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Duvvuri VR, Abdelrehim M, Singhal S. Socio-demographic predictors of not having private dental insurance coverage: machine-learning algorithms may help identify the disadvantaged. BMC Public Health 2024; 24:1386. [PMID: 38783219 PMCID: PMC11112852 DOI: 10.1186/s12889-024-18868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND For accessing dental care in Canada, approximately 62% of the population has employment-based insurance, 6% have some publicly funded coverage, and 32% have to pay out-of pocket. Those with no insurance or public coverage find dental care more unaffordable compared to those with private insurance. To support the development of more comprehensive publicly funded dental care programs, it is important to understand the socio-demographic attributes of all those, who find dental care unaffordable. METHODS This study is a secondary analysis of the data collected from Ontarians during the latest available cycle of the Canadian Community Health Survey (2017-18), a cross-sectional survey that collects information on health status, health care utilization, and health determinants for the Canadian population. First, bivariate analysis was conducted to determine the characteristics of Ontarians who lack dental insurance. Afterwards, we employed machine learning (ML) to analyze data and identify risk indicators for not having private dental insurance. Specifically, we trained several supervised ML models and utilized Shapley additive explanations (SHAP) to determine the relative feature importance for not having private dental insurance from the best ML model [the gradient boosting (GBM)]. RESULTS Approximately one-third of Ontarians do not have private insurance coverage for dental care. Individuals with an income below $20,000, those unemployed or working part-time, seniors aged above 70, and those unable to afford to have their own housing are more at risk of not having private dental insurance, leading to financial barriers in accessing dental care. CONCLUSION In the future, government-funded programs can incorporate these identified risk indicators when determining eligible populations for publicly funded dental programs. Understanding these attributes is critical for developing targeted and effective interventions, ensuring equitable access to dental care for Canadians.
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Affiliation(s)
- Venkata R Duvvuri
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mona Abdelrehim
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
| | - Sonica Singhal
- Public Health Ontario, Toronto, ON, Canada
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Tahani B, Baghban AA, Kazemian A. Determinants of oral health status: an ecological study in Iran. BMC Oral Health 2023; 23:910. [PMID: 37993816 PMCID: PMC10666374 DOI: 10.1186/s12903-023-03557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES The aim of this ecological study was to assess the association between behavioral, social position, circumstance factors, and caries experience in 35- to 44-year-old adults in Iran at a provincial level. MATERIALS AND METHODS The data from the 2011 Iranian Oral Health Survey were obtained from all 31 provinces across Iran on the population level. Oral health status was measured as the number of decayed, missing (MT), and filled (FT) teeth and the percentage of the population who were edentulous. Data were also gathered from each province on the percentage of smokers (Non-Communicable Diseases Risk Factors Surveillance Provincial Report 2009), per capita consumption of free sugars, concentration of fluoride in the drinking water (National and Sub-national Burden of Disease (NASBOD) Survey), number of dentists per 10,000 people, mean years of schooling of adults, expected years of schooling of children, life expectancy at birth and Gross National Income (Integrated Public Use Microdata Series, Global Data Lab). The data were analyzed using simple and multiple linear regression (α = 0.05). RESULTS Mean DMFT was positively associated with the percentage of smokers (B = 0.01 95%CI 0.01-0.14), and negatively with fluoride concentration (B =-2.6 95%CI -4.3- -0.96). The edentulousness percentage was positively associated with smoking (B = 0.2 (with 95%CI: 0.07-0.37) and negatively with mean years of education (B =-1.08 (with 95%CI: -2.04- -0.12). DT was associated with expected years of schooling (B =-0.6 (with 95%CI: -1.07- -0.17), negatively. Mt was negatively associated with life expectancy (B =-0.5 (with 95%CI: -1.1- -0.007), fluoride concentration (B =-3.4 (with 95%CI: -4.5- -1.5) and number of dentists per 10,000 people (B =-0.4 (with 95%CI: -0.8- -0.01). Mean Years of Schooling (B = 0.5 (with 95%CI: 0.2-0.8) and number of dentists per 10,000 people (B =-0.62 (with 95%CI: 0.51 - 0.48) were positively in associated with FT. CONCLUSIONS The present findings indicate that there were differences in the oral health measures and their social determinants among the provinces of Iran. Regarding the limitations of the study especially the limitation of the number of independent variables, it seems, this discrepancy could be better explained by social variables of the provinces such as income than by environmental factors.
