Bas A C, Azogui-Lévy S
Université Paris Diderot, UFR d'odontologie, LEPS EA 3412, 5, rue Garancière, 75006 Paris, France.
Université Paris Diderot, UFR d'odontologie, LEPS EA 3412, 5, rue Garancière, 75006 Paris, France.
Rev Epidemiol Sante Publique. 2020 Apr;68(2):91-98. doi: 10.1016/j.respe.2019.12.002. Epub 2020 Feb 20.
People with chronic disease often have dental (especially periodontal) disorders. Nevertheless, people with chronic disease seek dental care less often than others. We wanted to know if there is a relationship between the consumption of medical care and the consumption of dental care, and if so if the relationship is especially strong for people with chronic disease.
We conducted a longitudinal study that combined two data-sets: consumption data from the French National Health Insurance Fund and health and socioeconomic welfare data collected with a dedicated national survey. We studied healthcare expenditure and analyzed the association between healthcare consumption, health status and healthcare expenditure over a four-year period (2010-2013).
People who did not seek medical or dental care in 2010 exhibited irregular consumer behavior thereafter. This pattern was particularly evident among those with chronic disease whose healthcare expenditures did not stabilize during the study period compared with the rest of the study population. Among people who did not seek medical care in 2010, variation in average dental care expenditure was 91% in people with chronic disease versus 42% for those without chronic disease. Lack of medical care during the first year of the study was also associated with greater expenditure-delay in people with chronic disease (77%) compared with 15% in people without chronic disease.
The lack of medical or dental care in 2010 for people with chronic disease did not lead to an increase in medical and dental consumption in the following years. The catch-up delay was longer than four years. This highlights a problem of monitoring and identifies a marginalized population within the healthcare system.
慢性病患者常伴有牙齿（尤其是牙周）疾病。然而，慢性病患者寻求牙科护理的频率低于其他人。我们想了解医疗护理的使用与牙科护理的使用之间是否存在关联，若存在关联，对于慢性病患者而言这种关联是否尤为显著。
我们开展了一项纵向研究，该研究合并了两个数据集：法国国家健康保险基金的消费数据以及通过一项专门的全国性调查收集的健康和社会经济福利数据。我们研究了医疗保健支出，并分析了四年期间（2010 - 2013年）医疗保健消费、健康状况与医疗保健支出之间的关联。
2010年未寻求医疗或牙科护理的人此后呈现出不规律的消费行为。这种模式在慢性病患者中尤为明显，与研究中的其他人群相比，他们在研究期间的医疗保健支出并未稳定下来。在2010年未寻求医疗护理的人群中，慢性病患者的平均牙科护理支出变化为91%，而无慢性病患者为42%。研究第一年未接受医疗护理也与慢性病患者更高的支出延迟相关（77%），相比之下，无慢性病患者为15%。
慢性病患者在2010年未接受医疗或牙科护理并未导致在随后几年中医疗和牙科消费增加。追赶延迟超过四年。这凸显了监测问题，并识别出了医疗保健系统中的一个边缘化群体。
