Factors associated with oral health service utilization among adults and older adults in China, 2015‐2016

Xu, Mengru; Cheng, Ming; Gao, Xiaoli; Wu, Hongyan; Ding, Min; Zhang, Chunzi; Wang, Xing; Feng, Xiping; Tai, Baojun; Hu, Deyu; Lin, Huancai; Wang, Bo; Wang, Chunxiao; Zheng, Shuguo; Liu, Xuenan; Rong, Wensheng; Wang, Weijian; Xu, Tao; Si, Yan

doi:10.1111/cdoe.12497

Cited by 46 publications

(92 citation statements)

References 27 publications

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“…Poststratification weights were used to adjust for differences in the age‐by‐sex‐by‐location‐by‐province distribution between the sample and the general population in the 31 provinces involved in the study, consistent with the 6th National Demographic Census in 2010. 16 17 …”

Section: Methodsmentioning

confidence: 99%

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

Yuan

Sun

et al. 2020

BMJ Open

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ObjectiveThe purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey.MethodsFor decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships with different categories of all involved variables. As DMFT scores only have discrete values, Poisson mixture regression was adopted to model the heterogeneity and complex patterns in the association and to detect the subgroup. The Bayesian information criterion (BIC) was used to determine the optimal number of subgroups. A series of Wald tests were used to explore the relationship between risk factors including the interaction effects and the number of DMFT.ResultsA total of 100 986 individuals aged 12–15 years old were analysed. The model clustered different individuals into three subgroups and built three submodels for detailed statistical inference simultaneously. The number of individuals in the three subgroups were 52 576 (52.1%), 41 969 (41.5%) and 6441 (6.4%), respectively. The mean (SD) of DMFT of the three subgroups was 0.50 (1.05), 0.99 (1.21), 5.59 (2.50). The model fitting results indicated that the effects of all risk factors on DMFT appear to be different in three subgroups. Controlling the confounding effects, our analysis implied that the regional inequality was the main contributing factor to dental caries among adolescents in Chinese mainland.ConclusionsThe risk factors of dental caries exhibited heterogeneity in groups with different characteristics. The Poisson mixture regression model could cluster individuals into groups and identify the heterogeneous effects of risk factors among different groups. The findings support the need for different targeted interventions and prevention measures in groups with different dental health characteristics.

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Section: Methodsmentioning

confidence: 99%

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

Yuan

Sun

et al. 2020

BMJ Open

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“…When people are sorted by the variable of ability to pay (ATP) from poor to rich, the cumulative proportion of utilization graphs the concentration curve of medical care (Lu). As the utilization of dental service is treatmentoriented in China [22] d based on the behavior model of Anderson [23], an evaluated health variable for objective needs and the other subjective ones which reflect the demand for dental care should be considered at the evaluation of C N . Consider DT (Decayed teeth) reflected the unsatisfied primary dental need, it is used to be an evaluated need variable.…”

Section: Horizontal Inequality and Progressivitymentioning

confidence: 99%

Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Cheng

Wang

et al. 2020

BMC Oral Health

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Background: The financial burden of oral diseases is a growing concern as the medical expenses rise worldwide. The aim of this study was to investigate the dental expenditure, analyze its progressivity and horizontal inequality under the general health finance and insurance system, and identify the key social determinants of the inequality for Chinese adults. Methods: A secondary analysis used the data of 13,464 adults from the 4th National Oral Health Epidemiological Survey (NOHES) in China was undertaken. The dental expenditure was collected and divided into out-of-pocket and health insurance payments. Horizontal inequality index and Kakwani index were used to analyze the horizontal inequality and progressivity, respectively. The decomposition model of the concentration index was set up to explore the associated socioeconomic determinants. Results: The results showed that a mean dental expenditure per capita of Chinese adults was $20.55 (95% Confidence Interval-CI: 18.83,22.26). Among those who actually used dental service, the cost was $100.95 (95%CI: 93.22,108.68). Over 90% of dental spending was due to out-of-pocket expenses. For self-reported oral health, the horizontal inequality index was − 0.1391 and for the decayed tooth (DT), it was − 0.2252. For out-of-pocket payment, the Kakwani index was − 0.3154 and for health insurance payment it was − 0.1598. Income, residential location, educational attainment, oral hygiene practice, self-reported oral health, age difference were the main contributors to the inequality of dental expenditure.

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“…Some recent empirical studies (e.g., [10][11][12]) have emphasized the importance of all components of the Andersen model for dental service use. This may point to some over-or underuse of dental services.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that the Andersen model can be considered as a very important, widely acknowledged and widely used model to study the determinants of HCU [8]. Moreover, there are also some studies that have examined the determinants of dental service use, based on the Andersen model ( [10][11][12]). These studies showed, among other things, that-depending on the healthcare system-all components of the Andersen model (predisposing characteristics, enabling resources and need factors) are important determinants of dental service use.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Dental Service Use Based on the Andersen Model: A Study Protocol for a Systematic Review

2020

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Introduction: Drawing on the Andersen model, there is a large body of evidence examining the determinants of health care use, such as doctor visits or hospitalization. However, far less is known about the determinants of dental service use, explicitly using the Andersen model. Consequently, the aim of this systematic review is to summarize and critically analyze evidence from observational studies that examine the determinants of dental service use based on the Andersen model. Methods and analysis: The following electronic databases will be searched: PubMed, PsycInfo, and CINAHL. Our main inclusion criterion is: observational studies (cross-sectional and longitudinal) investigating the determinants of dental service use based on the Andersen model. Disease-specific samples will be excluded. Data extraction will concentrate on methods (such as measurement of dental service use), sample characteristics (such as age and gender) and key results. The study quality will be assessed using an appropriate tool. Three steps (selecting the studies, extracting the data and assessment of study conducted) will be performed by two reviewers. The findings will be displayed using figures, summary tables, narrative summaries and meta-analysis (if studies are deemed similar enough and of appropriate quality).

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Factors associated with oral health service utilization among adults and older adults in China, 2015‐2016

Cited by 46 publications

References 27 publications

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression

Dental expenditure, progressivity and horizontal inequality in Chinese adults: based on the 4th National Oral Health Epidemiology Survey

Determinants of Dental Service Use Based on the Andersen Model: A Study Protocol for a Systematic Review

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