Geography matters: state-level variation in children's oral health care access and oral health status. (May 2016)

• Record Type: Journal Article
• Authors: Fisher-Owens, S.A.; Soobader, M.J.; Gansky, S.A.; Isong, I.A.; Weintraub, J.A.; Platt, L.J.; Newacheck, P.W.
• Is Part Of: Public health. Volume 134(2016)
• Page Start: 54
• Page End: 63
• Publication Date: 2016-05
• Subjects: 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; Children's oral health -- State variation; Public health -- Periodicals; Public health -- Periodicals; Electronic journals; 362.1
• DOI: 10.1016/j.puhe.2015.04.024
• Languages: English
• ISSNs: 0033-3506

Abstract

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.