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Oladayo AM, Miyuraj Harishchandra HW, Zeng E, Caplan DJ, Butali A, Marchini L. Using machine learning algorithms to investigate factors associated with complete edentulism among older adults in the United States. SPECIAL CARE IN DENTISTRY 2024; 44:148-156. [PMID: 36749021 DOI: 10.1111/scd.12832] [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: 06/02/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 02/08/2023]
Abstract
AIMS Edentulism is an incapacitating condition, and its prevalence is unequal among different population groups in the United States (US) despite its declining prevalence. This study aimed to investigate the current prevalence, apply Machine Learning (ML) Algorithms to investigate factors associated with complete tooth loss among older US adults, and compare the performance of the models. METHODS The cross-sectional 2020 Behavioral Risk Factor Surveillance System (BRFSS) data was used to evaluate the prevalence and factors associated with edentulism. ML models were developed to identify factors associated with edentulism utilizing seven ML algorithms. The performance of these models was compared using the area under the receiver operating characteristic curve (AUC). RESULTS An overall prevalence of 11.9% was reported. The AdaBoost algorithm (AUC = 84.9%) showed the best performance. Analysis showed that the last dental visit, educational attainment, smoking, difficulty walking, and general health status were among the top factors associated with complete edentulism. CONCLUSION Findings from our study support the declining prevalence of complete edentulism in older adults in the US and show that it is possible to develop a high-performing ML model to investigate the most important factors associated with edentulism using nationally representative data.
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Affiliation(s)
- Abimbola M Oladayo
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | | | - Erliang Zeng
- Division of Biostatistics and Computational Biology, The University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Daniel J Caplan
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology, and Medicine and Iowa Institute for Oral Health, The University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Leonardo Marchini
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry, Iowa City, Iowa, 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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Teixeira CNG, Pereira SMDS, Hilgert JB, Oliveira NMAD, Ribeiro CCC, Neves M, Thomaz EBAF, Hugo FN, Alves CMC. [The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis]. CIENCIA & SAUDE COLETIVA 2023; 28:1087-1100. [PMID: 37042890 DOI: 10.1590/1413-81232023284.11452022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 09/20/2022] [Indexed: 04/13/2023] Open
Abstract
The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.
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Affiliation(s)
- Cinthia Nara Gadelha Teixeira
- Universidade de Fortaleza. R. São Mateus 1.650, 402, Vila União. 60410-642 Fortaleza CE Brasil.
- Universidade Federal do Maranhão. São Luís MA Brasil
| | | | | | | | | | - Matheus Neves
- Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil
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Hartmann CF, Meucci RD, Silva AER. Factors associated with the use of dental services in the previous 12 and 36 months by Brazilian older people residing in rural areas. Gerodontology 2022; 40:263-269. [PMID: 35964251 DOI: 10.1111/ger.12652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/25/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the use of dental services in two periods and associated factors in older people residing in the rural area of a municipality in southern Brazil. METHODS This was a cross-sectional study nested in a cohort study. A standardised questionnaire was used to collect the variables of interest. The dependent variables were the use of dental services in the 12 and 36 months prior to the interview. RESULTS A total of 863 older people were interviewed, 24.7% of whom had visited a dentist in the previous year and 38.7% had visited a dentist in the previous 3 years. Skin colour, health insurance and self-rated health were associated with both outcomes. Individuals with non-white skin, those who did not have health insurance and those who considered their health to be poor or very poor were more likely to take a long time before seeking oral health services. Differences between the two outcomes were observed in oral health and the use of tobacco. The likelihood of having gone more than 3 years without visiting a dentist was greater among smokers and lower among those with dental caries. CONCLUSIONS The prevalence of dental service use was low. Variables related to the adoption of unhealthy behaviours and the occurrence of oral diseases were only related to the use of dental services 36 months prior to the interview. Public policies must be reorganised to prioritise population groups with greater difficulties in the use of dental services.
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Affiliation(s)
- Clarissa Fialho Hartmann
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Santa Maria, Brazil
| | - Rodrigo Dalke Meucci
- Programa de Pós-Graduação em Saúde Pública, Universidade Federal do Rio Grande (FURG), Santa Maria, Brazil
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Santos ASF, Lima RFR, Ferreira RC, Alencar GP, Carreiro DL, Silveira MF, Trezena S, Martins AMEDBL. Use of oral health services among elderly Brazilians: mediation by tooth loss. CIENCIA & SAUDE COLETIVA 2022; 27:2777-2788. [PMID: 35730846 DOI: 10.1590/1413-81232022277.22122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.
