Chalmers Natalia I
Analytics and Publication, DentaQuest Institute, Columbia, MD, United States.
Front Public Health. 2017 Jul 18;5:164. doi: 10.3389/fpubh.2017.00164. eCollection 2017.
Hospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care.
2010-2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data.
Blacks, especially females aged 25-34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland's population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care.
There are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.
医院急诊科是许多美国人寻求牙科疾病治疗的场所。在牙科疾病方面，少数族裔利用急诊科的比例一直高于白人。对于这些差异的原因以及重大的公共卫生问题，人们的研究较少。在本文中，我们衡量了2010年至2013年马里兰州急诊科因牙科疾病出院的种族差异趋势。为了理解这些差异，我们还描述了不同种族群体在年龄、性别、收入、地点、支付方、合并症以及牙科护理可及性方面的差异。
分析使用了2010 - 2013年马里兰州的州急诊科数据。每10万人的比率是根据人口普查人口估计信息计算得出的。成本收费比用于估算急诊科出院的费用。牙科/口腔健康相关疾病（DOHRC）被定义为国际疾病分类第九版临床修订本（ICD - 9 - CM）编码520.0至529.9的出院诊断。描述性统计以及带有罕见事件校正的固定效应逻辑回归模型用于分析数据。
黑人，尤其是25 - 34岁的女性，因DOHRC导致的急诊科出院总数比例以及DOHRC的人口比率，均高于任何其他种族或族裔群体。2013年，黑人占马里兰州人口的30%，却承担了DOHRC急诊科费用的52%。西班牙裔和其他种族的DOHRC出院率则低得多。回归结果表明，黑人中DOHRC出院比例较高可能是由于黑人集中在低收入的中心城市，获得牙科护理的机会较少。
马里兰州在因DOHRC利用急诊科方面存在显著的种族差异。这些差异反映了由于成本和地理限制导致的牙科护理可及性不足。这导致了高昂的医疗成本以及对患者无效的解决方案。解决口腔健康差异将需要针对最有需求人群的政策解决方案，以及结合社区和州层面努力的行动计划。
