评估美国东南部各州儿科口腔保健的可及性。
Evaluating access to pediatric oral health care in the southeastern states.
出版信息
J Am Dent Assoc. 2022 Apr;153(4):330-341.e12. doi: 10.1016/j.adaj.2021.09.005. Epub 2022 Feb 3.
BACKGROUND
In this article, the authors addressed shortcomings in existing research on pediatric oral health care access using rigorous data and methods for identifying statistically significant disparities in oral health care access for children.
METHODS
The study population included children, differentiated by insurance status (Medicaid, Children's Health Insurance Program, private, none). The authors measured provider-level supply as the number of oral health care visits, stratified by provider type and urbanicity-rurality. The authors defined demand as the number of dental visits for children and derived demand and supply mainly from 2019 and 2020 data. Using statistical modeling, the authors evaluated where disparities in travel distance across communities or by insurance status were statistically significant.
RESULTS
Although Dental Health Professional Shortage Areas are primarily rural, this study found that the proportions of rural, suburban, and urban communities identified for access interventions ranged from 24% through 66% and from 8% through 86%, respectively. For some states (Florida, Louisiana, Texas), rural and suburban communities showed a need for interventions for all children, whereas in the remaining states, the lack of Medicaid and Children's Health Insurance Program access mainly contributed to these disparities. Variations in access disparities with respect to insurance status across states or by urbanicity-rurality were extensive, with the rate of communities identified for reducing disparities ranging from 1% through 100%.
CONCLUSIONS
All states showed a need for access interventions and for reducing disparities due to geographic location or insurance status. The sources of disparities were different across states, suggesting need for different policies and interventions across the 10 states.
PRACTICAL IMPLICATIONS
The study findings support the need for policies toward reducing disparities in oral health care access.
背景
本文作者使用严格的数据和方法来解决现有儿童口腔保健服务获取研究中的不足，以确定儿童口腔保健服务获取方面存在统计学显著差异。
方法
研究人群包括儿童，根据保险状况（医疗补助、儿童健康保险计划、私人、无保险）进行区分。作者以提供者类型和城乡分布为分层标准，测量了提供者层面的供应，即口腔保健服务的就诊次数。作者将儿童的就诊次数定义为需求，并主要从 2019 年和 2020 年的数据中推导出需求和供应。作者使用统计模型评估了社区间或保险状况下的旅行距离差异是否具有统计学意义。
结果
尽管牙科卫生专业短缺地区主要位于农村，但本研究发现，确定为需要进行获取干预的农村、郊区和城市社区的比例分别为 24%至 66%和 8%至 86%。对于某些州（佛罗里达州、路易斯安那州、德克萨斯州），农村和郊区社区的所有儿童都需要进行干预，而在其余各州，缺乏医疗补助和儿童健康保险计划主要导致了这些差异。各州之间的保险状况或城乡分布对获取差异的影响存在广泛差异，减少差异的社区比例从 1%至 100%不等。
结论
所有州都需要进行获取干预和减少因地理位置或保险状况而导致的差异。各州之间的差异来源不同，这表明需要在这 10 个州实施不同的政策和干预措施。
实践意义
研究结果支持采取政策减少口腔保健服务获取方面的差异。
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