Using a geographical information system to map the distribution of dentists in Ohio

Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio

OBJECTIVE

This study investigated whether insurance status and/or developmental disability moderated the association between adverse childhood experiences (ACE) and unmet dental needs among children aged 0 to 17 in Ohio.

METHODS

We utilized cross-sectional data from the 2021 Ohio Medicaid Assessment Survey to assess the dental needs of children. ACE scores, dental insurance status, and developmental disability status were analyzed using multivariable logistic regression to identify their potential association with parental-reported unmet dental needs.

RESULTS

The weighted sample represented 2,752,222 children in Ohio. Over half reported zero ACEs (55.8%) and no dental needs (56.1%). Approximately 1 in 9 lacked dental insurance (11.1%), and 1 in 10 had a developmental disability (9.9%). Children with one to three ACEs had three times the odds of unmet dental needs compared to children with zero ACEs (OR = 3.20; 95%CI [2.10, 4.89]), and children with four or more ACEs had eight times the odds of unmet dental needs (OR = 8.78; 95%CI [5.26, 14.67]). Children lacking dental insurance had over six times higher odds of unmet dental needs compared to children with dental insurance (OR = 6.10; 95%CI [3.92, 9.49]). The presence of developmental disability status did not moderate the presence of unmet dental needs; however, the lack of dental insurance status significantly moderated the association between ACEs and unmet dental needs.

CONCLUSION

Insurance status, not developmental disability, moderated the association between ACEs and unmet dental needs among children in Ohio. Efforts to ensure continuous access to dental insurance are warranted.

Health inequalities in the geographic distribution of dental practitioners in Costa Rica: An ecological study

OBJECTIVE

The uneven distribution of dental health services in a territory can cause an imbalance in accessibility, increasing health inequalities. This study aimed to describe the geographical distribution of dental health practitioners according to urbanicity and area-level socio-economic status in Costa Rica.

METHODS

A National Dentist Survey was developed to identify employment status, number of working hours, address and list of the working clinics. Data was completed using information from the national College of Surgeons, including all Costa Rican dentists. The Minimal Geographic Units (MGU) allowed for aggregating the population's individual level socio-economic position. Local Potential Accessibility (LPA) calculated the density of full-time hour's equivalents around each MGU using floating sectors. Clinics were geocoded using Geographic Information Systems, creating 2853 clinical points. Distance between each MGU and the nearest accessible clinics considering full-time working hours equivalents was estimated. MGU were divided into six categories: 'No accessibility', 'Very low accessibility', 'Low accessibility', 'Good accessibility' 'High accessibility' and 'Very high accessibility'.

RESULTS

Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibility, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessibility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU.

CONCLUSIONS

This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal health coverage, public institutions should focus their efforts on improving access to dental services in underserved areas.

How Phantom Networks, Provider Qualities, and Poverty Sway Medicaid Dental Care Access: A Geospatial Analysis of Manhattan

Access to general dental care is essential for preventing and treating oral diseases. To ensure adequate spatial accessibility for the most vulnerable populations, New York State mandates a ratio of one general dentist to 2000 Medicaid recipients within 30 min of public transportation. This study employed geospatial methods to determine whether the requirement is met in Manhattan by verifying the online directories of ten New York managed care organizations (MCOs), which collectively presented 868 available dentists from 259 facilities. Our survey of 118 dental facilities representing 509 dentists revealed that significantly fewer dentists are available to treat Medicaid recipients compared to MCO directories. The average dentist-to-patient ratio derived from the MCO listings by the Two-Step Floating Catchment Area (2SFCA) method was 1:315, while the average verified ratio was only 1:1927. “Phantom networks”, or inaccurate provider listings, substantially overstated Medicaid dental accessibility. Surprisingly, our study also discovered additional Medicaid providers unlisted in any MCO directory, which we coined “hidden networks”. However, their inclusion was inconsequential to the overall dental supply. We further scrutinized dental care access by uniquely applying six “patient-centered characteristics”, and these criteria vastly reduced accessibility to an average ratio of merely 1:4587. Our novel evaluation of the spatial association between poverty, dental care access, and phantom networks suggests that Medicaid dental providers wish to be located in wealthier census tracts that are in proximity to impoverished areas for maximum profitability. Additionally, we discovered that poverty and phantom networks were positively correlated, and phantom providers masked a lack of dental care access for Medicaid recipients.