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Affiliation(s)
- Aline Soares Figueiredo Santos
- Curso de Graduação em Odontologia, Universidade Estadual de Montes Claros (Unimontes). Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | - Renata Francine Rodrigues Lima
- Curso de Graduação em Odontologia, Universidade Estadual de Montes Claros (Unimontes). Av. Rui Braga s/n, Vila Mauricéia. 39401-089 Montes Claros MG Brasil.
| | | | | | | | | | - Samuel Trezena
- Programa de Pós-Graduação em Cuidado Primário em Saúde, Unimontes. Montes Claros MG Brasil
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Drachev SN, Puriene A, Aleksejuniene J, Stankeviciene I, Stangvaltaite-Mouhat L. Prevalence of and factors associated with dental service utilization among early elderly in Lithuania. BMC Health Serv Res 2022; 22:16. [PMID: 34974840 PMCID: PMC8721987 DOI: 10.1186/s12913-021-07388-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is no recent information about dental service utilization (DSU) among elderly in Lithuania. We examined DSU and its associated factors in Lithuanian early elderly based on the Andersen's behavioural model. METHODS The cross-sectional study conducted in 2017-2019 included a nationally representative stratified sample of 370 Lithuanian early elderly aged 65-74 years (response rate of 54.5%). Information on predisposing factors (age, sex, nationality and education), enabling factor (residence), need-based factors (status of teeth, oral pain or discomfort, and dry mouth), general health, personal health practices and perceived stress was obtained from a structured, self-administered questionnaire. Clinically-assessed need-based factors included number of missing teeth and dental treatment need. Multivariable Poisson regression with robust variance estimates was used. RESULTS A total of 239 study participants (64.6%) reported a dental visit during the last year and 338 (91.4%) needed dental treatments. A higher level of education (adjusted prevalence ratio [aPR] = 1.21, 95% confidence interval [CI]:1.04-1.40), pain or discomfort in teeth/mouth (aPR = 1.35, 95%CI: 1.13-1.62) and lower number of missing teeth (aPR = 0.99, 95%CI: 0.98-1.00) were associated with DSU. CONCLUSIONS Even though majority of early elderly needed dental treatments, only two-thirds visited a dentist during the last year. Predisposing and need-based factors were significant predictors of having a dental visit in the last year. A national oral health program for Lithuanian elderly with the focus on regular preventive dental check-ups is needed. More studies, both quantitative and qualitative, are warranted to investigate in depth the barriers for DSU among elderly in Lithuania.
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Affiliation(s)
- Sergei N Drachev
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway. .,Department of Prosthodontics, Northern State Medical University, Arkhangelsk, Russia.
| | - Alina Puriene
- Institute of Dentistry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jolanta Aleksejuniene
- Department of Preventive and Community Dentistry, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada
| | - Indre Stankeviciene
- Institute of Dentistry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lina Stangvaltaite-Mouhat
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.,Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway
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Santos ASF, Lima RFR, Ferreira RC, Alencar GP, Carreiro DL, Silveira MF, Trezena S, Martins AMEDBL. Use of oral health services among elderly Brazilians: mediation by tooth loss. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.22122021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.
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Bulgarelli AF, Dos Santos CM, Rech RS, Baumgarten A, Goulart BN. Tooth Loss Condition and Social Discrimination in Brazilian Healthcare Services. Int J Public Health 2021; 66:586597. [PMID: 34744559 PMCID: PMC8565290 DOI: 10.3389/ijph.2021.586597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: To explore factors associated with social discrimination against users of health services regarding dental aesthetic conditions. Methods: Based on a Brazilian National Survey, multivariate Poisson regressions with robust variance were used to explore the association of outcome discrimination related to different motivations in health services and exposure to sociodemographic and dental variables. Effect modification by complete prosthesis wearing was assessed. Results: Among the 60,200 people interviewed, 11.5% reported being discriminated against in health services. For women, a higher prevalence of discrimination was found among those in the age group of 30–44 years. For both sexes, discrimination was associated with black and brown skin color. Regarding dental characteristics, the higher the tooth loss was, the higher the prevalence of discrimination; however, complete prosthesis wearing presented as a protective factor. Social discrimination was the major motivation for reported discrimination and presented higher prevalence in edentulous individuals who did not wear prosthesis. Conclusion: Dental loss may lead to self-reported discrimination in health care services. The prevalence of discrimination increases when tooth loss increases, and the major reason associated is social discrimination.