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Affiliation(s)
- Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, Dental Research Institute, Dental School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kazemian
- Department of Community Oral Health, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
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Han DH, Kang HY, Ryu JI. The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study. BMC Oral Health 2023; 23:807. [PMID: 37891584 PMCID: PMC10612205 DOI: 10.1186/s12903-023-03387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship. METHODS This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA). RESULTS The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency. CONCLUSIONS Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.
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Affiliation(s)
- Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hee-Yeon Kang
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea
| | - Jae-In Ryu
- Department of Preventive and Social Dentistry, Kyung Hee University College of Dentistry, Seoul, Republic of Korea.
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Cheung A, Singhal S. Towards equitable dental care in Canada: Lessons from the inception of Medicare. Int J Health Plann Manage 2023; 38:1127-1134. [PMID: 37430413 DOI: 10.1002/hpm.3680] [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] [Received: 12/22/2022] [Revised: 04/19/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
Dental care in Canada is primarily financed through private insurance plans and out-of-pocket payments. While Canada is internationally recognized for Medicare, a publicly-funded health insurance system that covers hospital and physician-provided services at the point of care, it remains one of the least equitable Organization for Economic Co-operation and Development countries in terms of affordable access to dental care. Approximately one third of Canadians do not have access to dental insurance, including half of low-income individuals, and individuals with the greatest dental care needs are often unable to reliably access dental services. Select populations-such as children, Indigenous peoples, seniors, and persons living with disabilities-receive some level of publicly-funded dental services, amounting to approximately 6% of total dental spending nationwide. Despite the evolution of Medicare, dental care has been largely excluded from federal health legislation following World War II. However, in March 2022, the Liberal Party of Canada partnered with the federal New Democratic Party to advance common legislative goals, including a long-term nationwide dental program for low- and middle-income families. As an interim measure, Bill C-31 was signed into law on 17 November 2022, and created the Canada Dental Benefit, which provides a fixed transfer payment to individuals with an annual household income under $90,000. This commentary reviews the origins of Canadian Medicare, discusses the factors that led to the continued exclusion of dental care from federal health legislation, examines the newly-minted Canada Dental Benefit, and explores the potential for expanded public funding in Canadian dental care.
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Affiliation(s)
- Anson Cheung
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonica Singhal
- Department of Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Abdelrehim M, Ravaghi V, Quiñonez C, Singhal S. Trends in self-reported cost barriers to dental care in Ontario. PLoS One 2023; 18:e0280370. [PMID: 37418457 PMCID: PMC10328358 DOI: 10.1371/journal.pone.0280370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The affordability of dental care continues to receive attention in Canada. Since most dental care is privately financed, the use of dental care is largely influenced by insurance coverage and the ability to pay-out-of pocket. OBJECTIVES i) to explore trends in self-reported cost barriers to dental care in Ontario; ii) to assess trends in the socio-demographic characteristics of Ontarians reporting cost barriers to dental care; and iii) to identify the trend in what attributes predicts reporting cost barriers to dental care in Ontario. METHODS A secondary data analysis of five cycles (2003, 2005, 2009-10, 2013-14 and 2017-18) of the Canadian Community Health Survey (CCHS) was undertaken. The CCHS is a cross-sectional survey that collects information related to health status, health care utilization, and health determinants for the Canadian population. Univariate and bivariate analyses were conducted to determine the characteristics of Ontarians who reported cost barriers to dental care. Poisson regression was used to calculate unadjusted and adjusted prevalence ratios to determine the predictors of reporting a cost barrier to dental care. RESULTS In 2014, 34% of Ontarians avoided visiting a dental professional in the past three years due to cost, up from 22% in 2003. Having no insurance was the strongest predictor for reporting cost barriers to dental care, followed by being 20-39 years of age and having a lower income. CONCLUSION Self-reported cost barriers to dental care have generally increased in Ontario but more so for those with no insurance, low income, and aged 20-39 years.
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Affiliation(s)
- Mona Abdelrehim
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | - Carlos Quiñonez
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Kim NH, Elani HW, Kawachi I. Did Dental Insurance Expansion Improve Dental Care Needs Among Korean Adults? Difference in Difference Analysis. J Epidemiol 2023; 33:101-108. [PMID: 34121050 PMCID: PMC9794449 DOI: 10.2188/jea.je20200596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, focusing on low-income older adults. METHODS We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016-2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group. RESULTS Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing [4.0 percentage points, 95% CI: 0.2 to 7.9] and dental implants [5.0 percentage points, 95% CI: 2.1 to 7.9]; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, -35.0 to -8.5; P < 0.01). CONCLUSION Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.
