Does the regional deprivation impact the spatial accessibility to dental care services?

Travel Time for Dental Care Services Based on Patient Preference in South Korea

This study analyzed patient preferences using travel time from residence to dental institution when selecting dental care services. We used data from the Korean Health Panel from 2008 to 2017 and analyzed each dental service episode. Since the distribution of travel time was skewed to the left, median travel time was analyzed. The association of travel time with services was analyzed via the population-averaged generalized estimating equation (GEE) with the Poisson family. The median of the average travel time per episode was longer for non-National Health Insurance (NHI)-covered services and shorter for NHI-covered services. The first quintile of low-income subjects traveled the longest for all services and utilized dental care the most. In the GEE analysis, travel time was approximately three times longer for implant treatment and gold inlay/resin fillings and >2 times longer for orthodontic care than for NHI-covered services. Patients residing in rural counties traveled for longer than residents of large cities. Income was statistically significant; however, the coefficient was close to zero. Travel time was related to the type of service and reflected patient preference. This was more prominent for expensive non-NHI-covered services than for NHI-covered services. The findings suggest patients’ subjective preferences for dental clinic selection are expressed as rational deliberation considering each individual’s situation.

Differences in Accessibility of Public Health Facilities in Hierarchical Municipalities and the Spatial Pattern Characteristics of Their Services in Doumen District, China

This study used the two-step floating catchment area method and potential model to calculate facility accessibility and potential service scope of public health infrastructure distribution, and to evaluate its spatial equity. We applied the Gini coefficient to measure the spatial equilibrium at each level of public health infrastructure in Doumen District, Guangdong, China, from different perspectives. The following results were obtained: (1) Significant spatial differences were observed in the accessibility of public health facilities among different levels; the higher the health facility level, the greater the difference in spatial accessibility. Spatial differences in the accessibility of public health infrastructure at the primary level and higher were distributed in a block-like pattern, while spatial differences in the accessibility of rural health stations were distributed in a circular pattern. Administrative villages tended to have the highest and lowest accessibility of tertiary and secondary hospitals, but not of primary hospitals and rural health stations. The frequencies for administrative villages with the highest and lowest accessibility were 32.8% and 49.6% of the total number of villages in the district, respectively, for tertiary hospitals; 39.2% and 48.8% for secondary hospitals; 19.2% and 24.8% for primary hospitals; 16.8% and 21.6% for rural health stations. (2) The potential service scope was spatially dissociative for tertiary hospitals, and differed more significantly in terms of space for secondary hospitals; the potential service scope of the two overlapped. The potential service scope of primary hospitals was relatively balanced, with strong spatial continuity, while that of rural health service centers was spatially fragmented. The service scope of rural health service centers was mostly consistent with their respective village-level administrative divisions. (3) The higher the level of public health infrastructure, the less balanced its spatial layout. Conversely, the lower the level of public health infrastructure, the more balanced its spatial layout.

GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK?

Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.

Disparities in the geographic distribution of NHS general dental care services in England

Objectives To assess the geographic distribution of NHS dental practices in England in relation to deprivation and rurality.Methods A total of 7,851 dental practices in England were included in this study against a population of 53,004,517 from 171,349 statistical areas. The practices were mapped using geographic information systems technology and integrated with census population data, the Index of Multiple Deprivation and the rural-urban classification.Results Results showed that 92.1% of children and adolescents, 91.8% of working-age adults and 88.8% of older adults lived within 2.5 km of a practice. In general, dental practices were not socioeconomically distributed; 99.7% of people from the most deprived areas lived close to a practice compared to 92.9% of people from the least deprived areas. However, when age groups were delineated, much higher proportions of deprived children and adolescents lived within 2.5 km distance from a dental service, while the opposite was true for the older age group (high proportions of the least deprived older adults lived within 2.5 km distance from a dental service). In rural areas, 54.8%, 54.3% and 53.5% of children and adolescents, working-age adults and older adults lived outside 2.5 km of a dental practice, respectively.Conclusions Disparities exist in the distribution of NHS dental practices in England. The need to increase spatial availability of dental practices in England is evident.

Public transport access to NHS dental care in Great Britain

Objective Access to transport is a common barrier to oral health. Greater dependence on public transport has shown delayed oral healthcare, lack of usual source of care and greater unmet health needs. This study examined the spatial accessibility of the population of Great Britain to public transport in providing access to oral healthcare.Methods A total of 8,791 dental practices in Great Britain were identified and geocoded. There were 10,444 rail, metro and light rail stops and 348,961 bus and tram stops. Geographic information systems were utilised to integrate the dental practice locations and public transport points to respective census tracts of each nation containing population data, deprivation measures, and classification of rural and urban areas.Results Almost all dental clinics in Great Britain were located within 400 m of bus and tram stops or 800 m of a rail, metro or light rail stop. Similarly, in Scotland and England, 92% lived within any public transport (within 400m of bus and tram stops or 800m of a rail, metro or light rail stop), and in Wales, 84.2% lived within any public transport stop. However, only 75.1%, 79.6% and 60.4% of the population of Scotland, England and Wales had access to a high-frequency bus stop, respectively. In Scotland, England and Wales, 40.7%, 33.7% and 38.3% of rural residents did not have access to any public transport and only 4.9%, 7.5% and 14.6% of the rural residents had access to an optimal bus stop, respectively. In Wales, 19.5% of older adults do not have access to a bus stop.Conclusion Some transport-disadvantaged groups do not have adequate access to public transport services. There is a compelling need to address public transport integration with oral health facilities to ensure equality in accessing integral services.

Variation in dental services by rurality among privately insured adults in the United States

OBJECTIVES

Rurality is associated with reduced dental access and worse oral health outcomes. It is unknown whether there is variation in dental services received by rural adults who visit a dentist.

METHODS

This was a retrospective analysis of claims data from a large private insurer. All individuals who had at least one dental visit in 2018 were included. Patient demographics, whether or not a patient's ZIP code was rural as defined by the Federal Office of Rural Health Policy, as well as ZIP code demographics were collected. Differences in the frequency of dental services received were evaluated using χ² tests. Multilevel logistic regressions were used to evaluate the individual and ZIP code-level correlates of receiving a preventive dental procedure, a tooth extraction, or a denture-related dental procedure.

RESULTS

Rates of preventive, oral and maxillofacial surgery, and denture-related procedures were higher among rural adults. Accounting for individual age and gender, and ZIP code average income and dentist density, rural dwellers were more likely to receive a preventive procedure [odds ratio (OR) 1.15, P < 0.0001] or tooth extraction (OR 1.08, P < 0.0001), and less likely to have a denture-related procedure (OR 0.94, P = 0.015) compared to nonrural dwellers. Female gender was the strongest predictor of receiving a preventive procedure (OR 1.30, P < 0.0001).

CONCLUSIONS

Even among privately insured individuals with known access to dental care, rurality was associated with significant differences in the frequency of various dental procedures. Rural dental patients may have higher needs for oral surgical procedures, even when they have access to preventive care.