Association between local spatial accessibility of dental care services and dental care quality

BACKGROUND

The aim of our study was to evaluate the allocation of dental resources and explore access to dental care in Taiwan. In addition, we tried to understand the spatiotemporal characteristics of dental care quality and analyze the relationship between dental care quality and areas with deficiencies in dental resources.

METHODS

The study used a two-step floating catchment area to calculate the dental resources accessibility and explore the spatiotemporal distributions of dental care quality. The association between dental care quality and spatial accessibility was analyzed using a spatial error model.

RESULTS

Most areas with deficient dental resources and lower dental care quality were remote townships, agricultural towns, or aging towns with spatial clustering. The quality of children's preventive dental care had increased over time. Most highly urbanized areas had higher dental care quality. The quality of some dental care types such as children's preventive care and full-mouth calculous removal was associated with higher accessibility.

CONCLUSIONS

Understanding the spatiotemporal distribution of both dental care accessibility and quality can assist in allocation of dental care resources. Adequate dental resources may elevate dental care quality. Suggestions include policies to balance dental resources and routinely monitor improvement in areas with deficient dental care.

Spatial distribution analysis of dentists, dental technicians, and dental therapists in Indonesia

Background: Access to health services is needed around the world, from healthcare providers to doctors. One of the needs in public health is a system that is accessible for everyone, but, unequal distribution of healthcare provider and health workers, especially in dentistry fields is still a main problem in several countries, including Indonesia. The aim of this study is to analyze the spatial distribution of dentists, dental technicians, and dental therapists. Methods: This spatial analysis study was conducted after obtaining secondary data in Indonesia. All data were collected between September 1 ^st, 2020 and October 1 ^st, 2020 from open access sources of de-identified data. The data of dentists per area, dental technicians per area, and dental therapists per area were calculated for analysis. A spatial distribution map was prepared using the Quantum Geographic Information System (QGIS Desktop, version 3.10.6). Results: The results of this study found a ratio of dentists to members of the population in Indonesia of 1:17,105. The average number of dental technicians that work in the public health centers in each province (dental technicians per area) in Indonesia was calculated to be 0.13. The average number of dental therapists that work in the public health centers in each province (dental therapists per area) in Indonesia was calculated to be 0.40. This spatial autocorrelation illustrates that there is a relationship between values of dentists per area and dental therapists per area between provinces in Indonesia, and shows geographic clustering relationships or patterns that are grouped and have similar characteristics in adjacent locations. This spatial autocorrelation did not occur in the value of dental technicians. Conclusions: From this study we can conclude that there is an unequal distribution of dental personnel in Indonesia.

Current state of allocation of oral health human resources in northern China and future needs

OBJECTIVE

The aim of the present investigation was to describe the distribution, structure and allocation of oral health services personnel, evaluate oral health service capacity and predict the needs for oral health services in northern China over the coming 10 years.

METHODS

The questionnaires were sent to all the dental medical institutions included in this study directly from the Sanitation Bureau and the Health Supervision Station. All the institutions and dental personnel were asked to fill out the questionnaires, and then, the questionnaires were collected through postal service and email.

RESULTS

In Liaoning Province, which is in northern China, there are a total of 5617 dentists in total, 87.8% of whom are located in urban areas. Dentists in rural areas were found to be less educated and specialized. The ratio of dentists to nurses to technicians was about 6:2:1, and the ratio of dentists to total population was 1:7682. It was predicted that, in 2020, the number of dentists could reach 13 207. This would meet the area's needs for oral health services.