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Affiliation(s)
- Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic of Korea
| | - Hawazin W. Elani
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Cavalcanti RP, da Silva RO, Martelli PJDL, Sobrinho JEDL, Pucca Júnior GA, da Silveira Gaspar G, de Lucena EHG. Factors associated with the waiting time for access to specialized oral healthcare services in Brazil. Community Dent Oral Epidemiol 2021; 50:58-66. [PMID: 34967971 DOI: 10.1111/cdoe.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the factors associated with the waiting time for access to specialized care at Dental Specialties Centers (CEO, in Portuguese), by specialty (Stomatology, Surgery, Endodontics, Patients with Special Needs and Periodontology). METHODS The study was a descriptive and analytic exploratory secondary analysis of data from the 2nd phase of the National Program for Improving the Access to and Quality of CEO (PMAQ-CEO, in Portuguese). All 1097 CEO in Brazil were evaluated in loco in 2018. Binary logistic regression was used to analyse the likelihood of users having a shorter time for assistance at CEO, by specialty. RESULTS The highest and lowest median waiting times were found for endodontics (30 days) and stomatology (5 days), respectively. Smaller centres (type I CEO) had a shorter waiting list for patients with special needs (95%CI: 1.20-3.37), Endodontics (95%CI: 1.03-3.02) and Surgery (95%CI: 1.04-3.05). As for the specialties with the longest waiting list (Endodontics and Surgery), the direct route of user access to CEO was more effective than that regulated by the Healthcare System. CONCLUSIONS Factors related to the service, management, and to the form of relationship with primary health care influenced the waiting time for specialized care in CEO. The contact between professionals in the oral health network (primary care and secondary) was associated with a shorter waiting time, regardless of the specialty.
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Jo O, Kruger E, Tennant M. GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK? Br Dent J 2021:10.1038/s41415-021-3406-0. [PMID: 34552210 DOI: 10.1038/s41415-021-3406-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Olivia Jo
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia.
| | - Estie Kruger
- Department of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth, 6009, Australia; International Research Collaborative Oral Health and Equity, University of Western Australia, Crawley, 6009, Australia
| | - Marc Tennant
- Department of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth, 6009, Australia; International Research Collaborative Oral Health and Equity, University of Western Australia, Crawley, 6009, Australia
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Wallace B, Rea K. Enhancing equity-oriented care in psychedelic medicine: Utilizing the EQUIP framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103429. [PMID: 34461409 DOI: 10.1016/j.drugpo.2021.103429] [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: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.
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Affiliation(s)
- Bruce Wallace
- UVIC School of Social Work, Scientist, Canadian Institute for Substance Use Research (CISUR), University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Kerri Rea
- University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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Nurelhuda NM, Keboa MT, Lawrence HP, Nicolau B, Macdonald ME. Advancing Our Understanding of Dental Care Pathways of Refugees and Asylum Seekers in Canada: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168874. [PMID: 34444623 PMCID: PMC8395044 DOI: 10.3390/ijerph18168874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022]
Abstract
The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada’s Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP’s benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.
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Affiliation(s)
- Nazik M. Nurelhuda
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada; (N.M.N.); (H.P.L.)
| | - Mark T. Keboa
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
| | - Herenia P. Lawrence
- Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, ON M5G 1G6, Canada; (N.M.N.); (H.P.L.)
| | - Belinda Nicolau
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
| | - Mary Ellen Macdonald
- Faculty of Dentistry, 500-2001 McGill College, McGill University, Montréal, QC H3A 1G1, Canada; (M.T.K.); (B.N.)
