Does public transportation improve the accessibility of primary dental care in São Paulo, Brazil?

Objectives Income inequalities in access to dental care have been reported worldwide. While geographical accessibility may affect inequalities, no study has examined whether the use of public transportation reduces income inequalities in access to dental care. Therefore, we examined whether the use of public transportation is associated with reduced income inequalities in access to dental care. Methods This cross‐sectional study used data from the Japan Gerontological Evaluation Study conducted in 2016. Self‐reported questionnaires were distributed to 34 567 community‐dwelling independent older adults aged 65 years or over from 39 municipalities. The dependent variable was dental attendance for any treatment. The independent variables were daily public transportation use and household equivalent income. The covariates were age, years of education, marital status, self‐rated health, number of teeth, car use, having bus stops or railway stations nearby for individual level and density of dental clinics for community level. After multiple imputation, a two‐level linear regression analysis was performed and stratified by sex. Results The mean age of the 19 664 participants (response rate: 69.9%) was 73.8 years (standard deviation = 6.1). Among the participants with dental attendance for treatment in the past six months, daily public transportation users represented 45.5% of men and 56.1% of women. These users had higher levels of dental attendance for treatment (β = .109, 95% confidence interval (CI) = 0.051‐0.166 for men, β = .094, 95% CI = 0.039‐0.149 for women) than nondaily users. Household equivalent income was positively associated with higher dental attendance for treatment (β = .046, 95% CI = 0.029‐0.062 for men, β = .029, 95% CI = 0.013‐0.045 for women). Income inequalities in access to dental care were smaller among the daily public transportation users than in nondaily users, and a statistically significant interaction was observed only in men (P‐value interactions = .025 for men, .188 for women). Conclusion Income inequalities in access to dental care were smaller among older daily users of public transportation than in nondaily users. These results suggest that providing environment in which people can conveniently use public transportation is needed for reducing income inequalities in access to dental care, especially for men.

Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Does public transportation reduce inequalities in access to dental care among older adults? Japan Gerontological Evaluation Study

Kiuchi

Aida

Kusama

et al. 2019

“…Furthermore, in 2013, the clinic was more easily accessible by public transportation, including the underground or trams. The role of public transportation in improving accessibility to primary dental care was recently investigated in a South American study showing poor public transportation links between clinics and populations in socio‐demographically disadvantaged areas …”

Section: Discussionmentioning

confidence: 99%

The evolution of treatment over 80 years at the outpatient department of the Viennese school of dentistry

Haririan

Pachel-Tettinger

Kirchner

et al. 2018

Objectives The delivery of oral health services, diagnostics and treatment underwent significant changes in the 20th century thanks to achievements by pioneers in dentistry. The Golden Age of Dentistry in Vienna, Austria, was marked by renowned dentists like Bernhard Gottlieb in the 1930s. Data records from the outpatient department of this period have been found and served as a source from which to draw comparisons between those days and the present. To date, data supporting an overall perception of advances in dentistry during the last century in tooth preservation and patients’ demands have been lacking. The aim of this study was to evaluate changes in treatments and patient characteristics between the interwar period and the present and to assess how treatments for dental emergencies developed. Methods Patients’ records were extracted from books handwritten from January to May 1933 and compared with electronically generated data from the same period in 2013. In total, patient data from 10 111 individuals (3878 in 1933 and 6233 in 2013) were analysed. Comparisons were undertaken for gender, age, place of residence, diagnosis and therapy. Results Various statistically significant demographic and treatment differences were found between 1933 and 2013. Patients’ mean ages in 2013 and 1933 were 42 and 31 years, respectively. In 2013, there were significantly more women than in 1933 (3378 vs 1936), with 54% women in 2013 and 50% women in 1933. In 2013, there were significantly fewer tooth extractions as dental emergency treatment than in 1933 (2% vs 34%). Conclusions Treatment in the outpatient department is much more conservative in the 21st century. The characteristics of patients visiting the outpatient department have changed over the generations, and treatment needs should be evaluated accordingly.

“…There have been many GIS‐based studies in dental public health since the 1960s. These have covered a wide range of topics, including: dentist to patient ratios and payments; service usage and access to services and amenities; spatial variations in oral health outcomes; dental workforce numbers and utilization rates; the spatial patterning of dental services; the effects of interventions; and contextual level influences on oral health …”

Section: Where Are We Now?mentioning

confidence: 99%

“…These studies have used many different GIS‐related methods, including: the use of concentric circles, which indicate the radii from a defined point for a certain phenomenon (eg, service coverage); Voronoi polygons, whose boundaries define areas closest to a given point, relative to all other points; the use of Census and deprivation data to distinguish areas based on sociodemographic characteristics; buffer zones used to delineate the coverage areas of services; Euclidean (or straight line) distances between locations; transportation times and station locations; thematic mapping of oral health; point based location data to compare the locations of dental services to social phenomena; human cartograms, which depict geographical areas relative to a given variable other than land mass; geographical data on interventions; and the study of nested geographical data through multilevel modelling …”

Section: Where Are We Now?mentioning

confidence: 99%

Application of geographic information systems and simulation modelling to dental public health: Where next?

Broomhead

Ballas

Baker

2018

Public health research in dentistry has used geographic information systems since the 1960s. Since then, the methods used in the field have matured, moving beyond simple spatial associations to the use of complex spatial statistics and, on occasions, simulation modelling. Many analyses are often descriptive in nature; however, and the use of more advanced spatial simulation methods within dental public health remains rare, despite the potential they offer the field. This review introduces a new approach to geographical analysis of oral health outcomes in neighbourhoods and small area geographies through two novel simulation methods—spatial microsimulation and agent‐based modelling. Spatial microsimulation is a population synthesis technique, used to combine survey data with Census population totals to create representative individual‐level population datasets, allowing for the use of individual‐level data previously unavailable at small spatial scales. Agent‐based models are computer simulations capable of capturing interactions and feedback mechanisms, both of which are key to understanding health outcomes. Due to these dynamic and interactive processes, the method has an advantage over traditional statistical techniques such as regression analysis, which often isolate elements from each other when testing for statistical significance. This article discusses the current state of spatial analysis within the dental public health field, before reviewing each of the methods, their applications, as well as their advantages and limitations. Directions and topics for future research are also discussed, before addressing the potential to combine the two methods in order to further utilize their advantages. Overall, this review highlights the promise these methods offer, not just for making methodological advances, but also for adding to our ability to test and better understand theoretical concepts and pathways.