CONCLUSION

Currently, in northern China, the oral health infrastructure suffers from an insufficient number of dental professionals, disproportionate distribution and inappropriate structure. To improve social equity, it is necessary to adjust the distribution of dental personnel capable of performing for oral health services.

Pediatric dental clinic location and utilization in a high-resource setting

OBJECTIVES

Examine dental utilization by Medicaid-insured children living in a high-resource area. Characterize distance and travel-related variables to accessing care.

METHODS

Cross-sectional data were collected on dental clinics in Pittsburgh, Pennsylvania, caring for Medicaid-insured children ≥1 year. Shortest distances, drive times, and bus travel between dental clinics and high-poverty census tracts were determined through geographical information systems analysis. Primary care clinic (PCC) survey data were analyzed for children's dental use. Demographic characteristics and travel-related variables were compared between children who had and had not been to a dentist.

RESULTS

Ten dental clinics accepted Medicaid-insured children ≥1 year. Mean distance between high-poverty census tracts and their nearest clinic was 1.2 miles [standard deviation (SD) 0.2 miles], with mean bus travel time 15.6 minutes (SD 12.3 minutes). Overall, 46 percent of PCC children reported a dental visit, and this was not significantly different between those who lived in a high-poverty census tract versus those who did not (41 percent and 35 percent, respectively, P = 0.58). Children traveled a mean distance of 4.75 miles (SD 2.37 miles) to their dental clinic. Mean distance to their nearest dental clinic was 2.81 miles (SD 2.12 miles).

CONCLUSION

Dental clinics in a high-resource area are in close proximity to where young Medicaid-insured children live; and distances between children's homes and dental clinics are not significantly different between children who had and had not reported a dental visit, suggesting that barriers persist despite close proximity. Regardless, closer proximity may contribute to the higher utilization of services observed compared with national rates.

A Review and Framework for Categorizing Current Research and Development in Health Related Geographical Information Systems (GIS) Studies

OBJECTIVES

The application of GIS in health science has increased over the last decade and new innovative application areas have emerged. This study reviews the literature and builds a framework to provide a conceptual overview of the domain, and to promote strategic planning for further research of GIS in health.

METHOD

The framework is based on literature from the library databases Scopus and Web of Science. The articles were identified based on keywords and initially selected for further study based on titles and abstracts. A grounded theory-inspired method was applied to categorize the selected articles in main focus areas. Subsequent frequency analysis was performed on the identified articles in areas of infectious and non-infectious diseases and continent of origin.

RESULTS

A total of 865 articles were included. Four conceptual domains within GIS in health sciences comprise the framework: spatial analysis of disease, spatial analysis of health service planning, public health, health technologies and tools. Frequency analysis by disease status and location show that malaria and schistosomiasis are the most commonly analyzed infectious diseases where cancer and asthma are the most frequently analyzed non-infectious diseases. Across categories, articles from North America predominate, and in the category of spatial analysis of diseases an equal number of studies concern Asia.

CONCLUSION

Spatial analysis of diseases and health service planning are well-established research areas. The development of future technologies and new application areas for GIS and data-gathering technologies such as GPS, smartphones, remote sensing etc. will be nudging the research in GIS and health.

Tooth loss in Appalachia and the Mississippi delta relative to other regions in the United States, 1999-2010

OBJECTIVES

We examined regional variation in tooth loss in the United States from 1999 to 2010.

METHODS

We used 6 waves of the Behavioral Risk Factor Surveillance System and data on county characteristics to describe regional trends in tooth loss and decompose diverging trends into the parts explained by individual and county components.

RESULTS

Appalachia and the Mississippi Delta had higher levels of tooth loss than the rest of the country in 1999. From 1999 to 2010, tooth loss declined in the United States. However, Appalachia did not converge toward the US average, and the Mississippi Delta worsened relative to the United States. Socioeconomic status explained the largest portion of differences between regions in 1999, but a smaller portion of the trends. The Mississippi Delta is aging more quickly than the rest of the country, which explains 17% of the disparity in the time trend.

