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Taira K, Mori T, Ishimaru M, Iwagami M, Sakata N, Watanabe T, Takahashi H, Tamiya N. Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims. Lancet Reg Health West Pac 2021; 12:100170. [PMID: 34527966 PMCID: PMC8356097 DOI: 10.1016/j.lanwpc.2021.100170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study examined regional inequalities in dental care utilization in Japan and the association of dental care utilization with socioeconomic factors. METHODS Using the Fourth National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data, this ecological study analyzed 216 million pieces of aggregated data from April 2017 to March 2018. Nine indicators of dental care utilization were used: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan's 47 prefectures, which were divided into three groups based on the number of dental clinics per population, average income per capita, and the proportion of university enrollments. Associations of the dental care utilization with dental supply and regional socioeconomic factors were examined. FINDINGS The ratios of maximum to minimum of SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Dental supply was positively associated with outpatient visits, outreach services, dental calculus removal, and periodontal surgeries. Regional average income and educational level were positively associated with dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures. INTERPRETATION In Japan, regional inequalities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Regional income and educational levels appear to have influence on dental care utilization. FUNDING Ministry of Health, Labour and Welfare of Japan (H31-19FA1001).
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Affiliation(s)
- Kento Taira
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Miho Ishimaru
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Taeko Watanabe
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideto Takahashi
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- National Institute of Public Health, Wako, Saitama, Japan
| | - Nanako Tamiya
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
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