271099 Role of geographic proximity to dentists in children's access to dental care

Tuesday, October 30, 2012 : 1:10 PM - 1:30 PM

George Wehby, PhD , Department of Health Management and Policy, College of Public Health, University of Iowa, University of Iowa, Iowa city, IA
Adweta Joshi , Public Policy Center, University of Iowa, Iowa City, IA
Peter Damiano, DDS, MPH , Public Policy Center, University of Iowa, Iowa City, IA
Improving children's access to dental care is a commonly stated policy goal for improving their oral health. Distance to providers is a significant predictor of healthcare utilization. However, not much is known about the effects of geographic proximity to dentists on dental care use. This study evaluates the effects of children's distance to the nearest dentist on dental care use including preventive care measured by comprehensive oral evaluation and dental treatments classified into major (e.g., endodontic treatment and crowns) and minor treatments (e.g., surface fillings) and tooth extractions. We study a sample of about 45,000 children born in Iowa between 2000 and 2006 and enrolled in Medicaid. Children's addresses and dental care use are measured through 2009 from the Medicaid enrollment and claims files. Data on dentists providing care to Medicaid patients and their addresses are obtained from the Iowa Department of Human Services. We employ GEE-type logistic regression adjusting for demographic factors, year, and county-level socioeconomic and healthcare characteristics from the area-resource-file. We find that increasing distance to the nearest Medicaid-accepting dentist significantly reduces children's use of comprehensive oral evaluations, but has no effects on dental treatments (major/minor or extractions). A 10-mile increase in distance is associated with 7.4% decrease in the probability of obtaining comprehensive oral evaluations. Given the importance of comprehensive dental evaluations for maintaining oral health and preventing future dental problems, the study identifies geographic proximity to dental care providers as an important factor for improving children's access to preventive care and their oral health outcomes.

Learning Areas:
Provision of health care to the public
Public health or related education
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
- Design a study to identify the effect of geographic location on children's access to dental care - Analyze a large geo-coded dataset to assess the effects of distance to the nearest dentist and other contextual information on use of different types of dental care using appropriate statistical models

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed the study, carried out the statistical analysis, and wrote the abstract. I am an assistant professor in the College of Public Health at the University of Iowa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.