CONCLUSIONS

The disadvantage in tooth loss is persistent in Appalachia and growing in the Mississippi Delta. The increasing disparity is partly explained by changes in the age structure but is also associated with behavioral and environmental factors.

Radiation therapy resources and guideline-concordant radiotherapy for early-stage breast cancer patients in an underserved region

OBJECTIVE

To examine the relationship between radiation therapy resources and guideline-concordant radiotherapy after breast-conserving surgery (BCS) in Kentucky.

DATA SOURCES

The SEER registry and Area Resource File provided county-level data describing cancer care resources and socioeconomic conditions of Kentucky residents.

STUDY DESIGN

The outcome variable was rate of BCS without radiotherapy in each county for 2000-2007. Eight-year weighted average rates of radiation therapy providers and hospitals per 100,000 residents were explanatory variables of interest. Exploratory spatial data analyses and spatial econometric models were estimated.

PRINCIPAL FINDINGS

Appalachian counties in Kentucky had significantly fewer radiation oncologists, hospitals with radiation therapy facilities, and surgeons per 100,000 residents than non-Appalachian counties. The likelihood of BCS without radiation was significantly higher among Appalachian compared to non-Appalachian women (42.5 percent vs. 29.0 percent, p < .001). Higher proportions of women not receiving recommended radiotherapy after BCS were clustered in Eastern Kentucky around Lexington. This geographic disparity was partially explained by significantly fewer radiation therapy facilities in Appalachian Kentucky in adjusted analyses.

CONCLUSIONS

Scarce radiation therapy resources in Appalachian Kentucky are associated with disparities in receipt of guideline-concordant radiotherapy, suggesting that policy action is needed to improve the cancer treatment infrastructure in disadvantaged mountainous areas.

Smokeless tobacco use and periodontal health in a rural male population

BACKGROUND

Despite the reported effects of smokeless tobacco (ST) on the periodontium and high prevalence of ST use in rural populations and in men, studies on this specific topic are limited. The purpose of this cross-sectional investigation is to evaluate the periodontal health status of male ST users from a rural population.

METHODS

Adult male residents of two rural Appalachian Ohio counties and daily ST users, with a unilateral mandibular oral ST keratosis lesion, were recruited. Subjects completed a questionnaire and received oral examination. Teeth present, ST keratosis lesion, plaque and gingival index, probing depth (PD), recession depth (RD), and attachment level were recorded. Statistical analysis compared ST-site mandibular teeth (teeth adjacent to the subject's unilateral ST keratosis lesion) to NST-site teeth (contralateral corresponding teeth).

RESULTS

This study includes 73 ST users. Recession prevalence is much greater in ST-site quadrants (36%) compared to NST-site quadrants (18%; P <0.001). Twice as many teeth had recession on ST-site (approximately 20%) than NST-site (approximately 10%; P = 0.0001). Average buccal RD on ST-site teeth did not differ from that on the NST-site teeth (P = 0.0875). Although average buccal attachment loss is greater on ST-site teeth (P = 0.016), the mean difference is <0.5 mm. When stratified by years of ST use, subjects using ST for 10 to 18 years exhibit the most differences between ST and NST sites, whereas subjects using ST for <10 years show no differences.

CONCLUSION

The results indicate that greater gingival recession prevalence and extent are associated with ST placement site in rural male ST users.

