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Schuller AA, Hoeksema AR. Determinants and barriers for visiting a dental clinic among (frail) older individuals. Acta Odontol Scand 2023; 81:227-234. [PMID: 36112367 DOI: 10.1080/00016357.2022.2118166] [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] [Indexed: 11/01/2022]
Abstract
AIMS With increasing age, the proportion of older individuals visiting a dental clinic decreases. The aim was to gain insight into a) whether frailty or dental status were associated with visiting a dental clinic and b) their perceived barriers to accessing oral health care. METHODS Individuals eligible for the yearly influenza vaccination in Winschoten, The Netherlands, were invited to participate in a questionnaire survey about dental visits and perceived barriers to such visits. RESULTS A total of 1027 individuals aged 60+ completed the questionnaire - 80% of the non-frail, 71% of the mildly frail and 60% of the moderately to severe frail individuals visited a dental clinic in the previous year. Dental status was the crucial determinant for not visiting a dental clinic. Edentate individuals were more likely to drop out of the dental care system than dentate individuals or individuals with partial prostheses. A higher proportion of moderately and severe frail people were edentate than non-frail or mildly frail people. Barriers to visiting a dentist were making an appointment, costs, and services available. Conclusions: Dental clinicians should pay attention to the barriers that they can influence. The influenza vaccination seems to be an interesting momentum for identifying people who have dropped out of the oral healthcare system.
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Affiliation(s)
- Annemarie A Schuller
- Center for Dentistry and Oral Hygiene, University Medical Center, Groningen, The Netherlands
- TNO Child Health, Leiden, The Netherlands
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Hensel ALJ, Gomaa N. Social and economic capital as effect modifiers of the association between psychosocial stress and oral health. PLoS One 2023; 18:e0286006. [PMID: 37200290 DOI: 10.1371/journal.pone.0286006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES To assess the extent of the association of psychosocial stress with oral health in an Ontario population stratified by age groups, and whether any association is modified by indicators of social and economic capital. METHODS We retrieved data of 21,320 Ontario adults, aged 30-74 years old, from the Canadian Community Health Survey (CCHS: 2017-2018), which is a Canada-wide, cross-sectional survey. Using binomial logistic regression models that adjusted for age, sex, education, and country of birth, we examined the association of psychosocial stress (indicated by perceived life stress) with inadequate oral health (indicated as having at least one of the following: bleeding gums, fair/poor self-perceived oral health, persistent oral pain). We assessed the effect measure modification of indicators of social (sense of belonging to the local community, living/family arrangements) and economic capital (household income, dental insurance, dwelling ownership) on the perceived life stress-oral health relationship, stratified by age (30-44, 45-59, 60-74 yrs). We then calculated the Relative Excess Risk due to Interaction (RERI) which indicates the risk that is above what would be expected if the combination of low capital (social or economic) and high psychosocial stress was entirely additive. RESULTS Respondents with higher perceived life stress were at a significantly higher risk of having inadequate oral health (PR = 1.39; 95% CI: 1.34, 1.44). Adults with low social and economic capital were also at an increased risk of inadequate oral health. Effect measure modification showed an additive effect of indicators of social capital on the perceived life stress-oral health relationship. This effect was evident across all three age groups (30-44, 45-59, 60-74 yrs), with the highest attributable proportion of social and economic capital indicators in the psychosocial stress-oral health relationship in older adults (60-74 yrs). CONCLUSION Our findings suggest an exacerbating effect for low social and economic capital in the relationship of perceived life stress with inadequate oral health among older adults.
