Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
Community Dent Oral Epidemiol. 2024 Jun;52(3):336-343. doi: 10.1111/cdoe.12962. Epub 2024 Apr 21.
BACKGROUND/AIM(S): Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore.
Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD.
Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies.
Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.
背景/目的：全球研究表明，智力和/或发育障碍者（IDD）的口腔疾病负担较高，这可归因于他们对牙科服务的利用率较低。本研究旨在评估收入和财政补贴对新加坡 IDD 患者接受牙科保健服务的影响。
2020 年 8 月至 2021 年 8 月，通过新加坡为 IDD 患者提供早期干预计划、特殊教育学校和成人协会的中心进行了一项横断面研究。591 名 IDD 儿童和成人的照顾者完成了调查。收集了社会人口学信息、口腔健康行为和牙科利用情况的数据。通过评估接受政府资助的、可选的社区保健援助计划（CHAS）的情况来评估财政补贴状况，该计划为低收入家庭提供了固定的牙科服务补贴金额，以用于初级保健环境。使用单变量、多变量逻辑回归和修正泊松回归进行统计分析。在 R 版本 4.0.2 中进行倾向评分匹配，以评估财政补贴对 IDD 患者口腔保健利用的影响。
与月总收入较低的患者相比，月总收入超过 4000 新加坡元的 IDD 患者过去一年至少进行一次牙科就诊、过去一年至少进行一次预防性牙科就诊、每年至少看一次牙医的调整后患病率比分别为 1.28（95%CI 1.08-1.52）、1.48（95%CI 1.14-1.92）和 1.36（95%CI 1.09-1.70）。在符合 CHAS 蓝色补贴条件的 247 名参与者中，有 160 人（62.0%）参加了 CHAS 蓝色计划，96 人（35.4%）每年至少看一次牙医。在符合 CHAS 蓝色补贴条件的人群中，参加 CHAS 蓝色补贴计划的个体之间的牙科服务利用率没有统计学上的显著差异。
较高的家庭收入与过去一年的牙科就诊、过去一年的预防性牙科就诊和每年至少一次的牙科就诊的患病率较高相关。CHAS 蓝色补贴本身对符合补贴条件的 IDD 患者的牙科利用率影响有限。
