A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system.
A paradox of need: Gaps in access to dental care among people who use drugs in Canada's publicly funded healthcare system.
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DOI：
10.1111/hsc.13289
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发表时间：
2021-11
影响因子：
2.4
通讯作者：
Richardson L
中科院分区：
文献类型：
--
作者：
Jaffe K;Choi J;Hayashi K;Milloy MJ;Richardson L
在加拿大，公共资助的医疗保健提供免费获得大量但不全面的服务。牙科保健主要由私人保险或病人提供资金，造成了保健机会方面的就业和收入差距。在弱势群体中，包括吸毒者（PWUD），由于药物使用和健康合并症的副作用以及护理障碍，他们可能会遇到更大的牙科需求，因此难以获得牙科护理。本研究使用2014年至2018年期间在加拿大温哥华进行的两项PWUD前瞻性队列研究中收集的数据，旨在探索与牙科护理相关的因素。在1638名参与者中，246名参与者（15%）报告从未或仅偶尔获得足够的牙科护理。在广义线性混合效应模型中，结果显示获得牙科护理和使用阿片类药物之间存在显着的负相关（调整后的比值比[AOR]=0.73，95%置信区间[CI]=0.58-0.91），甲基苯丙胺（AOR=0.75，95% CI=0.59-0.95），大麻（AOR=0.78，95% CI=0.63-0.97），以及经历无家可归（AOR=0.54，95% CI=0.42-0.70）和街头创收（AOR=0.75，95% CI=0.59-0.94）。充分的牙科护理与阿片类药物依赖的阿片类激动剂治疗（OAT）（AOR=1.36，95% CI=1.07-1.72）和接受收入援助（AOR=1.70，95% CI=1.05-2.77）之间存在显著正相关。这些结果突出了可能阻碍牙科保健获得的特定物质使用模式和结构性暴露，以及收入援助和OAT的直接和间接好处如何改善获得。这些发现为最近呼吁扩大医疗保健覆盖范围和解决牙科保健不公平问题提供了支持。
In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need, due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalized linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR]=0.73, 95% Confidence Interval [CI]=0.58–0.91), methamphetamine (AOR=0.75, 95% CI=0.59–0.95), and cannabis (AOR=0.78, 95% CI=0.63–0.97), as well experiencing homelessness (AOR=0.54, 95% CI=0.42–0.70) and street-based income generation (AOR=0.75, 95% CI=0.59–0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR=1.36, 95% CI=1.07–1.72) and receiving income assistance (AOR=1.70, 95% CI=1.05–2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.
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