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Affiliation(s)
- Abby L J Hensel
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Noha Gomaa
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Hardgraves VM, Henry LJ, Patton SK. “I’m Gonna Hang on to These As Long As I Can”: Examining the Perspectives and Knowledge of Oral Health Issues of Older Adults Living Independently. Am J Lifestyle Med 2021. [DOI: 10.1177/15598276211026842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Advantages of fluoridated water, dental insurance, and greater awareness of preventive oral healthcare allow many adults in today’s aging cohort to maintain their teeth into their advanced years. The purpose of this study was to describe attitudes, expectations, knowledge, and intentions related to oral health issues from the experiences of older adults living independently in a largely rural south central state. Methods: A qualitative analysis guided by behavioral constructs of the Reasoned Action Approach was utilized to conduct semi-structured interviews of a purposeful sample of adults age 65 years and older living independently. Results: Participant data (N = 26) revealed 5 themes: difficulties accessing dental care; active coping; taking care of your mouth as part of overall health; interactions affecting oral health–related quality of life; and supporting roles. Overall, the intention to attain dental care was affected by the perceived need to prioritize many health issues over oral care. An overarching expectation to have affordable basic services available pervaded. Conclusion: The perceptions of participants reflect socioeconomic determinants that could be influenced through improved health literacy education focused on establishing a greater understanding of the oral systemic link especially as it relates to diabetes.
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Affiliation(s)
- Virginia M. Hardgraves
- From the University of Arkansas Fayetteville, Arkansas, USA (VH, SP) and Public Health/Community Health Promotion, University of Arkansas Fayetteville, Fayetteville Arkansas, USA (LH)
| | - Leah J. Henry
- From the University of Arkansas Fayetteville, Arkansas, USA (VH, SP) and Public Health/Community Health Promotion, University of Arkansas Fayetteville, Fayetteville Arkansas, USA (LH)
| | - Susan K. Patton
- From the University of Arkansas Fayetteville, Arkansas, USA (VH, SP) and Public Health/Community Health Promotion, University of Arkansas Fayetteville, Fayetteville Arkansas, USA (LH)
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Nitschke I, Hahnel S, Jockusch J. Health-Related Social and Ethical Considerations towards the Utilization of Dental Medical Services by Seniors: Influencing and Protective Factors, Vulnerability, Resilience and Sense of Coherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042048. [PMID: 33669815 PMCID: PMC7922367 DOI: 10.3390/ijerph18042048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/16/2022]
Abstract
The aim is to analyze protective and modifying factors (e.g., vulnerability, resilience, sense of coherence) in relation to the utilization of dental services by seniors at different levels of the healthcare system. Terminological imprecision in the use and transfer of existing terms (sense of coherence, resilience, salutogenesis) to gerodontology is clarified. Factors influencing a reduced utilization (static/dynamic factors) can occur isolated or in combination and, thus, model the risk of a reduced utilization of dental services (influencing-factor mechanism). Protective factors of utilization include patient-specific factors for self-motivation and factors that promote oral-health-related resilience. Resistance forces that counteract can be identified as oral-health-related resilience factors. Achieving social and individual appreciation and establishing a prevention-oriented approach to utilization will be increasingly challenging, since the population is becoming older and access is not equal in terms of opportunity. Resistance forces need to be strengthened in an ethical context. Studies should increasingly present resilience processes, determinants and modes of action at the various interfaces in the healthcare system, which can ensure sustainable medical care in old age. The concepts conveyed here are generally valid and able to point out inequalities and ageism in access to dental services.
