Manski Richard J, Cohen Leonard A, Brown Erwin, Carper Kelly V, Vargas Clemencia, Macek Mark D
Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA.
J Public Health Dent. 2014 Summer;74(3):219-26. doi: 10.1111/jphd.12049. Epub 2014 Jan 15.
The oral health of older Americans will assume increasing importance because of their increasing numbers and the evolving connections between oral health and general health. To establish a baseline and provide data for oral health workforce models, this report describes the types of dental procedures received by US adults 65 years and older in 2009 and looks at trends since 1999.
Data for this analysis came from the 1999 and 2009 Medical Expenditure Panel Survey. The primary outcome variable represented the types of dental procedures that were received during a dental visit in the preceding year. Descriptive variables included dental insurance and poverty status. Analysis was restricted to adults aged 65 and over.
In 2009, diagnostic and preventive procedures accounted for almost three-quarters of all services. Compared with services received by those with private insurance, there were significantly fewer diagnostic and endodontic procedures among those with public coverage. Between 1999 and 2009, the proportion of preventive services significantly increased, whereas the proportion of restorative and endodontic services significantly decreased. Also, the likelihood of receiving preventive procedures increased, whereas the probability of receiving restorative or endodontic services decreased.
Findings point to a shift in the mix of dental services received by older adults during the two periods. The predominance of diagnostic and preventive procedures has important access and workforce implications. An expanded role for dental hygienists in helping to meet the oral health needs of older adults is possible given a hygienist's current scope of practice.
由于美国老年人数量不断增加以及口腔健康与整体健康之间的联系不断演变,美国老年人的口腔健康将变得越来越重要。为了建立基线并为口腔卫生人力模型提供数据,本报告描述了2009年65岁及以上美国成年人接受的牙科治疗类型,并研究了自1999年以来的趋势。
本分析的数据来自1999年和2009年的医疗支出小组调查。主要结果变量代表前一年牙科就诊期间接受的牙科治疗类型。描述性变量包括牙科保险和贫困状况。分析仅限于65岁及以上的成年人。
2009年,诊断和预防程序占所有服务的近四分之三。与拥有私人保险的人接受的服务相比,拥有公共保险的人接受的诊断和牙髓治疗程序明显较少。1999年至2009年期间,预防服务的比例显著增加,而修复和牙髓治疗服务的比例显著下降。此外,接受预防程序的可能性增加,而接受修复或牙髓治疗服务的概率下降。
研究结果表明,在这两个时期,老年人接受的牙科服务组合发生了变化。诊断和预防程序的主导地位对就医机会和劳动力有重要影响。鉴于目前口腔保健员的执业范围,他们在帮助满足老年人口腔健康需求方面发挥更大作用是有可能的。