- Correspondence:
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Woldemichael A, Rezaei S, Kazemi Karyani A, Ebrahimi M, Soltani S, Aghaei A. The impact of out-of pocket payments of households for dental healthcare services on catastrophic healthcare expenditure in Iran. BMC Public Health 2021; 21:1474. [PMID: 34320939 PMCID: PMC8320192 DOI: 10.1186/s12889-021-11209-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 06/04/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Dental healthcare is the costliest and single most source of the financial barrier to seeking and use of needed healthcare. Hence, this study aims to analyses impact of out-of-pocket (OOP) payments for dental services on prevalence catastrophic healthcare expenditure (CHE) among Iranian households during 2018. METHODS We performed a cross-sectional analysis to determine the prevalence rate of CHE due to use of dental healthcare services among 38,858 Iranian households using the 2018 Household Income and Expenditure Survey (HIES) survey data of Iran. The WHO approach was used to determine the CHE due to use of dental care services at the 40% of household capacity to pay (CTP). Multiple logistic regression models were used to obtain the odds of facing with CHE among households that paid for any dental healthcare services over the last month while adjusting for covariates included in the model. These findings were reported for urban, rural areas and also for low, middle and high human development index HDI across provinces. RESULTS The study indicated that the prevalence of CHE among households that used and did not used dental services over the last month was 16.5% (95% CI: 14.9 to 18.3) and 4.3% (95% CI: 4.1 to 4.6), respectively. The adjusted odds ratio (AOR) for the covariates revealed that the prevalence of CHE for the overall households that used dental healthcare service was 6.2 times (95% CI: 5.4 to 7.1) than those that did not use dental healthcare services. The urban households that used dental healthcare had 7.8 times (95%CI: 6.4-9.4) while the rural ones had 4.7 times (95% CI: 3.7-5.7) higher odds of facing CHE than the corresponding households that did not use dental healthcare services. CONCLUSIONS The study indicates that out-of-pocket costs for dental care services impose a substantial financial burden on household's budgets at the national and subnational levels. Alternative health care financing strategies and policies targeted to the reduction in CHE in general and CHE due to dental services in particular are urgently required in low and middle income countries such as Iran.
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Affiliation(s)
- Abraha Woldemichael
- Department of Health Systems, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ebrahimi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abbas Aghaei
- Cancer and Immunology Research Center, Research Center for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Did Expanded Dental Insurance Reduce Out-of-Pocket Expenditures on Dental Care among Older Adults in Korea? Interrupted Time-Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063003. [PMID: 33804211 PMCID: PMC7999161 DOI: 10.3390/ijerph18063003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/17/2022]
Abstract
The Korean National Health Insurance extended its coverage to reduce the economic burden of receiving dentures and implants for older adults in 2012 and 2014, respectively. We examined whether the new policy resulted in reduced out-of-pocket dental care expenditure in the eligible population, specifically focusing on low-income adults. We used interrupted time-series analysis (ITSA), a quasi-experimental design, to identify the effects of the policy among persons aged 65 or older. Data were extracted from the Korea Health Panel Survey (KHP; 2008–2017). The main outcome was out-of-pocket expenditures on dental care. The ITSA showed that expenditures decreased annually by 4.5% (RR: 0.96, 95% CI: 0.95–0.96) between 2012 and 2014. However, expenditure increased by 7.8% (RR: 1.08, 95% CI: 1.07–1.08) after 2014. Dental insurance coverage did not contribute to reducing the out-of-pocket expenses for dentures among low-income adults, while coverage of dental implants led to an increase in dental expenditure.
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Agudelo-Suárez AA, Muñoz-Pino N, Vivares-Builes AM, Ronda-Pérez E. Oral Health and Oral Health Service Utilization in Native and Immigrant Population: A Cross-Sectional Analysis from the PELFI Cohort in Spain. J Immigr Minor Health 2021; 22:484-493. [PMID: 31919785 DOI: 10.1007/s10903-020-00972-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study analyzes associated factors to self-perceived oral health and use of oral health services in native and immigrant adults from the PELFI cohort in Spain. A cross-sectional analysis was conducted (401 adults ≥ 18 years, from Spain, Ecuador, Colombia and Morocco). Frequencies for sociodemographic, self-perceived general and oral health variables were calculated. The association between oral health/oral health services use and origin country was estimated by logistic regression (adjusted odds ratio-aOR-; 95% confidence intervals -95%CI-). Ecuadorian men were more likely to report dental caries (aPR 2.75; 95%CI 1.30-5.80) and Moroccan women were more likely to report gingival bleeding (aPR 3.61; 95%CI 1.83-7.15) and the use of oral health services ≥ 1 year/never (aPR 1.69; 95%CI 1.06-2.69). Colombian women were less likely to report missing teeth (aPR 0.73; 95%CI 0.56-0.95). Poor self-perceived oral health indicators were observed in immigrants and were modified for sociodemographic and general health variables.