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Affiliation(s)
- Ina Nitschke
- Clinic for Prosthetic Dentistry and Dental Materials Science, Leipzig University Medical Center, 04103 Leipzig, Germany;
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - Sebastian Hahnel
- Clinic for Prosthetic Dentistry and Dental Materials Science, Leipzig University Medical Center, 04103 Leipzig, Germany;
- Correspondence:
| | - Julia Jockusch
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland;
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Adeniyi A, Oyapero A. Predisposing, enabling and need factors influencing dental service utilization among a sample of adult Nigerians. POPULATION MEDICINE 2020. [DOI: 10.18332/popmed/128504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dental service utilization in the very old: an insurance database analysis from northeast Germany. Clin Oral Investig 2020; 25:2765-2777. [PMID: 32995975 PMCID: PMC7524568 DOI: 10.1007/s00784-020-03591-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022]
Abstract
Objectives We assessed dental service utilization in very old Germans. Methods A comprehensive sample of 404,610 very old (≥ 75 years), insured at a large statutory insurer (Allgemeine Ortskrankenkasse Nordost, active in the federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania), was followed over 6 years (2012–2017). Our outcome was the utilization of dental services, in total (any utilization) and in five subgroups: (1) examinations and associated assessment or advice, (2) restorations, (3) surgery, (4) prevention, (5) outreach care. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) German modified diagnosis-related groups (GM-DRGs) was explored. Results The mean (SD) age of the sample was 81.9 (5.4) years. The utilization of any dental service was 73%; utilization was highest for examinations (68%), followed by prevention (44%), surgery (33%), restorations (32%), and outreach care (13%). Utilization decreased with age for nearly all services except outreach care. Service utilization was significantly higher in Berlin and most cities compared with rural municipalities, and in individuals with common, less severe, and short-term conditions compared with life-threatening and long-term conditions. In multi-variable analysis, social hardship status (OR: 1.14; 95% CI: 1.12-1.16), federal state (Brandenburg 0.85; 0.84–0.87; Mecklenburg-Western Pomerania: 0.80; 0.78–0.82), and age significantly affected utilization (0.95; 0.95–0.95/year), together with a range of co-morbidities according to ICD-10 and DRG. Conclusions Social, demographic, regional, and general health aspects were associated with the utilization of dental services in very old Germans. Policies to maintain access to services up to high age are needed. Clinical significance The utilization of dental services in the very old in northeast Germany showed significant disparities within populations. Policies to allow service utilization for sick, economically disadvantaged, rural and very old populations are required. These may include incentives for outreach servicing, treatment-fee increases for specific populations, or referral schemes between general medical practitioners and dentists. Electronic supplementary material The online version of this article (10.1007/s00784-020-03591-z) contains supplementary material, which is available to authorized users.
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Smith BJ, Helgeson M, Prosa B, Finlayson TL, Orozco M, Asgari P, Pierce I, Norman G, Aronoff-Spencer E. Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota. PLoS One 2020; 15:e0232898. [PMID: 32407370 PMCID: PMC7224465 DOI: 10.1371/journal.pone.0232898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. METHODS Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. RESULTS Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. CONCLUSION Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.
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Affiliation(s)
- Barbara J. Smith
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Michael Helgeson
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Brenda Prosa
- Apple Tree Dental, Mounds View, Minnesota, United States of America
| | - Tracy L. Finlayson
- School of Public Health, San Diego State University, San Diego, California, United States of America
| | - Mario Orozco
- West Health Institute, San Diego, California, United States of America
| | - Padideh Asgari
- West Health Institute, San Diego, California, United States of America
| | - Ian Pierce
- West Health Institute, San Diego, California, United States of America
| | - Gregory Norman
- West Health Institute, San Diego, California, United States of America
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Piotrowska DE, Jankowska D, Huzarska D, Szpak AS, Pędziński B. Socioeconomic inequalities in use and non-use of dental services in Poland. Int J Public Health 2020; 65:637-647. [PMID: 32388573 PMCID: PMC7360667 DOI: 10.1007/s00038-020-01379-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives To assess the impact of classical socioeconomic factors on the use and non-use of dental services on a representative sample of Polish population. Methods The study was based on face-to-face surveys conducted by GUS (Statistics Poland) on 13,376 respondents in 2010 and 12,532 individuals in 2013. Results The percentage of people using dental services in the highest income group was approximately twice as high as that in the lowest one (Q1: 7.0% vs. Q5: 16.4%), with the same being true for education (the lowest education group: 8.3% vs. the highest education group: 18.0%), and place of residence (inhabitants of rural areas: 9.2% vs. inhabitants of largest cities: 15.9%) in 2013. The analysis has shown the disparities in not using dental services when in need to be less clear-cut. Conclusions The conducted research, based on two independent periods, a representative population sample, univariate analysis and the multivariate regression model has revealed pronounced social inequalities in dental care use. It is a challenge to determine the factors which contribute most to health inequalities and the interventions which are most effective in reducing them.
