Providing dental insurance can positively impact oral health outcomes in Ontario

Zivkovic, Nevena; Aldossri, Musfer; Gomaa, Noha; Farmer, Julie; Singhal, Sonica; Quiñonez, Carlos; Ravaghi, Vahid

doi:10.1186/s12913-020-4967-3

Cited by 25 publications

(26 citation statements)

References 41 publications

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“…For example, 28% of Indigenous adults on the Canadian Health Measures Survey [ 12 ], 39.9% on the First Nations Oral Health Survey [ 13 ], and 34.7% on the Inuit Oral Health Survey [ 11 ] reported having poor or fair perceptions of their oral health. It is possible this difference is due to the provision of dental coverage for Indigenous people, especially the Non-Insured Health Benefits Program which is specific to the Indigenous population [ 21 ], however, our findings did not show that dental insurance was predictive of poor self-rated oral health, consistent with prior reports [ 22 ]. Another possibility is that the number of Indigenous adults in our study who self-rated their oral health as good may be inflated or that they overestimated their oral health.…”

Section: Discussionsupporting

confidence: 85%

Predictors of self-rated oral health in Canadian Indigenous adults

2021

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Objectives The purpose of this study was to: (1) compare oral health indicators between Indigenous adults and the general population and (2) examine the predictors of poor self-rated oral health in the Indigenous population. Methods Data from the 2017–2018 cycle of the Canadian Community Health Survey was used and included 943 Indigenous and 20,011 non-Indigenous adults. Independent variables included demographic information, lifestyle behaviours, dental concerns and care utilization, and transportation access. The dependent variable was self-rated oral health. A logistic regression was performed to determine predictors of poor self-rated oral health. Results More than half of the Indigenous sample were aged between 35 and 64 years (57.3%); 57.8% were female. Compared to the general population, the Indigenous group were significantly more likely to have no partner, have less post-secondary education, and have an income of less than $40,000. Almost a fifth of the Indigenous sample self-rated their oral health as poor (18.5%) compared to 11.5% in the general population. Indigenous participants reported significantly poorer general health, had poorer oral care practices, and lifestyle behaviours than the general population (all p < .001). Indigenous adults having poor self-rated oral health was predicted by poorer general health, being a smoker, male, bleeding gums, persistent pain, feeling uncomfortable eating food, avoiding foods, and not seeking regular dental care. Conclusions There are many predictors of poor self-rated oral health, many of which are preventable. Providing culturally adapted oral health care may improve the likelihood of Indigeneous adults visiting the dentist for preventative care.

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Section: Discussionsupporting

confidence: 85%

Predictors of self-rated oral health in Canadian Indigenous adults

2021

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“…The average cost of dental care per patient from areas having a higher median household income was less than that of patients from areas with lower median household income. This was seen in both the 15-17-year age group as well as the 18-24-year age group, consistent with the findings of other studies showing that individuals from lower income families may end up spending more on dental care [32,33]. The findings are also in keeping with those of a similar study conducted on children below 15 years of age [21], suggesting that socioeconomic determinants of healthcare affect individuals across different age groups.…”

Section: Discussionsupporting

confidence: 90%

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario

et al. 2022

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We examined whether the association of neighborhood-level socioeconomic status (SES) with the cost of dental care and dental care outcomes differs between adolescents and young adults. A total of 2915 patient records were split into two groups: adolescents (15 to 17 years of age) and young adults (18 to 24 years of age). Three dental care outcomes—routine oral evaluation (OEV-CH-A), utilization of preventive services (PRV-CH-A), and dental treatment services (TRT-CH-A)—were determined according to the Dental Quality Alliance (DQA) criteria. Associations of neighborhood SES and other sociodemographic variables with dental care outcomes and the cost of dental care were assessed using binary logistic and univariate linear regression models, respectively. Young adults had significantly lower PRV-CH-A and higher TRT-CH-A scores when compared to adolescents. We observed a significant negative association between TRT-CH-A and median household income in both adolescents and young adults. Utilization of dental treatment services was positively associated with the cost of care in both age groups, whereas utilization of preventive services was inversely associated with the cost of care in young adults, but not in adolescents. Neighborhood-level income was inversely associated with increased TRT-CH-A in both young adults and adolescents. In summary, young adults showed significantly worse preventive and treatment outcomes when compared to adolescents. Moreover, individuals from neighborhoods with a lower household income showed a significantly higher cost of dental care, yet worse treatment outcomes.

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“…The latter highlights the importance of structural factors and further supports the role of social determinants in health. Widespread public health insurance coverage or implementation of pro-equity policies could result in the decline of dental health care inequalities and inequity [ 12 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Use of oral health care services in the United States: unequal, inequitable—a cross-sectional study

Mejía

et al. 2021

BMC Oral Health

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Background Social determinants drive disparities in dental visiting. Disparities can be measured simply by comparing outcomes between groups (inequality) but can also consider concepts of social justice or fairness (inequity). This study aimed to assess differences in dental visiting in the United States in terms of both social inequality and inequity. Methods Data were obtained from a cross-sectional study—the National Health and Nutrition Examination Survey (NHANES) 2015–2016, and participants were US adults aged 30+ years. The outcome of interest, use of oral health care services, was measured in terms of dental visiting in the past 12 months. Disparity was operationalized through education and income. Other characteristics included age, gender, race/ethnicity, main language, country of birth, citizenship and oral health status. To characterize existing inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration index (ACI and RCI), the slope index of inequality (SII) and relative index of inequality (RII) and through concentration curves (CC). Indirect standardization with a non-linear model was used to measure inequity. Results A total of 4745 US adults were included. Bivariate analysis showed a gradient by both education and income in dental visiting, with a higher proportion (> 60%) of those with lower educational attainment /lower income having not visited a dentist. The concentration curves showed pro-higher education and income inequality. All measures of absolute and relative indices were negative, indicating that from lower to higher socioeconomic position (education and income), the prevalence of no dental visiting decreased: ACI and RCI estimates were approximately 8% and 20%, while SII and RII estimates were 50% and 30%. After need-standardization, the group with the highest educational level had nearly 2.5 times- and the highest income had near three times less probability of not having a dental visit in the past 12 months than those with the lowest education and income, respectively. Conclusion The findings indicate that use of oral health care is threatened by existing social inequalities and inequities, disproportionately burdening disadvantaged populations. Efforts to reduce both oral health inequalities and inequities must start with action in the social, economic and policy spheres.

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Providing dental insurance can positively impact oral health outcomes in Ontario

Cited by 25 publications

References 41 publications

Predictors of self-rated oral health in Canadian Indigenous adults

Predictors of self-rated oral health in Canadian Indigenous adults

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario

Use of oral health care services in the United States: unequal, inequitable—a cross-sectional study

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