Simon Lisa, Karhade Deepti Shroff, Fox Kathe, Barrow Jane, Palmer Nathan
Dr. Simon is a fellow, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Mass., USA;, Email:
Dr. Karhade is a resident, Division of Pediatric and Public Health, Adams School of Dentistry, at the University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
Pediatr Dent. 2020 Sep 15;42(5):387-391.
The purpose of this study was to determine differences in dental services received between rural and urban residents in a national sample of children with private insurance. This was a retrospective study of deidentified claims data from a major national private insurer. Children younger than 18 years of age enrolled throughout 2018 and who had at least one visit to the dentist that year were included. Differences in the frequency of dental procedures received were determined by chi-square tests. Multilevel logistic regression was used to evaluate the effect of individual-level and ZIP Code-level covariates, including rurality, on the odds of receiving a preventive dental service or having a tooth extracted. A total of 603,064 children, with an average age of 10.2±4.4 (standard deviation) years, visited a dentist, and 6.52 percent lived in a rural area. In a multilevel logistic regression correcting for patient age, patient gender, ZIP Code average income, and dental provider density, rurality was positively associated with receiving a tooth extraction (odds ratio [OR] equals 1.06; P<0.001) and negatively associated with receiving a preventive service (OR equals 0.85; P<0.001). Female gender was a negative predictor of preventive services and a predictor of having a tooth extracted. Children living in rural areas had reduced rates of preventive dental care and higher rates of tooth extraction than their nonrural counterparts.
本研究的目的是确定全国范围内有私人保险的儿童样本中，农村和城市居民接受牙科服务的差异。这是一项对来自一家大型全国性私人保险公司的匿名索赔数据的回顾性研究。纳入了2018年全年登记的、当年至少去看了一次牙医的18岁以下儿童。通过卡方检验确定接受牙科治疗程序频率的差异。使用多水平逻辑回归来评估个体层面和邮政编码层面的协变量（包括农村地区）对接受预防性牙科服务或拔牙几率的影响。共有603,064名儿童去看了牙医，平均年龄为10.2±4.4（标准差）岁，其中6.52%居住在农村地区。在对患者年龄、患者性别、邮政编码平均收入和牙科服务提供者密度进行校正的多水平逻辑回归中，农村地区与拔牙呈正相关（优势比[OR]等于1.06；P<0.001），与接受预防性服务呈负相关（OR等于0.85；P<0.001）。女性性别是预防性服务的负预测因素和拔牙的预测因素。与非农村地区的儿童相比，农村地区的儿童接受预防性牙科护理的比例较低，拔牙的比例较高。