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Affiliation(s)
- Dorota Elżbieta Piotrowska
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.
| | - Dorota Jankowska
- Department of Statistics and Medical Informatics, Medical University of Bialystok, ul.Szpitalna 37, Białystok, 15-295, Poland
| | - Dorota Huzarska
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland
| | - Andrzej Stanisław Szpak
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.,Institute of Rural Health, ul.Jaczewskiego 2, Lublin, 20-090, Poland
| | - Bartosz Pędziński
- Department of Public Health, Medical University of Bialystok, ul. Szpitalna 37, 15-295, Białystok, Poland.,Lomza Medical Center Ltd., ul.Ks.Kardynała Wyszyńskiego 9, Lomza, 18-400, Poland
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Hempel FM, Krois J, Paris S, Beuer F, Kuhlmey A, Schwendicke F. Prosthetic treatment patterns in the very old: an insurance database analysis from Northeast Germany. Clin Oral Investig 2020; 24:3981-3995. [PMID: 32300981 PMCID: PMC7544711 DOI: 10.1007/s00784-020-03264-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We assessed dental prosthetic services utilization in very old Germans. METHODS A comprehensive sample of 404,610 very old (≥ 75 years), insured at one large statutory insurer (Allgemeine Ortskrankenkasse Nordost, acting in the federal states Berlin, Brandenburg, Mecklenburg-Vorpommern), were followed over 6 years (2012-2017). Our outcome was the utilization of prosthetic services, in total and seven subgroups: (1) Crowns/partial crowns, (2) fixed dental prostheses (FDPs), (3) partial removable prostheses (RDPs), (4) full RDPs, (5) temporary services, (6) relining/rebasing/repairing/extending RDPs, (7) repairing FDPs. Association of utilization with (1) gender, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses and (6) German diagnoses related groups (G-DRG) was explored. RESULTS The mean (SD) age of the sample was 81.9 (5.4) years; mean follow-up was 1689 (705) days. The mean utilization of any prosthetic service was 27.0%; the most often utilized service type were total RDPs (13.2% utilization), crowns (8.1%), and partial RDPs (7.1%). Utilization decreased with age for nearly all services (except relining/rebasing/repairing/extending RDPs). Utilization of prosthetic services was significantly higher in Berlin and most cities compared with rural municipalities and in individuals with common, less severe conditions according to ICD-10 and DRGs compared with life-threatening conditions or dementia. In multivariable analysis, gender (OR; 95% CI: 0.95; 0.93-0.98), social hardship status (1.19; 1.17-1.21), federal state (Brandenburg 0.57; 0.56-0.59; Mecklenburg-Vorpommern: 0.66; 0.64-0.67) and age significantly affected utilization (0.95; 0.95-0.95/year). CONCLUSIONS Patient-related and healthcare factors determine the utilization of prosthetic services in very old Germans. Interventions to maintain sufficient prosthetic care up to high age are required. CLINICAL SIGNIFICANCE The utilization of prosthetic services in the very old in Northeast Germany showed significant disparities within populations and service types. There seems to be great need to better understand the drivers of utilization, and to develop and evaluate interventions to maintain sufficient prosthetic care up to high age.
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Affiliation(s)
- Fabian M Hempel
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Mittal R, Wong ML, Koh GCH, Ong DLS, Lee YH, Tan MN, Allen PF. Factors affecting dental service utilisation among older Singaporeans eligible for subsidized dental care - a qualitative study. BMC Public Health 2019; 19:1075. [PMID: 31395045 PMCID: PMC6688284 DOI: 10.1186/s12889-019-7422-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background The World Health Organization has highlighted the paucity of research into the oral health needs of older adults. In Singapore, until recently, publically funded/subsidized oral health care for adults has been limited to basic primary care at government-funded polyclinics. Access to a more comprehensive range of subsidized care in the private sector was widened through the government-funded Community Health Assistance Scheme (CHAS) in 2012 and Pioneer Generation (PG) scheme in 2015. Little is known about the attitude to dental service utilization among older adults in Singapore since then. Methods We conducted semi-structured individual interviews with 25 participants above 65 years of age who were eligible for subsidized dental care plans. Participants were recruited from a public teaching hospital and a public primary care clinic in Singapore. The duration of each interview was 15–30 min. Interviews were transcribed verbatim and the transcripts were analyzed thematically using a phenomenological approach. Results Pertinent themes emerged related to four major areas: (a) general awareness towards oral health, (b) life course perspective of oral health, (c) barriers to visit the dentist, (d) shaping dental service utilisation behaviours through provision of financial subsidies for dental care. Most participants perceived a strong relationship between oral health and systemic health. However, there were erroneous traditional beliefs such as oral health is not part of physical health and edentulous participants did not need to visit a dentist. Fear, anxiety, previous negative experience and lack of knowledge were barriers to visiting the dentist. Trust and convenience were considerations for patients when deciding whether to switch from public to private dental services where CHAS/PG were only available. Conclusion Our study provided important insights regarding oral health perceptions and beliefs of older people residing in the community which may affect their dental service utilization. This further highlights the importance of understanding the concerns of this group when implementing healthcare policies for elderly in Singapore. The findings of our study will serve as a baseline for future studies in Singapore and inform studies in other countries that implement targeted schemes for older adults.
