Dental Care Utilization by Adults in a Socially Diverse Metropolitan Area
Abstract
Objectives: This study assessed the association of dental care utilization with individual and contextual characteristics, and measured disparities based on age and contextual deprivation.
Materials and Methods: This cross-sectional study recruited 1,510 randomly selected adults residing in Tehran by phone-based interviews between January 2023 and June 2023. A questionnaire that consisted of questions about predisposing (sociodemographic), enabling (economic status, insurance coverage, neighborhood deprivation, and dental knowledge), and needs characteristics (oral health-related problems, and time loss) influencing dental care utilization was used for data collection. Dental care utilization was assessed using a dichotomized variable. The hierarchical logistic regression model and concentration indices were applied for data analysis using STATA 16 (alpha=0.05).
Results: The participants' mean age was 46.21±18.43 years. Approximately 48.0% of the participants reported no dental care utilization. Enabling sources [dental insurance (P<0.001) and neighborhood deprivation (P<0.001)], and need factors [time loss due to oral conditions (P<0.001) and not wearing dentures P<0.001)] were significantly associated with dental care utilization. Age as a predisposing factor had a significant association with dental care utilization with a concentration index of -0.27 (P<0.001). Conversely, the concentration index of socioeconomic status was 0.03 (P=0.005).
Conclusion: Disparities in dental care utilization were evident in more affluent groups and among younger age groups. Dental care utilization was associated with psychosocial loss, productivity loss, and contextual deprivation barriers. Moreover, Andersen’s model revealed that social structure, time loss, and enabling sources, rather than the other indicators, determined dental care utilization.
2. Hayes A, Azarpazhooh A, Dempster L, Ravaghi V, Quiñonez C. Time loss due to dental problems and treatment in the Canadian population: analysis of a nationwide cross-sectional survey. BMC Oral Health. 2013 Apr;13(1):17.
3. Singh KA, Brennan DS. Use of dental services among middle-aged adults: predisposing, enabling and need variables. Aust Dent J. 2021 Sep;66(3):270-7.
4. Tan YR, Tan EH, Jawahir S, Mohd Hanafiah AN, Mohd Yunos MH. Demographic and socioeconomic inequalities in oral healthcare utilisation in Malaysia: evidence from a national survey. BMC Oral Health. 2021 Jan;21(1):34.
5. Chen M, Wright CD, Tokede O, Yansane A, Montasem A, Kalenderian E, et al. Predictors of dental care utilization in north-central Appalachia in the USA. Community Dent Oral Epidemiol. 2019 Aug;47(4):283-90.
6. Galvão MHR, Medeiros ADA, Roncalli AG. Using Andersen's behavioural model to examine individual and contextual factors associated with dental service utilization in Brazil. Community Dent Oral Epidemiol. 2023 Oct;51(5):746-54.
7. Najafi E, Amini-Rarani M, Moeeni M. Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels. BMC Oral Health. 2021 Oct;21(1):550.
8. Rezaei S, Hajizadeh M, Irandoost SF, Salimi Y. Socioeconomic inequality in dental care utilization in Iran: a decomposition approach. Int J Equity Health. 2019 Oct;18(1):161.
9. Krause DD, May WL, Lane NM, Cossman JS, Konrad TR. An analysis of oral health disparities and access to services in the Appalachian region. University of Mississippi Medical Center; 2011. Chapter 2; p. 30-32.
10. McNeil DW, Hayes SE, Randall CL, Polk DE, Neiswanger K, Shaffer JR, et al. Depression and rural environment are associated with poor oral health among pregnant women in Northern Appalachia. Behav Modif. 2016 Jan-Mar;40(1-2):325-40.
11. Vargas CM, Dye BA, Hayes KL. Oral health status of rural adults in the United States. J Am Dent Assoc. 2002 Dec;133(12):1672-81.
12. Esmailnasab N, Hassanzadeh J, Rezaeian S, Barkhordari M. Use of health care services and associated factors among women. Iran J Public Health. 2014 Jan;43(1):70-8.
13. Bahramian H, Mohebbi SZ, Khami MR, Asadi-Lari M, Shamshiri AR, Hessari H. Psychosocial determinants of dental service utilization among adults: Results from a population-based survey (Urban HEART-2) in Tehran, Iran. Eur J Dent. 2015 Oct-Dec;9(4):542-50.
