Maternal and Child Health Epidemiology Program, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
Matern Child Health J. 2012 Dec;16 Suppl 2(0 2):320-9. doi: 10.1007/s10995-012-1099-3.
The objectives of this study is to identify factors associated with lack of preventive dental care among U.S. children and state-level factors that explain variation in preventive dental care access across states. We performed bivariate analyses and multilevel regression analyses among 68,350 children aged 5-17 years using the 2007 National Survey of Children's Health data and relevant state-level data. Odds ratios (ORs) for child- and state-level variables were calculated to estimate associations with preventive dental care. We calculated interval odds ratios (IOR), median odds ratios (MOR), and intraclass correlation coefficients (ICC) to quantify variation in preventive dental care across states. Lack of preventive dental care was associated with various child-level factors. For state-level factors, a higher odds of lack of preventive dental care was associated with a higher percentage of Medicaid-enrolled children not receiving dental services (OR = 1.30, 95 % confidence interval (CI): 1.15-1.47); higher percentage of children uninsured (OR = 1.48, 95 % CI: 1.29-1.69); lower dentist-to-population ratio (OR = 1.36, 95 % CI: 1.03-1.80); and lower percentage of dentists submitting Medicaid/State Children's Health Insurance Program claims (OR = 1.04, 95 % CI: 1.01-1.06). IORs for the first three state-level factors did not contain one, indicating that these state-level characteristics were important in understanding variation across states. Lack of preventive dental care varied by state (MOR = 1.40). The state-level variation (ICC = 3.66 %) accounted for a small percentage of child- and state-level variation combined. Child- and state-level characteristics were associated with preventive dental care access among U.S. children aged 5-17 years. State-level factors contribute to variation in dental care access across states and need to be considered in state-level planning.
本研究旨在确定与美国儿童缺乏预防性牙科保健相关的因素，以及解释各州之间预防性牙科保健获取情况差异的州级因素。我们使用 2007 年全国儿童健康调查数据和相关州级数据，对 68350 名 5-17 岁儿童进行了双变量分析和多层次回归分析。计算了儿童和州级变量的比值比（OR），以估计与预防性牙科保健的关联。我们计算了间隔比值比（IOR）、中位数比值比（MOR）和组内相关系数（ICC），以量化各州之间预防性牙科保健的差异。缺乏预防性牙科保健与各种儿童层面的因素有关。对于州级因素，接受医疗补助但未接受牙科服务的儿童比例较高（OR=1.30，95%置信区间（CI）：1.15-1.47）、儿童未参保比例较高（OR=1.48，95%CI：1.29-1.69）、牙医与人口比例较低（OR=1.36，95%CI：1.03-1.80）以及提交医疗补助/州儿童健康保险计划索赔的牙医比例较低（OR=1.04，95%CI：1.01-1.06），与缺乏预防性牙科保健的关联性更高。前三个州级因素的 IOR 不包含 1，这表明这些州级特征对于理解各州之间的差异很重要。缺乏预防性牙科保健的情况因州而异（MOR=1.40）。州级差异（ICC=3.66%）占儿童和州级差异总和的一小部分。儿童和州级特征与美国 5-17 岁儿童获得预防性牙科保健的情况有关。州级因素对各州之间的牙科保健获取情况差异有影响，需要在州级规划中加以考虑。