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Affiliation(s)
- Rakhi Mittal
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | | | - Yun Hui Lee
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Mei Na Tan
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Moeller JF, Chen H, Manski RJ. Diversity in the use of specialized dental services by older adults in the United States. J Public Health Dent 2019; 79:160-174. [PMID: 30716173 PMCID: PMC6565445 DOI: 10.1111/jphd.12309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/20/2018] [Accepted: 01/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We estimated the use of any dental services and the use of specific types of dental services conditional on any dental use for adults 50 and over in the United States to analyze: a) disparities in the use of specialized dental services and b) whether older adults receiving routine dental care use fewer expensive specialized dental services. METHODS We relied on data tabulations and estimated logistic regressions from the 2014 Medical Expenditure Panel Study to analyze the influence of various covariates such as age, race/ethnicity, education, dental insurance, income, and health status on the likelihood of a) using any dental care and b) using routine dental care (prophylaxis, examinations, bitewings, etc.) and specialized services for restorative, periodontal, oral surgery, or prosthetic dental care conditional on using any dental care. RESULTS We found a) lower use of specialized services among higher income, more educated, healthier, nonminority older adults and b) association between lower use of routine dental care and higher use of expensive restorative, oral surgery, and prosthetic dental services. CONCLUSIONS Our study identifies diversity in the use of specialized dental services among an older adult population and suggests that more widespread use of routine dental services could potentially improve oral health and limit the need for expensive specialized dental care for this population.
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Affiliation(s)
- John F Moeller
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Haiyan Chen
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Richard J Manski
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
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Naouri D, Bussiere C, Pelletier-Fleury N. What Are the Determinants of Dental Care Expenditures in Institutions for Adults With Disabilities? Findings From a National Survey. Arch Phys Med Rehabil 2018; 99:1471-1478. [PMID: 29355507 DOI: 10.1016/j.apmr.2017.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/31/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the determinants of dental care expenditures in institutions for adults with disabilities. DESIGN Health and disability survey and insurance database. SETTING Institutional setting. PARTICIPANTS Adults (N=2222) living in institutions for people with cognitive, sensory, and mobility disabilities. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We used a Heckman selection model to correct for potential sample selection bias due to the high percentage of non-dental care users. The Heckman selection model is a 2-step statistical approach based on the simultaneous estimation of 2 multiple regression models-a selection equation (step 1) and an outcome equation (step 2)-offering a means of correcting for nonrandomly selected samples. The selection equation modeled whether the individual had consulted a dentist at least once, whereas the outcome equation explained the dental care expenditures. Disability severity was assessed by scoring mobility and cognitive functional limitations. Regressions also included sociodemographic characteristics and other health-related variables. RESULTS Individuals with the highest cognitive limitation scores, without family visits, without supplementary health insurance, and with poor oral health status were less likely to consult a dentist. After controlling for potential selection bias, the only variable that remained statistically significant in the outcome equation was the oral health status: when individuals with poor health status had consulted at least once, they had a higher level of dental care expenditure. CONCLUSIONS Functional limitations were barriers to accessing dental care even in institutions for adult with disabilities. These barriers should be overcome because they may worsen their oral health status and well-being. Given the lack of literature on this specific topic, our results are important from a policy perspective. Health authorities should be alerted by these findings.