14. Ahmadi A, Jahangard E. Ranking of the neighborhoods of Tehran metropolis in terms of development and quality of life: a fuzzy TOPSIS approach. Urban Econ. 2020 Apr;5(1):127-48.
15. Sahab DA, Bamashmous MS, Ranauta A, Muirhead V. Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia. BMC Oral Health. 2022 Apr;22(1):135.
16. Gholami M, Pakdaman A, Montazeri A, Virtanen JI. Evaluation of the impact of a mass media campaign on periodontal knowledge among Iranian adults: a three-month follow-up. PLoS One. 2017 Jan;12(1):e0170464.
17. Tadin A, Badrov M. Oral health knowledge, self-assessed oral health behavior, and oral hygiene practices among the adult general population in Croatia. Healthcare (Basel). 2023 Dec;12(1):88.
18. Singh A, Gambhir RS, Singh S, Kapoor V, Singh J. Oral health: How much do you know?–A study on knowledge, attitude and practices of patients visiting a North Indian dental school. European journal of dentistry. 2014 Jan;8(01):063-7..
19. Andersen R. A behavioral model of families' use of health services. 1968;(25).
20. Yaghoubi Z, Khajedaluee M, Mohammadi T. Introducing a valid questionnaire for assessment of perceived oral health care needs, barriers to accessing oral health care services and its utility. Int J Dent Oral Health. 2017 Aug;3(4):1-4.
21. Lambert D. Zero-inflated Poisson regression, with an application to defects in manufacturing. Technometrics. 1992 Feb;34(1):1-14.
22. Biks GA, Shiferie F, Tsegaye DA, Asefa W, Alemayehu L, Wondie T, et al. High prevalence of zero-dose children in underserved and special setting populations in Ethiopia using a generalize estimating equation and concentration index analysis. BMC Public Health. 2024 Feb;24(1):592.
23. Manski RJ, Moeller JF, Maas WR. Dental services: an analysis of utilization over 20 years. J Am Dent Assoc. 2001 May;132(5):655-64.
24. Mariño R, Browning C, Kendig H. Factors associated with self-reported use of oral health services among older Melbournians. Australas J Ageing. 2007 Sep;26(3):141-4.
25. Maunder P, Landes DP, Steen N. The equity of access to primary dental care for children in the North East of England. Community Dent Health. 2006 Jun;23(2):116-9.
26. Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Melzer D. Neighbourhood deprivation and incident mobility disability in older adults. Age Ageing. 2008 Jul;37(4):403-10.
27. Lang IA, Llewellyn DJ, Langa KM, Wallace RB, Huppert FA, Melzer D. Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing. J Am Geriatr Soc. 2008 Feb;56(2):191-8.
28. Kubrin CE, Weitzer R. Retaliatory homicide: concentrated disadvantage and neighborhood culture. Soc Probl. 2003 May;50(2):157-80.
29. Bauder H. Neighbourhood effects and cultural exclusion. Urban Stud. 2002 Jan;39(1):85-93.
30. Campo M, Yon Y. The influence of social support on dental care utilization among older adults in Canada. Can J Dent Hyg. 2014 Oct;48(4):147-57.
31. Pouraskari Z, Yazdani R, Hessari H. Exploring the challenges in covering dental services through complementary insurance in Iran: a qualitative study. Int J Dent. 2024 Mar;2024:1-12.
32. Ramraj C. Dental treatment needs in the Canadian population [Master's Theses (2009)]. Toronto: University of Toronto; 2012.
33. Quiñonez C, Sherret L, Grootendorst P, Shim M, Azarpazhooh A, Locker D. An environmental scan of publicly financed dental care in Canada. Community Dental Health Services Research Unit and Office of the Chief Dental Officer, Health Canada. 2005.
34. Quiñonez C, Figueiredo R, Locker D. Disability days in Canada associated with dental problems: a pilot study. Int J Dent Hyg. 2011 May;9(2):132-5.
35. Reisine S, Miller J. A longitudinal study of work loss related to dental diseases. Soc Sci Med. 1985;21(12):1309-14.
36. McGrath C, Bedi R. Influences of social support on the oral health of older people in Britain. J Oral Rehabil. 2002 Oct;29(10):918-22.
37. Bahadori M, Ravangard R, Asghari B. Perceived barriers affecting access to preventive dental services: application of DEMATEL method. Iran Red Crescent Med J. 2013 Aug;15(8):655-62.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Dental Health Services Utilization Adults HealthCare Disparities Socioeconomic Factors Dental Health Services | ||
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