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Public Health. 2016 May;134:54-63. doi: 10.1016/j.puhe.2015.04.024. Epub 2016 Mar 16.

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

Author information

1
University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA. Electronic address: fisherowens@peds.ucsf.edu.
2
Statworks, Boston, MA, USA.
3
Division of Oral Epidemiology & Dental Public Health, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA; Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
4
MGH Center for Child and Adolescent Health Policy, Boston, MA, USA.
5
Center to Address Disparities in Children's Oral Health (CAN-DO), University of California, UCSF School of Dentistry, Department of Preventive & Restorative Dental Sciences, San Francisco, CA, USA.
6
Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, San Francisco, CA, USA.
7
University of California, San Francisco School of Medicine, Department of Pediatrics, San Francisco, CA, USA; Philip R. Lee Institute for Health Policy Studies, San Francisco, CA, USA.

Abstract

OBJECTIVES:

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.

KEYWORDS:

Children's oral health; State variation

PMID:
26995567
PMCID:
PMC4884054
DOI:
10.1016/j.puhe.2015.04.024
[Indexed for MEDLINE]
Free PMC Article

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