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Affiliation(s)
- Diane Naouri
- University of Paris Sorbonne, UPMC, Paris, France; Emergency Department, Saint-Antoine Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France.
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Caldwell JT, Lee H, Cagney KA. The Role of Primary Care for the Oral Health of Rural and Urban Older Adults. J Rural Health 2017; 33:409-418. [DOI: 10.1111/jrh.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Julia T. Caldwell
- Department of Hospital Medicine; University of Chicago; Chicago Illinois
| | - Haena Lee
- Department of Sociology; University of Chicago; Chicago Illinois
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Kreider B, Moeller J, Manski RJ, Pepper J. The effect of dental insurance on the use of dental care for older adults: a partial identification analysis. HEALTH ECONOMICS 2015; 24:840-58. [PMID: 24890257 PMCID: PMC4247826 DOI: 10.1002/hec.3064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 02/11/2014] [Accepted: 04/24/2014] [Indexed: 05/16/2023]
Abstract
We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75% to around 80% under universal dental coverage.
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Affiliation(s)
| | - John Moeller
- Division of Health Services Research University of Maryland Dental School
| | - Richard J. Manski
- Division of Health Services Research University of Maryland Dental School
| | - John Pepper
- Department of Economics University of Virginia
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Moeller JF, Manski RJ, Mathiowetz NA, Campbell N, Pepper JV. Response error in reporting dental coverage by older Americans in the health and retirement study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2014; 51:51/0/0046958014561325. [PMID: 25428430 PMCID: PMC4283597 DOI: 10.1177/0046958014561325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this research was to analyze the inconsistency in responses to survey questions within the Health and Retirement Study (HRS) regarding insurance coverage of dental services. Self-reports of dental coverage in the dental services section were compared with those in the insurance section of the 2002 HRS to identify inconsistent responses. Logistic regression identified characteristics of persons reporting discrepancies and assessed the effect of measurement error on dental coverage coefficient estimates in dental utilization models. In 18% of cases, data reported in the insurance section contradicted data reported in the dental use section of the HRS by those who said insurance at least partially covered (or would have covered) their (hypothetical) dental use. Additional findings included distinct characteristics of persons with potential reporting errors and a downward bias to the regression coefficient for coverage in a dental use model without controls for inconsistent self-reports of coverage. This study offers evidence for the need to validate self-reports of dental insurance coverage among a survey population of older Americans to obtain more accurate estimates of coverage and its impact on dental utilization.
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Affiliation(s)
- John F Moeller
- University of Maryland School of Dentistry, Baltimore, USA
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Manski RJ, Moeller JF, Chen H. Dental care coverage and use: modeling limitations and opportunities. Am J Public Health 2014; 104:e80-7. [PMID: 25343171 DOI: 10.2105/ajph.2013.301693] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. METHODS We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. RESULTS Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. CONCLUSIONS Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.
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Wiener RC, Shockey AT. Oral Health Knowledge and Dental Visits in Community Living Older Adults in Rural Appalachia-West Virginia: A Cross-Sectional Analysis. JOURNAL OF STUDIES IN SOCIAL SCIENCES 2014; 8:1-14. [PMID: 25530938 PMCID: PMC4269834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship between oral health knowledge and dental visits of older adults in an Appalachian county. METHODS A cross-sectional study design was used. Surveys were returned from 205 older adults (50 years and above) from an Appalachian county. Questions were asked about oral health, last dental visit and sociodemographics. RESULTS The variable of interest, oral health knowledge, was associated with dental visit. Having low oral health knowledge increased odds of having delayed a dental visit beyond a year (unadjusted odds ratio: 2.99; 95% Confidence interval: 1.70, 5.28). Even after considering the number of existing teeth, and controlling for age, sex, education and smoking, the association remained positive and independently significant (adjusted odds ratio: 2.25; 95% Confidence interval: 1.05, 4.82). Education was the only sociodemographic variable associated with last dental visit. CONCLUSION The surveyed older adults have a need for increasing dental visits within the previous year. Increasing dental knowledge was associated with odds of increased dental visits. Improving dental knowledge may be a strategy to improve the number of older adults having a dental visit within the year.