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Affiliation(s)
- Alexandre F Bulgarelli
- Graduate Program in Collective Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila M Dos Santos
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela S Rech
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Baumgarten
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bárbara N Goulart
- Psychology Institute, Department of health and human communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Moreira RDS, Mauricio HDA, Monteiro IDS, Marques MMMDR. Use of dental services by the Brazilian elderly: latent class analysis. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210024. [PMID: 34076090 DOI: 10.1590/1980-549720210024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health. METHODS Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable "profile of dental service use" from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%. RESULTS Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile. CONCLUSION Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.
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Affiliation(s)
- Rafael da Silveira Moreira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz - Recife (PE), Brasil.,Faculdade de Medicina, Universidade Federal de Pernambuco - Recife (PE), Brasil
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Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052491. [PMID: 33802430 PMCID: PMC7967618 DOI: 10.3390/ijerph18052491] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023]
Abstract
Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.
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Macarevich Condessa A, Pilotto LM, Celeste RK, Hilgert JB. Use of dental services by disability status in Brazil in 2013. Community Dent Oral Epidemiol 2021; 49:471-477. [PMID: 33521999 DOI: 10.1111/cdoe.12623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the prevalence and factors associated with the use of oral health services in people with and without disabilities in Brazil. METHODS A cross-sectional study was used with the secondary data of 60,202 individuals from the Brazilian National Health Survey of 2013. The main exposure variable was 'Disability', and the main outcome was 'Dental service use'. Independent variables were selected using the modified Andersen and Davidson model, according to four groups: exogenous variables, primary determinants of oral health, health behaviours and oral health conditions. The analysis was based on a hierarchical approach stratified by 'disability (yes/no)', with multiple logistic regression incorporating sampling design. Interaction terms between the disability variable and covariates were tested in logistic regression models. RESULTS A total of 45.5% of the people without disabilities and 34.1% of those with disabilities visited the dentist in the last year. In the crude model, the nondisabled group used dental services more (OR = 1.61, 95%CI = 1.45-1.79), but the difference was no longer significant (OR = 1.18, 95%CI = 0.93-1.51) when adjusted by the health behaviour and oral health condition blocks. Determinants of dental use were similar among people with and without a disability. CONCLUSIONS No difference in dental service use according to disability status was found after adjusting for oral health conditions. Although edentulism is more prevalent among disabled people, they do not go to the dentist as regularly as nondisabled people. Health services should actively schedule maintenance visits to ensure that the needs of disabled individuals are fully addressed.
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Affiliation(s)
- Aline Macarevich Condessa
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciane Maria Pilotto
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Kim SY, Kim NH. Trends in Self-Rated Poor Oral Health Among all Age Populations in Korea from 2007 to 2015: Monitoring Expansion of Dental Insurance. Int Dent J 2021; 71:76-84. [PMID: 33616056 PMCID: PMC9275200 DOI: 10.1111/idj.12608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study explored trends in self-rated poor oral health (SRPOH) from 2007 to 2015 among all age groups to monitor changes after the expansion of dental insurance. METHODS Repeated cross-sectional data from 2007 to 2015 Korea National Health and Nutrition Examination Surveys were collected and analysed. The respondents (n = 20,199) were categorised into four age groups: 0-19, 20-44, 45-64, and ≥65 years. The outcome variable was SRPOH, with independent variables being socioeconomic factors, sex, household income, and education. The age-sex standardised prevalence rate was calculated to determine trends, and complex samples logistic regression analysis was performed to confirm the factors affecting SRPOH. RESULTS Self-rated poor oral health prevalence decreased significantly from 2007 to 2009 (25%) to 2013 to 2015 (14%) in the age groups of 0-19 and 20-44 years (P < 0.05), whereas the SRPOH prevalence in the age groups of 45-64 and ≥65 years did not undergo any significant changes. Although the prevalence decreased by 6% among older adults, over 40% older women still experienced SRPOH. A sex gap increased with age but did not change over time. SRPOH was strongly associated with sex, income, and education across all age groups; the association did not notably change from 2007 to 2015. CONCLUSIONS Self-rated poor oral health improved among younger people in Korea. The gender gap in the prevalence increased with age and persisted over time. However, income was the strongest determinant of SRPOH among all age groups, regardless of dental insurance expansion. Further studies should aim to draw causal inferences to explore the policy impact of dental insurance benefits.