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Affiliation(s)
- Andrés A Agudelo-Suárez
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia. .,Public Health Research Group, University of Alicante, Alicante, Spain.
| | - Natalia Muñoz-Pino
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Annie M Vivares-Builes
- Faculty of Dentistry, University of Antioquia, Calle 70 N° 52-21, 05010, Medellín, Antioquia, Colombia
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, Alicante, Spain.,Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
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14
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Dentistry's social contract is at risk. J Am Dent Assoc 2020; 151:334-339. [PMID: 32336345 DOI: 10.1016/j.adaj.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/29/2019] [Accepted: 01/22/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The implications of the social contract for medicine and those it serves has been debated by bioethicists, political scientists, and physicians. Far less attention, however, has been given to dentistry's social contract. METHODS The existing literature from medicine is used to explore the social contract and the role of dentistry in today's society, focusing on several areas of interest. RESULTS The authors' analysis discusses the history of the social contract and its implications for professionalism. The authors examine the failure of the dental profession to adequately address population needs and inequities in oral health, situating this in the context of an increasingly commodified, commercialized, cosmetically oriented, and proprietary culture in the profession. The authors highlight the important role of organized dentistry in facilitating change and renewing the social contract. CONCLUSIONS The authors conclude that reforms are necessary for dentistry to remain a profession. PRACTICAL IMPLICATIONS The authors' findings may inform oral health policies and underscore the need for change among dental providers and organized dentistry to maintain dentistry's professional status.
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Ravaghi V, Farmer J, Quiñonez C. Persistent but narrowing oral health care inequalities in Canada from 2001 through 2016. J Am Dent Assoc 2020; 151:349-357.e1. [PMID: 32220345 DOI: 10.1016/j.adaj.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Similar to the United States, inequality in oral health care use is longstanding in Canada. It remains unclear whether this inequality is improving or worsening. In this study, the authors report on income-related inequality in dental visits in Canada and across its provinces over time and interprovincial inequality in dental visits among Canadian provinces. METHODS The authors used 7 nationally representative health surveys of the Canadian population and collected data from 2001 through 2016. The magnitude of income-related inequality was measured using the slope index of inequality and relative index of inequality. Interprovincial inequality was examined using a number of indexes including the Theil index. RESULTS Income-related inequality in dental visits was present in all survey years, with people in higher income groups reporting higher dental visit prevalence rates. However, results from the slope index of inequality and relative index of inequality showed a steady decline, meaning there was a decrease in the magnitude of inequality over time. Absolute and relative inequality decreased by 7.2% and 22.9% from 2000 through 2016, respectively. A similar decline was observed across most Canadian provinces. Interprovincial differences in dental visits also decreased over time. CONCLUSIONS There appears to be persistent but narrowing income-related inequality in dental visits in Canada and across its provinces over time. In addition, it appears that Canadian provinces are becoming more equal in terms of dental services use. PRACTICAL IMPLICATIONS Narrowing income-related inequality in dental visits in Canada is promising, suggesting a more equal distribution of dental visits. However, unequal use of dental services remains an issue affecting the Canadian population.
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Zivkovic N, Aldossri M, Gomaa N, Farmer JW, Singhal S, Quiñonez C, Ravaghi V. Providing dental insurance can positively impact oral health outcomes in Ontario. BMC Health Serv Res 2020; 20:124. [PMID: 32066434 PMCID: PMC7027064 DOI: 10.1186/s12913-020-4967-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Universal coverage for dental care is a topical policy debate across Canada, but the impact of dental insurance on improving oral health-related outcomes remains empirically unexplored in this population. Methods We used data on individuals 12 years of age and older from the Canadian Community Health Survey 2013–2014 to estimate the marginal effects (ME) of having dental insurance in Ontario, Canada’s most populated province (n = 42,553 representing 11,682,112 Ontarians). ME were derived from multi-variable logistic regression models for dental visiting behaviour and oral health status outcomes. We also investigated the ME of insurance across income, education and age subgroups. Results Having dental insurance increased the proportion of participants who visited the dentist in the past year (56.6 to 79.4%, ME: 22.8, 95% confidence interval (CI): 20.9–24.7) and who reported very good or excellent oral health (48.3 to 57.9%, ME: 9.6, 95%CI: 7.6–11.5). Compared to the highest income group, having dental insurance had a greater ME for the lowest income groups for dental visiting behaviour: dental visit in the past 12 months (ME highest: 17.9; 95% CI: 15.9–19.8 vs. ME lowest: 27.2; 95% CI: 25.0–29.3) and visiting a dentist only for emergencies (ME highest: -11.5; 95% CI: − 13.2 to − 9.9 vs. ME lowest: -27.2; 95% CI: − 29.5 to − 24.8). Conclusions Findings suggest that dental insurance is associated with improved dental visiting behaviours and oral health status outcomes. Policymakers could consider universal dental coverage as a means to support financially vulnerable populations and to reduce oral health disparities between the rich and the poor.