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Affiliation(s)
- R Constance Wiener
- Dental Practice and Rural Health, School of Dentistry, Department of Epidemiology, School of Public Health, West Virginia University, 104A Health Sciences Center Addition PO Box 9448, Morgantown, WV 26506
| | - Alcinda Trickett Shockey
- Department of Periodontics; Division of Dental Hygiene, West Virginia University, Health Sciences Center, Morgantown, WV 26506
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Manski RJ, Moeller JF, Chen H, Schimmel J, St Clair PA, Pepper JV. Dental usage under changing economic conditions. J Public Health Dent 2012; 74:1-12. [PMID: 22994647 DOI: 10.1111/j.1752-7325.2012.00370.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans. METHODS Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates. RESULTS We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population. CONCLUSIONS Older Americans' dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive.
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Affiliation(s)
- Richard J Manski
- Division of Health Services Research, Department of Health Promotion and Policy, Dental School, University of Maryland, Baltimore, MD, USA Mathematica Policy Research, Inc., Washington, DC, USA RAND Corporation, Santa Monica, CA, USA Department of Economics, University of Virginia, Charlottesville, VA, USA
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Castrejón-Pérez RC, Borges-Yáñez SA, Gutiérrez-Robledo LM, Avila-Funes JA. Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis. BMC Public Health 2012; 12:773. [PMID: 22971075 PMCID: PMC3490998 DOI: 10.1186/1471-2458-12-773] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 09/03/2012] [Indexed: 11/11/2022] Open
Abstract
Background Oral health is an important component of general well-being for the elderly. Oral health-related problems include loss of teeth, nonfunctional removable dental prostheses, lesions of the oral mucosa, periodontitis, and root caries. They affect food selection, speaking ability, mastication, social relations, and quality of life. Frailty is a geriatric syndrome that confers vulnerability to negative health-related outcomes. The association between oral health and frailty has not been explored thoroughly. This study sought to identify associations between the presence of some oral health conditions, and frailty status among Mexican community-dwelling elderly. Methods Analysis of baseline data of the Mexican Study of Nutritional and Psychosocial Markers of Frailty, a cohort study carried out in a representative sample of people aged 70 and older residing in one district of Mexico City. Frailty was defined as the presence of three or more of the following five components: weight loss, exhaustion, slowness, weakness, and low physical activity. Oral health variables included self-perception of oral health compared with others of the same age; utilization of dental services during the last year, number of teeth, dental condition (edentate, partially edentate, or completely dentate), utilization and functionality of removable partial or complete dentures, severe periodontitis, self-reported chewing problems and xerostomia. Covariates included were gender, age, years of education, cognitive performance, smoking status, recent falls, hospitalization, number of drugs, and comorbidity. The association between frailty and dental variables was determined performing a multivariate logistic regression analysis. Final models were adjusted by socio-demographic and health factors Results Of the 838 participants examined, 699 had the information needed to establish the criteria for diagnosis of frailty. Those who had a higher probability of being frail included women (OR = 1.9), those who reported myocardial infarction (OR = 3.8), urinary incontinence (OR = 2.7), those who rated their oral health worse than others (OR = 3.2), and those who did not use dental services (OR = 2.1). For each additional year of age and each additional drug consumed, the probability of being frail increased 10% and 30%, respectively. Conclusions Utilization of dental services and self-perception of oral health were associated with a higher probability of being frail.
