NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston, Queensland, Australia.
Community Dent Oral Epidemiol. 2023 Jun;51(3):452-461. doi: 10.1111/cdoe.12776. Epub 2022 Jul 26.
Most studies on factors influencing dental attendance are cross-sectional and focus on specific age groups. The associations between private ancillary health insurance, tobacco smoking, alcohol consumption and overweight/obesity with dental attendance were examined in three cohorts of Australian women of different ages using multiple waves of data over similar time periods.
Data from 10 233, 12 378 and 7892 women born in 1973-1978, 1946-1951 and 1921-1926 participating in the Australian Longitudinal Study on Women's Health were used. Poisson regression using generalized estimating equations was used to investigate factors associated with self-report of not visiting the dentist in the 12 months before completing each wave.
The role of dental non-attendance was higher in women without insurance (versus those with insurance) in all cohorts with adjusted rate ratios (RR) of 1.52 95% CI 1.48-1.57, RR 1.45 95% CI 1.41-1.49 and RR 1.32 95% CI 1.28-1.36 in the 1973-78, 1946-51 and 1921-26 cohorts respectively. Current smokers at any intensity (versus never smokers) had a higher risk of non-attendance and the risk was strongest for women in the 1946-51 cohort who smoked ≥20 cigarettes/day (RR 1.35 95% CI 1.30-1.41). Compared with low-risk drinkers, non-drinkers were more likely to be non-attenders, but only in the two older cohorts. Women who were overweight or obese (versus healthy weight) were more likely to be non-attenders in all cohorts, with the risk of non-attendance higher with increasing BMI.
This study emphasizes the continued need to address socioeconomic inequities in access to dental care, along with strategies to overcome barriers for those who are obese or smoke. In this study, barriers to access existed for women of all ages, indicating that interventions need to be appropriate across age groups.
大多数关于影响牙科就诊因素的研究都是横断面研究，且聚焦于特定年龄组。本研究使用来自三个不同年龄队列的澳大利亚女性的多波数据，在相似的时间段内，考察了私人辅助健康保险、吸烟、饮酒和超重/肥胖与牙科就诊之间的关联。
本研究共纳入了 10233 名、12378 名和 7892 名分别于 1973-1978 年、1946-1951 年和 1921-1926 年出生的女性，这些女性参与了澳大利亚女性健康纵向研究。采用广义估计方程泊松回归，分析了每个波次完成前的 12 个月内自我报告未看牙医的相关因素。
在所有队列中，无保险（而非有保险）的女性牙科就诊率较低，调整后的相对危险比（RR）分别为 1.52（95%可信区间 1.48-1.57）、1.45（95%可信区间 1.41-1.49）和 1.32（95%可信区间 1.28-1.36）。任何强度的当前吸烟者（而非从不吸烟者）的就诊风险更高，风险最强的是 1946-51 队列中每天吸烟≥20 支的女性（RR 1.35，95%可信区间 1.30-1.41）。与低风险饮酒者相比，非饮酒者更有可能不就诊，但仅在两个较年长的队列中如此。在所有队列中，超重或肥胖者（而非健康体重者）更有可能不就诊，且 BMI 越高，就诊风险越高。
本研究强调了继续解决牙科保健获取方面的社会经济不平等问题的必要性，以及为肥胖或吸烟的人群克服障碍的策略。在本研究中，所有年龄段的女性都存在就诊障碍，这表明干预措施需要在所有年龄段都适用。
