Predictors of dental care utilization in north-central Appalachia in the USA
Predictors of dental care utilization in north-central Appalachia in the USA
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DOI：
10.1111/cdoe.12453
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发表时间：
2019-08-01
影响因子：
2.3
通讯作者：
McNeil, Daniel W.
中科院分区：
文献类型：
--
作者：
Chen, Mengxia;Wright, Casey D.;McNeil, Daniel W.
目的牙科使用是口腔健康和幸福的重要决定因素。本研究的目的是评估各种生物心理社会因素和牙科利用率之间的潜在关联，在美国中北部的阿巴拉契亚，一个地区的口腔健康的差距是深刻的。方法本研究使用来自阿巴拉契亚口腔健康研究中心（COHRA 1）在阿巴拉契亚中北部的研究，包括449个家庭，868名成年人的家庭为基础的数据。广义估计方程（GEE）的方法被用来确定最佳拟合的预测模型的成年家庭成员之间的牙齿利用。结果：在西弗吉尼亚州和宾夕法尼亚州，平均而言，在3年的时间内，拥有牙科保险与更高的牙科利用率相关（OR = 2.20，95%CI = 1.54，3.14）。当按州分层时，仅西弗吉尼亚州（OR = 2.41，95%CI = 1.54，3.79）的相关性，宾夕法尼亚州居民（OR = 1.50，95%CI = 0.80，2.79）的相关性不显著。来自宾夕法尼亚州的个人更有可能利用牙科护理，而来自西弗吉尼亚州的参与者则较少（2.31，95% CI = 1.57，3.40）。来自宾夕法尼亚州的女性比男性更有可能定期寻求牙科护理（OR = 1.44，95%CI = 1.00，2.05），在西弗吉尼亚州，较高的收入与定期牙科就诊的频率较高（OR = 1.21，95%CI = 1.09，1.34）。来自宾夕法尼亚州的人得分较高的生理唤醒子量表的牙科恐惧调查更有可能参加常规护理访问（OR = 1.18，95% CI = 1.03，1.35）。在这两个国家，更多的宿命论的信念与口腔保健也预测较少的常规护理（OR = 0.87，95%CI = 0.81，0.94），更多的投资或更积极的态度对一个人的口腔健康也与更高的利用率（OR = 1.18，95%CI = 1.13，1.23）。结论总体而言，这项研究的结果表明，州居民，性别，保险，收入，宿命论的信念，健康价值观，以及牙科护理相关的焦虑和恐惧方面预测的牙科护理利用率在中北部的阿巴拉契亚。这些发现强化了解决影响利用率的保险和其他经济因素的必要性，并考虑个人层面的宿命论信仰和口腔健康价值观如何影响常规口腔保健的利用。
Objectives Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. Methods This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. Results On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). Conclusions Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.