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Affiliation(s)
- Roberto Carlos Castrejón-Pérez
- Coordinación de Salud Pública Bucal, División de Estudios de Posgrado e Investigación, Facultad de Odontología, Universidad Nacional Autónoma de México, Ciudad Universitaria, Av, Universidad 3000, Del, Coyoacán, C,P, 04510, Distrito Federal, México
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Abstract
This study of the Medicare Current Beneficiary Survey (MCBS) updates trends in utilization of dental services between 1998 and 2006 for community-dwelling U.S. adults of age 65 years and older. Bivariate comparisons were made between dependent variables (annual dental visits and types of dental procedures) and independent variables (age, gender, race, income, education, population density, marital status, U.S. Census Bureau regions, and self-reported health). The estimated percentage of community-dwelling Medicare beneficiaries with a dental visit for the years studied increased from 45.0% in 1998 to 46.3% in 2006. The age group of respondents who were 85 years and older had the greatest percentage increase in dental visits. Those reporting visits with preventive procedures increased from 87.8% to 91.2% whereas those reporting visits with nonpreventive procedures declined from 63.9% to 58.4%. The prevalence of dental visits continues to trend upward for this population of older adults. Increasing delivery of preventive services will likely impact the future mix of dental services as U.S. adults live longer.
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Affiliation(s)
- Daniel D Skaar
- Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.
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Manski RJ, Moeller JF, Chen H, St Clair PA, Schimmel J, Pepper JV. Wealth effect and dental care utilization in the United States. J Public Health Dent 2012; 72:179-89. [PMID: 22515635 PMCID: PMC3433846 DOI: 10.1111/j.1752-7325.2012.00312.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this article is to examine the relationship of wealth and income and the relative impact of each on dental utilization in a population of older Americans, using data from the Health and Retirement Study (HRS). METHODS Data from the HRS were analyzed for US individuals aged 51 years and older during the 2008 wave of the HRS. The primary focus of the analysis is the relationship between wealth, income, and dental utilization. We estimate a multivariable model of dental use controlling for wealth, income, and other potentially confounding covariates. RESULTS We find that both wealth and income each have a strong and independent positive effect on dental care use of older Americans (P < 0.05). A test of the interaction between income and wealth in our model failed to show that the impact on dental care utilization as wealth increases depends on a person's income level or, alternatively, that the impact on dental use as income increases depends on a person's household wealth status (P > 0.05). CONCLUSIONS Relative to those living in the wealthiest US households, the likelihood of utilizing dental care appears to decrease with a decline in wealth. The likelihood of utilizing dental care also appears to decrease with a decline in income as well.
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Affiliation(s)
- Richard J Manski
- Division of Health Services Research, Department of Health Promotion and Policy, Dental School, University of Maryland, Baltimore, MD 21201, USA.
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Lupi-Pegurier L, Clerc-Urmes I, Abu-Zaineh M, Paraponaris A, Ventelou B. Density of dental practitioners and access to dental care for the elderly: A multilevel analysis with a view on socio-economic inequality. Health Policy 2011; 103:160-7. [DOI: 10.1016/j.healthpol.2011.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 08/30/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022]
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Manski RJ, Moeller JF, St Clair PA, Schimmel J, Chen H, Pepper JV. The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006. Am J Public Health 2011; 101:1882-91. [PMID: 21852656 DOI: 10.2105/ajph.2011.300227] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status. METHODS We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates. RESULTS We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods. CONCLUSIONS Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.
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Affiliation(s)
- Richard J Manski
- Division of Health Services Research, University of Maryland Dental School, 650 West Baltimore St, Baltimore, MD 21201, USA.
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Chen H, Moeller J, Manski RJ. The influence of comorbidity and other health measures on dental and medical care use among Medicare beneficiaries 2002. J Public Health Dent 2011. [DOI: 10.1111/j.1752-7325.2011.00251.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chen H, Moeller J, Manski RJ. The influence of comorbidity and other health measures on dental and medical care use among Medicare beneficiaries 2002. J Public Health Dent 2011; 71:202-211. [PMID: 21972460 PMCID: PMC3188950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the impact of comorbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. METHODS A comorbidity index is the main independent variable of our study. It includes oral cancer as a comorbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and comorbidity after controlling for other explanatory variables. RESULTS High scores on the comorbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20 percent of the sample with missing claims, but the resulting comorbidity index performed no differently than the index constructed without imputation. CONCLUSIONS Comorbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study's findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries.
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Affiliation(s)
- Haiyan Chen
- Division of Health Services Research Department of Health Promotion and Policy Dental School, University of Maryland at Baltimore, Baltimore, MD, USA.
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