Jaffe Kaitlyn, Choi JinCheol, Hayashi Kanna, Milloy M-J, Richardson Lindsey
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Department of Sociology, University of British Columbia, Vancouver, BC, Canada.
Health Soc Care Community. 2021 Nov;29(6):1799-1806. doi: 10.1111/hsc.13289. Epub 2021 Jan 25.
In Canada, publicly funded healthcare provides no-cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment- and income-dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed-effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58-0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59-0.95) and cannabis (AOR = 0.78, 95% CI = 0.63-0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42-0.70) and street-based income generation (AOR = 0.75, 95% CI = 0.59-0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07-1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05-2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities.
在加拿大，公共资助的医疗保健提供了一套庞大但并不全面的免费服务。牙科护理主要由私人保险或患者提供资金，这在获得护理方面造成了依赖就业和收入的差距。在包括吸毒者（PWUD）在内的弱势群体中，获得牙科护理的困难可能会加剧，这些人可能因药物使用的副作用和健康合并症而有更大的牙科需求，同时还面临护理障碍。本研究利用2014年至2018年期间从加拿大温哥华两项正在进行的吸毒者前瞻性队列研究中收集的数据，旨在探讨与获得牙科护理相关的因素。在1638名参与者中，246名参与者（15%）报告从未或仅偶尔获得足够的牙科护理。在广义线性混合效应模型中，结果显示，获得牙科护理与使用阿片类药物（调整后的优势比[AOR]=0.73，95%置信区间[CI]=0.58-0.91）、甲基苯丙胺（AOR=0.75，95%CI=0.59-0.95）和大麻（AOR=0.78，95%CI=0.63-0.97）之间存在显著的负相关，同时与经历无家可归（AOR=0.54，95%CI=0.42-0.70）和以街头为生的收入来源（AOR=0.75，95%CI=0.59-0.94）也存在显著的负相关。获得足够的牙科护理与因阿片类药物依赖而接受阿片类药物激动剂治疗（OAT）（AOR=1.36，95%CI=1.07-1.72）和获得收入援助（AOR=1.70，95%CI=1.05-2.77）之间存在显著的正相关。这些结果突出了可能阻碍获得牙科护理的特定药物使用模式和结构性暴露，以及收入援助和OAT的直接和间接益处如何改善获得护理的情况。这些发现为最近扩大医疗保健覆盖范围和解决牙科护理不平等问题的呼吁提供了支持。
