Geography matters: state-level variation in children's oral health care access and oral health status

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• 作者：S.A. Fisher-Owens^a ; ^c ; ^{fisherowens@peds.ucsf.edu" class="auth_mail" title="E-mail the corresponding author} ; M.J. Soobader^b ; ^h ; S.A. Gansky^c ; ^e ; I.A. Isong^d ; J.A. Weintraub^e ; ⁱ ; L.J. Platt^f ; P.W. Newacheck^a ; ^g
• 关键词：AHRQ ; Agency for Healthcare Research and Quality ; CV ; coefficient of variation ; DHPSA ; Dental Health Professional Shortage Area ; FPL ; federal poverty level ; NSCH ; National Survey of Children's Health ; SD ; standard deviation ; WIC ; supplemental nutrition program for women ; infants ; and children
• 刊名：Public Health
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：134
• 期：Complete
• 页码：54-63
• 全文大小：1007 K

文摘

To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences.

Study design

Observational study using cross-sectional surveys.

Methods

Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation.

Results

Unadjusted rates of no preventive dental care ranged 9.0–26.8% (mean 17.5%), with little impact of adjusting (10.3–26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1–14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7–10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation.

Conclusion

Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.