Health Care Unit, RAND, Arlington, Virginia, USA.
Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA.
J Public Health Dent. 2022 Jun;82(3):271-279. doi: 10.1111/jphd.12518. Epub 2022 Apr 3.
To examine variation in the delivery of fluoride varnish during pediatric medical visits by rurality.
This observational study used private health insurance claims (2016-2018) for children aged 1-5 years from Connecticut, Maine, New Hampshire, and Rhode Island linked to the county-level Rural-Urban Continuum codes. County-level Rural-Urban Continuum codes were categorized into three groups: metropolitan, rural, and remote rural. Logistic regression models were used to estimate the odds of a well-child medical visit including fluoride varnish by county rurality, adjusting for other individual and county characteristics.
Among 328,661 pediatric well-child visits paid by private insurance, fluoride varnish was included in 4.3% of visits in metropolitan counties, 6.2% of visits in rural counties, and 10.3% of visits in remote rural counties. There were significantly higher odds of a visit including fluoride varnish in rural remote counties (odds ratio [OR] = 3.5, 95% confidence interval [CI] = 2.3-5.3, p < 0.001) and in rural counties (OR = 2.4, 95% CI = 1.4-4.0, p < 0.001) compared to metropolitan counties. Rates of fluoride varnish during well-child visits increased since 2016 in metropolitan counties and remained stable in rural counties.
All young children are recommended to receive fluoride varnish applications in medical settings, yet overall rates were low. For privately insured young children, pediatric well-child medical visits were more likely to include fluoride varnish in rural and rural remote counties than metropolitan counties.
根据农村地区的不同，研究在儿科医疗就诊期间氟化物漆的使用情况。
本观察性研究使用了 2016 年至 2018 年康涅狄格州、缅因州、新罕布什尔州和罗德岛州私人健康保险索赔（针对 1 至 5 岁儿童），并与县一级的农村-城市连续体代码相关联。县一级的农村-城市连续体代码分为三组：都市、农村和偏远农村。使用逻辑回归模型来估计按县农村情况，包括氟化物漆在内的儿童健康检查就诊的可能性，同时调整了其他个人和县级特征。
在由私人保险支付的 328661 次儿科健康检查就诊中，氟化物漆包含在大都市县就诊的 4.3%、农村县就诊的 6.2%和偏远农村县就诊的 10.3%。农村偏远县（优势比[OR] = 3.5，95%置信区间[CI] = 2.3-5.3，p<0.001）和农村县（OR = 2.4，95%置信区间[CI] = 1.4-4.0，p<0.001）就诊中包含氟化物漆的可能性明显更高。大都市县自 2016 年以来，儿童健康检查中氟化物漆的使用比例有所增加，而农村县的比例则保持稳定。
所有幼儿都被建议在医疗环境中接受氟化物漆的应用，但总体比例仍然较低。对于私人保险的幼儿来说，儿科健康检查就诊中包含氟化物漆的可能性在农村和农村偏远县比大都市县更高。
