Change in Geographic Accessibility to Dental Clinics Affects Access to Care.
Change in Geographic Accessibility to Dental Clinics Affects Access to Care.
复制标题
牙科诊所地理可达性的变化会影响获得护理的机会。
DOI：
10.1177/00220345231167771
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发表时间：
2023
影响因子：
7.6
通讯作者：
Aida,J
中科院分区：
文献类型：
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作者：
Yamamoto,T;Hanazato,M;Hikichi,H;Kondo,K;Osaka,K;Kawachi,I;Aida,J
牙科诊所的可及性是社区服务环境的一个特征，可能会影响口腔医疗保健的利用。然而，住宅选择对因果推理提出了挑战。通过研究 2011 年东日本大地震和海啸 (GEJE) 幸存者的非自愿搬迁，我们研究了到牙科诊所的地理距离的变化与牙科就诊之间的关联。本研究对岩沼市直接受 GEJE 影响的一组老年居民的纵向数据进行了分析。基线调查于 2010 年进行，即 GEJE 发生前 7 个月，并于 2016 年进行随访。使用泊松回归模型，我们根据最近的牙科诊所到家中距离的变化，估计了假牙使用率（作为牙科就诊的代理）的发生率比 (IRR) 和 95% 置信区间 (CI)。基线年龄、灾难造成的住房损坏、经济状况恶化和体力活动恶化被用作混杂因素。在 GEJE 之前未佩戴假牙的 1,098 名参与者中，495 名是男性 (45.1%)，基线时的平均±标准差年龄为 74.0±6.9 岁。在 6 年的随访期间，372 名（33.9%）参与者开始使用假牙。与那些距离牙科诊所距离大幅增加（>370.0–6,299.1 m）的人相比，距离牙科诊所距离大幅缩短（>429.0–5,382.6 m）的灾难幸存者中开始使用假牙的比例明显较高（IRR = 1.28；95% CI，0.99–1.66）。严重住房损坏的经历与较高的假牙使用率独立相关（IRR = 1.77；95% CI，1.47−2.14）。改善牙科诊所的地理分布可能会增加灾难幸存者的牙科就诊次数。需要在非受灾地区进行进一步的研究来推广这些发现。
Access to dental clinics is a feature of the neighborhood service environment that may influence oral health care utilization. However, residential selection poses a challenge to causal inference. By studying the involuntary relocation of survivors of the 2011 Great East Japan Earthquake and Tsunami (GEJE), we examined the association between changes in geographic distance to dental clinics and dental visits. Longitudinal data from a cohort of older residents in Iwanuma City directly impacted by the GEJE were analyzed in this study. The baseline survey was conducted in 2010, 7 mo before the occurrence of GEJE, and a follow-up was conducted in 2016. Using Poisson regression models, we estimated the incidence rate ratios (IRR) and 95% confidence intervals (CIs) for the uptake of denture use (as a proxy for dental visits) according to changes in distance from the nearest dental clinic to their house. Age at baseline, housing damage by the disaster, deteriorating economic conditions, and worsened physical activity were used as confounders. Among the 1,098 participants who had not worn dentures before the GEJE, 495 were men (45.1%), with a mean ± SD age at baseline of 74.0 ± 6.9 y. During the 6-year follow-up, 372 (33.9%) participants initiated denture use. Compared to those who experienced a large increase in distance to dental clinics (>370.0–6,299.1 m), a large decrease in distance to dental clinics (>429.0–5,382.6 m) was associated with a marginally significantly higher initiation of denture use among disaster survivors (IRR = 1.28; 95% CI, 0.99–1.66). The experience of major housing damage was independently associated with higher initiation of denture use (IRR = 1.77; 95% CI, 1.47−2.14). Improved geographic access to dental clinics may increase dental visits of disaster survivors. Further studies in non-disaster-affected areas are needed to generalize these findings.