Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand.
J Dent. 2018 Aug;75:1-6. doi: 10.1016/j.jdent.2018.04.010. Epub 2018 Apr 16.
Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors.
Three electronic databases (Medline, Embase, Central) were searched (2005-2017).
We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy.
The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p < 0.001). Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present.
Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization.
Higher developmental status of countries is reflected in greater regular/preventive utilization of dental services. However, large demographic, health-related and social differences in utilization remain. These may contribute to dental health inequalities.
定期/预防性的牙科服务利用是医疗保健获取的一个指标，与改善健康结果相关。我们评估了定期/预防性利用牙科服务的个体比例，以及人口统计学、与健康相关和社会因素如何影响这一比例。
三个电子数据库（Medline、Embase、Central）进行了检索（2005-2017 年）。
我们纳入了研究预防性/常规牙科服务利用与年龄、口腔和一般健康、无牙、家庭结构和健康素养之间关联的观察性研究。
我们提取了总体和不同亚组中定期/预防性利用个体的比例。采用随机效应荟萃分析，并按地区进行亚组分析。采用Meta 回归评估关联是否以及如何随时间和国家人类发展状况（HDI）而变化。来自 28 个国家的 7395697 名参与者的 103 项研究被纳入。全球平均（95%CI）定期/预防性利用牙科服务的个体比例为 54%（50-59%）。在人类发展指数较高的国家，更多的人定期/预防性地利用服务（p<0.001）。年龄对成年人的利用没有显著影响（OR=1.00；0.89-1.12）。与年龄较大的儿童相比，年龄较小的儿童利用服务的比例显著较低（OR=0.52；0.46-0.59），一般健康状况较差的个体（OR=0.73；0.65-0.80）和口腔健康状况较差的个体（OR=0.64；0.52-0.75）、无牙个体（OR=0.32；0.23-0.41）、家庭结构支持较少的个体（OR=0.81；0.73-0.89）或健康素养较差的个体（OR=0.41；0.01-0.81）。人群内的观察到的差异在时间上没有显著变化，并且普遍存在。
定期/预防性的利用在国家之间和国家内部差异很大。了解和解决这一现象背后的原因可能有助于持续改善利用情况。
国家较高的发展水平反映在更频繁/预防性地利用牙科服务上。然而，利用方面仍然存在巨大的人口统计学、与健康相关和社会差异。这些可能导致牙科健康不平等。