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Affiliation(s)
- Song-Yi Kim
- Department of Dental Hygiene, The Graduate School, Yonsei University, Seoul, South Korea
| | - Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
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Soares GH, Ortiz-Rosa E, Alves CP, Paz D, An KS, Pereira AC, Biazevic MGH, Frias AC, Michel-Crosato E. Factors associated with utilisation of dental services by the elders from São Paulo, Brazil. Gerodontology 2020; 38:216-227. [PMID: 33354806 DOI: 10.1111/ger.12519] [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: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Population ageing in Brazil is rapid and is likely to place additional pressure over the Brazilian public health system. OBJECTIVE This study aims to examine the factors associated with utilisation of dental services in the previous year among a representative sample of older adults from São Paulo, Brazil. METHODS The sample included 5951 older adults who participated in the SBSP-15 study, an epidemiological survey conducted in 2015 in the State of São Paulo, Brazil. The outcome "utilisation of dental services" was defined as having visited a dentist in the previous year. Chi-square tests were employed in the bivariate analyses and Poisson regressions with robust variance in the multilevel analysis. RESULTS Only 30.5% of the participants had their last dental appointment within the previous year. Number of teeth and dental pain presented the strongest effects on the investigated outcome. Education, income, age, ethnicity, living alone, higher Family Health Strategy coverage and the Metropolitan area were associated with having visited a dentist in the previous year. Older adults who rated their oral health as positive did not report treatment need nor prosthodontic need, presented negative oral health-related quality of life, had their last dental appointment in the public health system and sought treatment due to pain or extraction also were more likely to report the utilisation of dental services in the previous year. CONCLUSION Regional, sociodemographic and subjective factors are associated with utilisation of dental services in the previous year among the elders from the State of São Paulo, Brazil.
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Affiliation(s)
- Gustavo Hermes Soares
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Ezequiel Ortiz-Rosa
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Caroline Paula Alves
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | | | - Ki Sung An
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Pereira
- Community Dentistry Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Maria Gabriela Haye Biazevic
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Antônio Carlos Frias
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
| | - Edgard Michel-Crosato
- Forensic Dentistry and Community Health Department, Dentistry School, University of São Paulo, São Paulo, Brazil
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Kim HN, Han SJ, Jun EJ, Kim JB. Factors Related to Oral Healthcare Service Utilization among Korean Adults Aged 25-79 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176032. [PMID: 32825072 PMCID: PMC7504307 DOI: 10.3390/ijerph17176032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022]
Abstract
The factors related to oral healthcare service utilization (OHSU) among Korean adults aged 25-79 years were assessed using the Andersen model with the sixth Korean National Health and Nutrition Examination Survey data. The study included 12,937 participants aged 25-79 years who answered questions on the predisposing, enabling, and need factors related to OHSU at dental clinics within the past 1 year. Age, sex, and education level were selected as predisposing factors; household income, residence region, and national and private health insurance status as enabling factors; and self-perceived oral health, dental pain, chewing status, and discomfort while speaking as need factors. These factors were assessed using multivariable complex logistic regression models. OHSU at dental clinics within the past 1 year was lower among less-educated participants, those with low, middle-low, and middle-high household income levels, rural participants, those benefiting from the Medicaid system, and non-insured participants. OHSU was higher among older participants, those who rated their self-perceived oral health status as bad, those with experience of dental pain, and those who experienced discomfort while chewing and speaking. The need factors were the most influential. Thus, interventions to reduce inequalities in OHSU are required to promote oral health for all.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea;
| | - Sang-Jun Han
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (S.-J.H.); (E.-J.J.)
| | - Eun-Joo Jun
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (S.-J.H.); (E.-J.J.)
| | - Jin-Bom Kim
- Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, Yangsan 50612, Korea; (S.-J.H.); (E.-J.J.)
