Sydenham Dental Centre and Essential Dental, Christchurch, Canterbury, New Zealand.
GeoHealth Laboratory, Geospatial Research Institute, Te Whare Wānanga o Waitaha, University of Canterbury, Christchurch, Canterbury, New Zealand.
Community Dent Oral Epidemiol. 2023 Jun;51(3):388-398. doi: 10.1111/cdoe.12858. Epub 2023 Apr 5.
Non-utilization of dental care during adolescence can result in poorer oral health and subsequently higher expenditures on dental services. This study examined the geospatial and epidemiological factors associated with utilization of the publicly funded Adolescent Oral Health Services (AOHS) in Canterbury, Aotearoa New Zealand (NZ).
A secondary analysis of prospectively collected routine data from AOHS visits of adolescents in school Year 9 (13-14 years) for the financial year 2019-2020. Geographic information systems examined distance from home to dental practices. Multilevel mixed-effects Poisson regression models investigated associations between geospatial, demographic and clinical factors and non-utilization of dental services. Models were adjusted for sex, ethnicity, area-level deprivation, rural/urban classification, previous caries experience and the distance from home address to dental practice referred.
Dental practices were concentrated in large urban areas and in the least deprived neighbourhoods, with several service area gaps identified. Rural areas and the most deprived areas of Christchurch City had the highest non-utilization rates. After adjustment, adolescents residing in the most deprived areas had a higher risk of non-utilization (adjusted risk ratio [aRR] = 1.38; 95% CI 1.26-1.51) compared to adolescents in the least deprived areas. Adolescents in remote areas also had an increased risk of non-utilization (aRR = 1.36; 95% CI 1.20-1.54) compared to adolescents in urban core areas. Finally, Māori (aRR = 1.37; 95% CI 1.29-1.46) and Pasifika (aRR = 1.46; 95% CI 1.35-1.59) adolescents had significantly higher risks of non-utilization compared to their NZ European counterparts.
Inequitable utilization of dental services exists among adolescents in Canterbury, NZ, and is associated with Māori, Pasifika and those living in rural and most deprived areas. Adolescents at the greatest oral health risk are geographically underserved by current oral health services. The current health system should also explore the possibility of partnering with Māori and Pasifika communities to provide services within culturally appropriate settings.
青少年在接受牙科保健方面的利用率较低可能会导致口腔健康状况较差，并随后增加对牙科服务的支出。本研究旨在调查与新西兰坎特伯雷地区青少年利用公共资助的青少年口腔健康服务（AOHS）相关的地理空间和流行病学因素。
对 2019-2020 财年 9 年级（13-14 岁）在校青少年 AOHS 就诊的前瞻性收集的常规数据进行二次分析。地理信息系统检查了家庭住址与牙科诊所之间的距离。多水平混合效应泊松回归模型调查了地理空间、人口统计学和临床因素与牙科服务未利用率之间的关联。模型根据性别、种族、地区贫困程度、城乡分类、既往龋齿经历以及家庭住址到就诊牙科诊所的距离进行了调整。
牙科诊所集中在大城市和贫困程度最低的社区，同时还发现了几个服务区域差距。农村地区和克赖斯特彻奇市最贫困的地区未利用率最高。调整后，与贫困程度最低地区的青少年相比，居住在最贫困地区的青少年未利用率更高（调整后的风险比 [aRR] = 1.38；95%CI 1.26-1.51）。偏远地区的青少年未利用率也有所增加（aRR = 1.36；95%CI 1.20-1.54），与城市核心地区的青少年相比。最后，与新西兰欧洲裔青少年相比，毛利人（aRR = 1.37；95%CI 1.29-1.46）和太平洋岛裔青少年（aRR = 1.46；95%CI 1.35-1.59）的未利用率明显更高。
新西兰坎特伯雷地区青少年的牙科服务利用不平等，与毛利人、太平洋岛裔以及农村和最贫困地区的人有关。口腔健康风险最高的青少年在地理上得不到当前口腔卫生服务的充分服务。当前的卫生系统还应探讨与毛利人和太平洋岛裔社区合作，在文化上合适的环境中提供服务的可能性。
