The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.
The relationship between body system-based chronic conditions and dental utilization for Medicaid-enrolled children: a retrospective cohort study.
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DOI：
10.1186/1472-6831-12-28
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发表时间：
2012-08-07
期刊：
影响因子：
2.9
通讯作者：
Raklios NA
中科院分区：
文献类型：
--
作者：
Chi DL;Raklios NA
牙齿护理是慢性病儿童最常见的未满足的医疗保健需求。然而，轶事证据表明，并非所有患有慢性病的儿童都难以获得牙科护理。本研究的目的是评估医疗补助登记的慢性病儿童的牙科保健使用情况，并确定最不可能使用牙科保健服务的慢性病儿童亚组。这项研究的重点是2005年和2006年参加爱荷华州医疗补助计划的3-14岁慢性病儿童。自变量是儿童是否患有以下10种基于身体系统的慢性疾病（否/是）：血液学;心血管;颅面;糖尿病;内分泌;消化;耳/鼻/喉;呼吸;灾难性神经系统;或肌肉骨骼。主要结果指标是2006年使用任何牙科护理。2006年测量的次要结果是诊断性牙科护理、预防性牙科护理、常规修复性牙科护理和复杂修复性牙科护理的使用。我们使用泊松回归模型来估计与10种慢性疾病的5种结局指标中的每一种相关的相对风险（RR）。在10个慢性病亚组中，未经调整的牙科使用率范围从44.3%（患有灾难性神经系统疾病的儿童）到60.2%（患有肌肉骨骼疾病的儿童）。在调整模型协变量后，患有灾难性神经系统疾病的儿童使用大多数类型的牙科护理的可能性显着降低（RR：0.48至0.73）。当存在差异时，患有内分泌或颅面疾病的儿童不太可能使用牙齿护理，而患有血液或消化系统疾病的儿童更可能使用牙齿护理。与其他患有慢性疾病但没有这些特定疾病的儿童相比，患有呼吸道、肌肉骨骼或耳/鼻/喉疾病的儿童更有可能使用大多数类型的牙科护理（RR：1.03至1.13; 1.0至1.08; 1.02至1.12;分别）。糖尿病或心血管疾病儿童使用所有类型的牙科护理与其他患有慢性疾病但没有这些特殊疾病的儿童相比没有差异。牙科使用在慢性疾病亚组中并不均匀。在我们的研究中，近42%的儿童在2006年没有使用任何牙科护理。这些研究结果支持多层次临床干预措施的发展，这些干预措施针对的是最有可能在获得牙科护理方面遇到问题的慢性疾病的医疗补助儿童亚组。
Dental care is the most common unmet health care need for children with chronic conditions. However, anecdotal evidence suggests that not all children with chronic conditions encounter difficulties accessing dental care. The goals of this study are to evaluate dental care use for Medicaid-enrolled children with chronic conditions and to identify the subgroups of children with chronic conditions that are the least likely to use dental care services. This study focused on children with chronic conditions ages 3-14 enrolled in the Iowa Medicaid Program in 2005 and 2006. The independent variables were whether a child had each of the following 10 body system-based chronic conditions (no/yes): hematologic; cardiovascular; craniofacial; diabetes; endocrine; digestive; ear/nose/throat; respiratory; catastrophic neurological; or musculoskeletal. The primary outcome measure was use of any dental care in 2006. Secondary outcomes, also measured in 2006, were use of diagnostic dental care, preventive dental care, routine restorative dental care, and complex restorative dental care. We used Poisson regression models to estimate the relative risk (RR) associated with each of the five outcome measures across the 10 chronic conditions. Across the 10 chronic condition subgroups, unadjusted dental utilization rates ranged from 44.3% (children with catastrophic neurological conditions) to 60.2% (children with musculoskeletal conditions). After adjusting for model covariates, children with catastrophic neurological conditions were significantly less likely to use most types of dental care (RR: 0.48 to 0.73). When there were differences, children with endocrine or craniofacial conditions were less likely to use dental care whereas children with hematologic or digestive conditions were more likely to use dental care. Children with respiratory, musculoskeletal, or ear/nose/throat conditions were more likely to use most types of dental care compared to other children with chronic conditions but without these specific conditions (RR: 1.03 to 1.13; 1.0 to 1.08; 1.02 to 1.12; respectively). There was no difference in use across all types of dental care for children with diabetes or cardiovascular conditions compared to other children with chronic conditions who did not have these particular conditions. Dental utilization is not homogeneous across chronic condition subgroups. Nearly 42% of children in our study did not use any dental care in 2006. These findings support the development of multilevel clinical interventions that target subgroups of Medicaid-enrolled children with chronic conditions that are most likely to have problems accessing dental care.
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影响因子：
16.2
作者：
Lalla, E;Cheng, B;Lamster, IB
通讯作者：
Lamster, IB
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