- Dental and Life Science Institute, Pusan National University, Yangsan 50612, Korea
- Correspondence: ; Tel.: +85-51-510-8223; Fax: +82-51-510-8221
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Tôrres LHDN, De Marchi RJ, Hilgert JB, Hugo FN, Ismail AI, Antunes JLF, Sousa MDLRD. Oral health and Obesity in Brazilian elders: A longitudinal study. Community Dent Oral Epidemiol 2020; 48:540-548. [PMID: 32786084 DOI: 10.1111/cdoe.12566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 07/01/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Obesity is an important risk factor for chronic diseases and can also result in greater mortality. The aim of this longitudinal study was to investigate whether poor oral health acts as a risk factor for obesity as indicated by body mass index (BMI) and waist circumference (WC). METHODS We included in this analysis all participants who volunteered in a cohort study entitled 'Carlos Barbosa Cohort Study-CBCS' in the city of Carlos Barbosa, Southern Brazil. The interview questionnaire comprised socio-demographic information, behavioural questions and medical history. Oral examinations and anthropometric assessments were carried out. The outcome was obesity measured by both BMI (≥30 kg/m2 ) and WC (>0.80 for women and >0.94 for men). Variables were collected longitudinally. Those associated with the outcome and epidemiologically relevant to the conceptual framework participated in the analysis and were adjusted for socio-demographic, behavioural, general and oral health conditions. RESULTS Six hundred and thirty-three independently living elders participated. The baseline mean age was 67.5 ± 6.1 years. Individuals who never visited a dentist (OR = 3.02, 95% CI: 1.25-7.26) as well as participants who needed a dental prosthesis in the lower arch (OR = 4.38, 95% CI: 1.34-14.32) were more likely to be obese, through BMI and WC measures, respectively. Edentulous participants with complete dentures in both arches (OR = 0.23, 95% CI: 0.06-0.84) and those who perceived their oral health as unsatisfactory (OR = 0.41, 95% CI: 0.19-0.88) had a lower likelihood of being obese, according to BMI and WC measures. CONCLUSIONS Older persons with poor oral health may be at risk for general and central obesity, a relationship that may have important clinical implications.
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Affiliation(s)
| | - Renato José De Marchi
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Neves Hugo
- Department of Social and Preventive Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Amid Ibrahim Ismail
- Department of Oral Health Sciences, Maurice H Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | | | - Maria da Luz Rosário de Sousa
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Herkrath FJ, Vettore MV, Werneck GL. Utilisation of dental services by Brazilian adults in rural and urban areas: a multi-group structural equation analysis using the Andersen behavioural model. BMC Public Health 2020; 20:953. [PMID: 32552777 PMCID: PMC7301519 DOI: 10.1186/s12889-020-09100-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 06/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas. Methods Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household’s crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas. Results Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = − 0.36, β = − 0.16, β = − 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = − 0.12, respectively). The enabling financing (non-utilisation, βrural = − 0.02 [95%CI: − 0.03 to − 0.02], βurban = 0.00 [95%CI: − 0.01 to 0.00]) and PHC registration (non-utilisation, βrural = − 0.03 [95%CI: − 0.04 to − 0.02], βurban = − 0.01 [95%CI, − 0.01 to − 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = − 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, βrural = − 0.07, βurban = − 0.04; interval since last dental visit, βrural = − 0.07, βurban = − 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (βrural = 0.26, βurban = 0.17). Conclusion Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.
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Affiliation(s)
- Fernando José Herkrath
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus, Amazonas, 69065-001, Brazil. .,Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil. .,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524, Maracanã, Bloco D, 7° andar - UERJ, Rio de Janeiro, Rio de Janeiro, 20550-013, Brazil.