Research protocol: EB-GIS4HEALTH UK - foundation evidence base and ontology-based framework of modular, reusable models for UK/NHS health and healthcare GIS applications

EB-GIS4HEALTH UK aims at building a UK-oriented foundation evidence base and modular conceptual models for GIS applications and programmes in health and healthcare to improve the currently poor GIS state of affairs within the NHS; help the NHS understand and harness the importance of spatial information in the health sector in order to better respond to national health plans, priorities, and requirements; and also foster the much-needed NHS-academia GIS collaboration. The project will focus on diabetes and dental care, which together account for about 11% of the annual NHS budget, and are thus important topics where GIS can help optimising resource utilisation and outcomes. Virtual e-focus groups will ensure all UK/NHS health GIS stakeholders are represented. The models will be built using Protégé ontology editor based on the best evidence pooled in the project's evidence base (from critical literature reviews and e-focus groups). We will disseminate our evidence base, GIS models, and documentation through the project's Web server. The models will be human-readable in different ways to inform NHS GIS implementers, and it will be possible to also use them to generate the necessary template databases (and even to develop "intelligent" health GIS solutions using software agents) for running the modelled applications. Our products and experience in this project will be transferable to address other national health topics based on the same principles. Our ultimate goal is to provide the NHS with practical, vendor-neutral, modular workflow models, and ready-to-use, evidence-based frameworks for developing successful GIS business plans and implementing GIS to address various health issues. NHS organisations adopting such frameworks will achieve a common understanding of spatial data and processes, which will enable them to efficiently and effectively share, compare, and integrate their data silos and results for more informed planning and better outcomes.

Is NHS dentistry in crisis? 'Traffic light' maps of dentists distribution in England and Wales

BACKGROUND: 'Traffic light' (red-yellow-green) maps are potentially powerful tools for 'at a glance' problem detection, for optimising resource allocation/reallocation, setting priorities, and targeting interventions to areas most in need. The maps can be also used for administrative area comparisons and performance monitoring over time. Interactive Web versions of the maps can be generated with many handy features to further empower organisations and decision makers. Methodological issues to consider when creating 'traffic light' maps include hue thresholding, data timeliness and stability of administrative boundaries. RESULTS: We used 'traffic light' maps to study the distribution of dentists per 1,000 population in all 304 English Primary Care Trusts (PCTs) and 22 Welsh Local Health Boards (LHBs) using datasets of dentist numbers per PCT (as at 31 December 2002) and LHB (as at 26 February 2004) from the Dental Practice Board, and 2001 Census population figures for PCTs and LHBs from the Office for National Statistics. The overall NHS dentists per 1,000 population figures for England (0.374) and Wales (0.359) are low compared to many other countries, with less than 0.3 dentist per 1,000 people available to 24.1% of the total population of England (81 PCTs or 26.6% of all PCTs) and 26.1% of the total population of Wales (6 LHBs or 27.3% of all LHBs). A general shortage of NHS dentists can be observed at a glance across England and Wales on all the 'traffic light' maps in our study, even on those using a more "tolerant" classification and an additional orange-yellow class. The distribution of NHS dentists in England and Wales was also found to be not uniform, with some PCTs/LHBs, especially those located in some of the deprived or less populated urban and rural communities, suffering significantly more shortage of dentists than others (see http://healthcybermap.org/PCT/dentists/). These results confirm recent media reports of a shortage of NHS dentists in various parts of England and Wales. CONCLUSION: Suitable programmes are urgently needed to increase the numbers of NHS dentists across England and Wales. We have included a set of recommendations to dental health policymakers and planners, in addition to ideas for further work.

GIS and health care

GIS and related spatial analysis methods provide a set of tools for describing and understanding the changing spatial organization of health care, for examining its relationship to health outcomes and access, and for exploring how the delivery of health care can be improved. This review discusses recent literature on GIS and health care. It considers the use of GIS in analyzing health care need, access, and utilization; in planning and evaluating service locations; and in spatial decision support for health care delivery. The adoption of GIS by health care researchers and policy-makers will depend on access to integrated spatial data on health services utilization and outcomes and data that cut across human service systems. We also need to understand better the spatial behaviors of health care providers and consumers in the rapidly changing health care landscape and how geographic information affects these dynamic relationships.