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Affiliation(s)
- Nevena Zivkovic
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada.
| | - Musfer Aldossri
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Noha Gomaa
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Julie W Farmer
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carlos Quiñonez
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, England
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17
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Kim NH, Kawachi I. Did the Expansion of Insurance Coverage for Oral Health Reduce Self-reported Oral Health Inequalities in Korea? Results of Repeated Cross-Sectional Analysis, 2007-2015. J Epidemiol 2019; 30:537-541. [PMID: 31813892 PMCID: PMC7661332 DOI: 10.2188/jea.je20190119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2009, the South Korean government expanded universal health insurance to include oral health services. In the present study, we sought to examine whether improved access resulted in a reduction in income-based self-reported oral health inequalities. METHODS We analyzed repeated cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) waves IV through VI (2007-2015). We analyzed self-reported oral health status among 68,431 subjects. Changes in oral health inequalities across four income levels (low, middle-low, middle-high, and high) were assessed with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS The average oral health status of children and adolescents improved the most over the observation period. The absolute magnitude of oral health inequalities (measured by the SII) improved for most groups, with the notable exception of young male adults. By contrast, the ratio of poor oral health between high- and low-income groups (measured by the RII) changed little over time, indicating that relative inequalities remained resistant to change. CONCLUSIONS The expansion of dental health insurance may not be sufficient to move the needle on self-reported oral health inequalities among adults.
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Affiliation(s)
- Nam-Hee Kim
- Department of Dental Hygiene, Wonju College of Medicine, Yonsei University.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
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18
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Lino PA, Sohn W, Singhal A, Martins MAP, Silva MEDSE, Abreu MHNGD. A national study on the use of opioid analgesics in dentistry. Braz Oral Res 2019; 33:e076. [PMID: 31432927 DOI: 10.1590/1807-3107bor-2019.vol33.0076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.
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Affiliation(s)
- Patrícia Azevedo Lino
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Community and Preventive Dentistry, Belo Horizonte, MG, Brazil
| | - Woosung Sohn
- The University of Sidney, School of Medicine, Sidney, New South Wales, Australia
| | - Astha Singhal
- Boston University, Henry M. Goldman School of Dental Medicine , Department of Health Policy & Health Services Research, Boston, Massachusetts, USA
| | | | - Maria Elisa de Souza E Silva
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Operative Dentistry, Belo Horizonte, MG, Brazil
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19
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Affiliation(s)
- Jamie Moeller
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Carlos Quiñonez
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
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20
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Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, Weyant RJ, Mathur MR, Guarnizo-Herreño CC, Celeste RK, Peres MA, Kearns C, Benzian H. Ending the neglect of global oral health: time for radical action. Lancet 2019; 394:261-272. [PMID: 31327370 DOI: 10.1016/s0140-6736(19)31133-x] [Citation(s) in RCA: 394] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 12/13/2022]
Abstract
Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.
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Affiliation(s)
- Richard G Watt
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Blánaid Daly
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Paul Allison
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Lorna M D Macpherson
- Department of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Renato Venturelli
- WHO Collaborating Centre in Oral Health Inequalities and Public Health, Department of Epidemiology and Public Health, University College London, London, UK
| | - Stefan Listl
- Quality and Safety of Oral Healthcare, Department of Dentistry, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Section for Translational Health Economics, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Robert J Weyant
- Department of Dental Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Carol C Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco A Peres
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, QLD, Australia
| | - Cristin Kearns
- Department of Preventive and Restorative Dental Sciences and Philip R Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Habib Benzian
- WHO Collaborating Centre for Quality-Improvement, Evidence-Based Dentistry, Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA; New York University College of Global Public Health, New York, NY, USA
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21
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Dehmoobadsharifabadi A, Singhal S, Quiñonez CR. Impact of public dental care spending and insurance coverage on utilization disparities among Canadian jurisdictions. J Public Health Dent 2018; 78:346-351. [DOI: 10.1111/jphd.12283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/01/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sonica Singhal
- Dental Public Health, Faculty of Dentistry; University of Toronto; Toronto ON Canada
- Public Health Ontario; Toronto ON Canada
| | - Carlos R. Quiñonez
- Dental Public Health, Faculty of Dentistry; University of Toronto; Toronto ON Canada
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