| | - Mario Vianna Vettore
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier, 524, Maracanã, Bloco D, 7° andar - UERJ, Rio de Janeiro, Rio de Janeiro, 20550-013, Brazil.,Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Avenida Horácio Macedo, S/N, Ilha do Fundão, Cidade Universitária, Rio de Janeiro, Rio de Janeiro, 21941-598, Brazil
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Chamut S, Boroumand S, Iafolla TJ, Adesanya M, Fazio EM, Dye BA. Self-Reported Dental Visits Among Older Adults Receiving Home- and Community-Based Services. J Appl Gerontol 2020; 40:902-913. [PMID: 32525439 DOI: 10.1177/0733464820925320] [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: 11/16/2022] Open
Abstract
Objective: To investigate factors associated with infrequent dental use among older adults receiving home- and community-based services. Method: This cross-sectional study analyzed responses from the 2014 National Survey of Older Americans Act participants who received home- and community-based services. Descriptive and multivariable analyses were conducted to examine the association between infrequent dental use and key sociodemographic and health indicators. Results: Infrequent dental use was highest among adults participating in case management and home-delivered meals (63%); the lowest among those participating in congregate meals (41%). Participants who did not complete high school were 2 to 5 times more likely to be infrequent dental users compared to those with educational attainment beyond high school. Discussion: Among older adults receiving home- and community-based services, improving oral health knowledge and health literacy may reduce infrequent dental use.
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Affiliation(s)
| | - Shahdokht Boroumand
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Timothy J Iafolla
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Margo Adesanya
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
| | - Elena M Fazio
- National Institutes of Health, National Institute on Aging, Bethesda, MD, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research (NIH/NIDCR), Bethesda, MD, USA
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Rostam Beigi M, Shamshiri AR, Asadi-Lari M, Hessari H, Jafari A. A crossectional investigation of the relationship between complementary health insurance and frequency of dental visits in 15 to 64 years old of Tehran population, Iran, a secondary data analysis (urban HEART-2). BMC Health Serv Res 2019; 19:678. [PMID: 31533819 PMCID: PMC6751603 DOI: 10.1186/s12913-019-4526-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. Methods The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. Results The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. Conclusion Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.
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Affiliation(s)
- Morteza Rostam Beigi
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Hessari
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jafari
- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. .,Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Sória GS, Nunes BP, Bavaresco CS, Vieira LS, Facchini LA. Acesso e utilização dos serviços de saúde bucal por idosos de Pelotas, Rio Grande do Sul, Brasil. CAD SAUDE PUBLICA 2019; 35:e00191718. [DOI: 10.1590/0102-311x00191718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/11/2019] [Indexed: 11/21/2022] Open
Abstract
Resumo: O objetivo foi medir a falta de acesso e a utilização dos serviços de saúde bucal por idosos de Pelotas, Rio Grande do Sul, Brasil. Estudo transversal de base populacional foi realizado no ano de 2014, na zona urbana do município, incluindo indivíduos com 60 anos e mais. Variáveis sociodemográficas e de necessidade autorreferidas foram associadas aos desfechos. Utilizou-se regressão de Poisson para as análises bruta e ajustada. Foram entrevistados 1.451 idosos mediante um questionário estruturado. Falta de acesso no último ano alcançou uma prevalência de 1,8% (IC95%: 0,7-3,0). Idosos que nunca consultaram somaram 3,1% (IC95%: 2,2-4,0) e a utilização de serviços de saúde bucal no último ano registrou prevalência de 38,3% (IC95%: 36,0-41,0). A utilização no último ano apresentou associação positiva com as seguintes variáveis: faixa etária mais jovem (RP = 1,16), ter companheiro (RP = 1,28), alta escolaridade (RP = 1,31), problema na boca ou nos dentes (RP = 1,93), necessidade de prótese dentária (RP = 1,36) e ser edêntulo (RP = 3,11). A falta de acesso no último ano foi baixa. A utilização de serviços de saúde bucal foi mais alta do que a observada em outros estudos. Os achados parecem refletir a expansão desses serviços, particularmente na rede pública, sendo úteis para as ações de planejamento das políticas de saúde.
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Herkrath FJ, Vettore MV, Werneck GL. Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis. PLoS One 2018; 13:e0192771. [PMID: 29420660 PMCID: PMC5805334 DOI: 10.1371/journal.pone.0192771] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.
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Affiliation(s)
- Fernando José Herkrath
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- * E-mail:
| | - Mario Vianna Vettore
- Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - Guilherme Loureiro Werneck
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Brzoska P, Erdsiek F, Waury D. Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany. Front Public Health 2017; 5:201. [PMID: 28856132 PMCID: PMC5557791 DOI: 10.3389/fpubh.2017.00201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Patrick Brzoska
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
| | - Fabian Erdsiek
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
| | - Dorothee Waury
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
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