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Geographic disparities in unmet dental care needs among US children with special health care needs

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Angelia M. Paschal, PhD , Department of Health Science, The University of Alabama, Tuscaloosa, AL
Jereme Wilroy, M.A. , Department of Health Science, College of Human Environmental Sciences, University of Alabama, Tuscaloosa, AL
Suzanne Hawley, PhD, MPH , Department of Public Health Sciences, Wichita State Unviersity, Wichita, KS
Meaghan James , Department of Health Science, The University of Alabama, Tuscaloosa, AL
INTRODUCTION: Poor oral health, including dental caries, tooth loss, and tooth disfigurement, has been associated with mouth pain, decreased nutritional status, low self-esteem, poor social development, and school absenteeism. Dental caries has been associated with heart disease, diabetes, and obesity. While dental caries can be prevented, affordable dental insurance & accessible dental care services are significant issues for economically disadvantaged families. Families of children with special health care needs (CSHCN) are further at risk. This study examined geographic disparities in unmet dental care needs among US CSHCN 17 years old and younger.

METHODS: Data from the 2009-2010 National Survey of Children with Special Health Care Needs was used to estimate prevalence & odds of having unmet dental care needs in 40,242 CSHCN according to state. Logistic regression was used to examine individual- & state-level determinants. The primary outcome was unmet dental care need, defined as whether CSHCN were said to have needed dental care but were unable to obtain it. Among the individual-level covariates measured were: state of residence, sociodemographic characteristics (e.g., child’s race/ethnicity, gender, household income), insurance status & type, disability, & medical home. Among the state-level covariates that were measured included: poverty rate, percentage immigrant or non-English-speaking population, Medicaid/State Children’s Health Insurance Program (SCHIP) eligibility criteria, Medicaid expenditure per child, primary care physician supply rates, & dentist supply rates.

RESULTS: The study results indicated that unmet dental care needs in CSHCN varied across geographic areas. Several states experienced related problems, for example, CSHCN not having a medical home. Adjustments for some factors reduced state disparities in unmet dental care needs.

DISCUSSION:  Several individual and state-level health variables were important predictors of unmet dental care needs. Geographic disparities exist, with CSHCN in several states at high risk.  This study points to a need for broad-reaching public health initiatives and policies to address unmet dental needs in CSHCN.

Learning Areas:

Assessment of individual and community needs for health education
Epidemiology
Provision of health care to the public
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Assess the observed and adjusted prevalence and odds of having unmet dental care needs among children with special health care needs across the 50 states and the District of Columbia Identify individual level and state level social and health policy determinants of unmet dental care needs among children with special health care needs

Keyword(s): Children With Special Needs, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I am a funded and published researcher in this area of study. I am one of two PIs of a NIH grant that is exploring how uninsured children and their families access and use dental care services and public health insurance. I also teach a course in health disparities and most of my research addresses health inequities.
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.

Back to: 4086.0: Social/Behavior Epidemiology and Epidemiology of Health Disparities Poster Session 4