Ghanbarzadegan Arash, Ju Xiangqun, Sohn Woosung, Jamieson Lisa
Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
Population Oral Health, Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Community Dent Oral Epidemiol. 2025 Feb;53(1):42-49. doi: 10.1111/cdoe.13004. Epub 2024 Aug 18.
Oral health is often overlooked in ageing health issues, despite its impact on overall health and quality of life. Older Australians, especially those in rural and remote areas, face difficulties accessing oral health services. The aim of the study was to investigate the factors that contribute to financial barriers to accessing dental services among the ageing population in Australia in relation to their residential location.
The study included a weighted sample of Australian adults aged 65 years and over from a population-based survey called the National Study of Adult Oral Health (NSAOH) conducted in 2017-18. Descriptive analysis was conducted and generated cross-tabulation tables to investigate the distributions of the outcome, exposure and covariates, including Sex, Education level (the highest level of education), Equivalised household income, Dental insurance, Concession card ownership, Difficulty paying a dental bill and last dental visit. Blinder-Oaxaca decomposition counterfactual analysis was used to explore the potential impact of a person's residence on their financial difficulty accessing dental services.
The findings showed that 26.2% (95% CI: 24.3-29.3) of major city residents and 30.1% (95% CI: 26.9-33.3) of rural residents avoided or delayed dental visits due to cost. The decomposition analysis indicated that 53.8% of the disparities in the prevalence of avoided or delayed dental visits due to cost were explained by the selected variables, while 46.2% remained unexplained. The explanatory variable with the largest contribution was difficulty paying a $200 dental bill, accounting for 62.4% of the differences, followed by dental insurance, last dental visit and equivalised household income, which explained 42.1%, 20.8% and 14.9% of the differences, respectively.
Regional/remote populations experience more financial barriers to accessing dental care than major city populations and the identified factors explain a significant proportion of these disparities. Based on the study findings, recommendations include expanding public dental service coverage, evaluating concession card mechanisms and advocating for regular dental visits to mitigate disparities in dental care access.
尽管口腔健康对整体健康和生活质量有影响，但在老龄健康问题中，口腔健康常常被忽视。澳大利亚老年人，尤其是农村和偏远地区的老年人，在获得口腔健康服务方面面临困难。本研究的目的是调查与居住地点相关的、导致澳大利亚老年人口获得牙科服务存在经济障碍的因素。
该研究纳入了2017 - 18年进行的一项名为全国成人口腔健康研究（NSAOH）的基于人群调查中65岁及以上澳大利亚成年人的加权样本。进行了描述性分析并生成交叉列表，以调查结果、暴露因素和协变量的分布情况，包括性别、教育水平（最高教育程度）、等值家庭收入、牙科保险、优惠卡持有情况、支付牙科账单困难程度以及上次看牙时间。采用布林德 - 奥克亚分解反事实分析来探讨一个人的居住地点对其获得牙科服务的经济困难的潜在影响。
研究结果显示，26.2%（95%置信区间：24.3 - 29.3）的大城市居民和30.1%（95%置信区间：26.9 - 33.3）的农村居民因费用问题避免或推迟看牙。分解分析表明，因费用导致的避免或推迟看牙患病率差异中有53.8%可由所选变量解释，而46.2%仍无法解释。贡献最大的解释变量是支付200澳元牙科账单困难，占差异的62.4%，其次是牙科保险、上次看牙时间和等值家庭收入，分别解释了差异的42.1%、20.8%和14.9%。
与大城市人群相比，地区/偏远地区人群在获得牙科护理方面面临更多经济障碍，且所确定的因素解释了这些差异的很大一部分。基于研究结果，建议包括扩大公共牙科服务覆盖范围、评估优惠卡机制以及倡导定期看牙以减少获得牙科护理方面的差异。
