR = 1.38; 95%CI = 1.07–1.78) compared to non-Hispanic white individuals, and individuals with untreated dental caries (OR = 2.06; 95%CI = 1.72–2.47). The odds for oral health-related productivity loss were 13.85 times higher among individuals who reported oral pain (95%CI = 8.07–23.77), and 2.18 times higher among individuals with untreated dental caries (95%CI = 1.65–2.89). The odds of oral pain and reported oral health-related productivity loss decreased as family income increased. Conclusions Factors including non-Hispanic black race/ethnicity, lower socio-economic status, and untreated dental caries are associated with oral pain experience, which increases the odds of oral health-related productivity losses. Identifying factors associated with oral pain and productivity loss will enable clinicians, policymakers, and employers to proactively target and prioritize the higher-risk groups in early interventions and policies.
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Affiliation(s)
- Muath Aldosari
- Department of Periodontics and Community Dentistry, College of Dentistry at King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
| | | | - Ahad Aldosari
- College of Dentistry at King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah Aldosari
- Department of Oral Medicine and Diagnostic Science, College of Dentistry at King Saud University, Riyadh, Kingdom of Saudi Arabia
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Gaskin DJ, Zare H, McCleary R, Kanwar O, Davis AL. Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis. JDR Clin Trans Res 2021; 7:398-406. [PMID: 34323109 DOI: 10.1177/23800844211035669] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.
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Affiliation(s)
- D J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Global Health Services and Administration, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - R McCleary
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - O Kanwar
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A L Davis
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Zhou J, Sweiss K, Nutescu EA, Han J, Patel PR, Ko NY, Lee TA, Chiu BCH, Calip GS. Racial Disparities in Intravenous Bisphosphonate Use Among Older Patients With Multiple Myeloma Enrolled in Medicare. JCO Oncol Pract 2021; 17:e294-e312. [PMID: 33449809 PMCID: PMC8257921 DOI: 10.1200/op.20.00479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/07/2020] [Accepted: 10/13/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Intravenous (IV) bisphosphonates reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in IV bisphosphonate utilization outside of clinical trial settings are limited. We evaluated population-level IV bisphosphonate initiation and discontinuation among patients of age ≥ 65 years with MM. METHODS We conducted a retrospective cohort study of patients of age ≥ 65 years diagnosed with first primary MM between 2001 and 2011. Patients were identified using the SEER-Medicare linked database and followed through December 2013. Cumulative incidences of IV bisphosphonate initiation and time to discontinuation among users were compared between racial and ethnic groups. In Fine and Gray competing risk models, we estimated subdistribution hazard ratios (SHRs) and 95% CIs for initiation and discontinuation. RESULTS We included 14,231 eligible patients with MM (median age, 76 years; 52% male). Over a median follow-up of 23.1 months, 54% of patients received at least one IV bisphosphonate dose. Our final analytical sample included 10,456 non-Hispanic (NH) Whites, 2,267 NH Blacks, 548 Asian and Pacific islanders, and 815 Hispanic and Latino patients. A higher proportion of White patients (56.1%) newly received IV bisphosphonates after MM diagnosis compared with NH Blacks (45.4%). Compared with White patients, NH Black patients were less likely to initiate IV bisphosphonates (SHR, 0.74; 95% CI, 0.70 to 0.79) and slightly more likely to discontinue treatment (SHR, 1.10; 95% CI, 1.01 to 1.19). CONCLUSION Approximately half of the patients with MM of age ≥ 65 years did not receive IV bisphosphonates, with significant delay among racial minority groups. These findings highlight the need for improvement of IV bisphosphonate uptake in patients with MM of age ≥ 65 years.
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Affiliation(s)
- Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- University of Illinois at Chicago, Chicago, IL
| | | | | | - Jin Han
- University of Illinois at Chicago, Chicago, IL
| | | | - Naomi Y. Ko
- Boston University School of Medicine, Boston, MA
| | - Todd A. Lee
- University of Illinois at Chicago, Chicago, IL
| | | | - Gregory S. Calip
- University of Illinois at Chicago, Chicago, IL
- Flatiron Health, New York, NY
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Kranz AM, Gahlon G, Dick AW, Stein BD. Characteristics of US Adults Delaying Dental Care Due to the COVID-19 Pandemic. JDR Clin Trans Res 2020; 6:8-14. [PMID: 32985322 PMCID: PMC7527908 DOI: 10.1177/2380084420962778] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has disrupted the delivery of health care services, including dental care. The objective of this study was to quantify and describe US adults who delayed dental care due to the COVID-19 pandemic. Methods: We analyzed cross-sectional responses collected from a nationally representative and long-running panel survey of US adults conducted in late May and early June 2020 (response rate = 70%). The survey included questions about dental care delayed due to the COVID-19 pandemic, purpose of the delayed dental visits, timing of future dental visits, and demographic information. Pearson’s chi-square tests were used to determine if rates of delayed dental care varied by subgroup. A multivariable regression model, adjusted for age, race, Hispanic ethnicity, census division, and rurality, was estimated to predict the odds of reporting delayed dental care. Results: Nearly half of respondents (46.7%) reported delaying going to the dentist or receiving dental care due to the COVID-19 pandemic. Among adults who reported delaying dental care due to the pandemic, 74.7% reported delaying a checkup, 12.4% reported delaying care to address something that was bothering them, and 10.5% reported delaying care to get planned treatment. About 44.4% of adults reported that they planned to visit the dentist within the next 3 mo. In the multivariable regression model, only living in an urban (vs. rural) area was associated with significantly higher odds of delayed dental care due to the pandemic (odds ratio: 1.5; 95% confidence interval: 1.1, 2.1). Conclusions: Nearly half of US adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020. Our results offer insight into the experiences of patients seeking dental care this spring and the economic challenges faced by dental providers due to the pandemic. Knowledge Transfer Statement: This article describes US adults who delayed dental care due to the COVID-19 pandemic. Results can be used by clinicians and policymakers to understand delayed care during the pandemic.
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Affiliation(s)
- A M Kranz
- RAND Corporation, Arlington, VA, USA
| | - G Gahlon
- RAND Corporation, Arlington, VA, USA
| | - A W Dick
- RAND Corporation, Boston, MA, USA
| | - B D Stein
- RAND Corporation, Pittsburgh, PA, USA
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