Rahman Md Shahinoor, Blossom Jeffrey C, Kawachi Ichiro, Tipirneni Renuka, Elani Hawazin W
Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine, Boston, Massachusetts.
School of Public Health at LSU Health Sciences Center New Orleans, Louisiana.
JAMA Netw Open. 2024 Dec 2;7(12):e2451625. doi: 10.1001/jamanetworkopen.2024.51625.
Little is known about the spatial accessibility to dental clinics across the US.
To map the spatial accessibility of dental clinics nationally and to examine the characteristics of counties and US Census block groups with dental care shortage areas.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of US dental clinics in 2023 using data from the IQVIA national practitioners' database, which includes 205 762 active dentists. Data were analyzed from November 2023 to April 2024.
Socioeconomic characteristics of block groups and counties including rurality, area deprivation, racial and ethnic segregation, and uninsured population.
Enhanced 2-step floating catchment area method with a 30-minute drive time impedance was used to calculate the accessibility score to dental clinics at the block group level. The outcomes were dental clinic shortage areas and inequality in access to dental clinics.
Nearly 1.7 million people in the US (0.5%) lacked access to dental clinics within a 30-minute drive. This included 0.9 million male (52.2%), 1.2 million White (71.0%), 52 636 Black (3.0%), and 176 885 Hispanic (10.2%) individuals. Approximately 24.7 million people (7.5%) lived in dental care shortage areas (defined as <1 dentist per 5000 population). There was a significant difference in spatial accessibility scores between rural and urban areas, with 1 dentist for every 3850 people in rural areas and 1 dentist for every 1470 people in urban areas. Additionally, there were 387 counties with significant disparities in access to dental clinics. Rural block groups (23.9 percentage points [pp]; 95% CI, 23.6-24.3), block groups with higher levels of Black (1.5 pp; 95% CI, 1.3-1.7) and Hispanic (4.5 pp; 95% CI, 4.3-4.8) segregation, and block groups with the highest levels of area deprivation (5.5 pp; 95% CI, 5.1-5.9) were more likely to experience dental care shortages compared with urban block groups and those with lower levels of segregation and area deprivation. Moreover, rural counties (11.3 pp; 95% CI, 8.9-13.7), counties with a high uninsured population (3.0 pp; 95% CI, 1.5-4.4), and counties with high levels of deprivation (5.8 pp; 95% CI, 2.1-9.5) were more likely to have inequality in access to dental clinics.
In this cross-sectional study of US dental clinics, there was geographic shortage and maldistribution of the dental workforce. These findings can support dental workforce planning efforts at the federal and state levels to encourage dentists to practice in underserved areas to reduce disparities in access to dental care.
美国各地牙科诊所的空间可达性情况鲜为人知。
绘制全国牙科诊所的空间可达性地图，并研究存在牙科护理短缺地区的县和美国人口普查街区组的特征。
设计、设置和参与者：2023年对美国牙科诊所进行的横断面研究，使用来自艾昆纬全国从业者数据库的数据，该数据库包含205762名在职牙医。数据于2023年11月至2024年4月进行分析。
街区组和县的社会经济特征，包括农村性、地区贫困、种族和民族隔离以及未参保人口。
采用增强的两步浮动集水区方法，以30分钟驾车时间阻抗来计算街区组层面牙科诊所的可达性得分。结局为牙科诊所短缺地区以及获得牙科诊所服务的不平等情况。
美国近170万人（0.5%）在驾车30分钟内无法到达牙科诊所。其中包括90万男性（52.2%）、120万白人（71.0%）、52636名黑人（3.0%）和176885名西班牙裔（10.2%）。约2470万人（7.5%）生活在牙科护理短缺地区（定义为每5000人口中牙医不足1名）。农村和城市地区的空间可达性得分存在显著差异，农村地区每3850人有1名牙医，城市地区每1470人有1名牙医。此外，有387个县在获得牙科诊所服务方面存在显著差异。与城市街区组以及隔离和地区贫困程度较低的街区组相比，农村街区组（23.9个百分点[pp]；95%置信区间，23.6 - 24.3）、黑人（1.5 pp；95%置信区间，1.3 - 1.7）和西班牙裔（4.5 pp；95%置信区间，4.3 - 4.8）隔离程度较高的街区组以及地区贫困程度最高的街区组更有可能经历牙科护理短缺。此外，农村县（11.3 pp；95%置信区间，8.9 - 13.7）、未参保人口比例高的县（3.0 pp；95%置信区间，1.5 - 4.4）以及贫困程度高的县（5.8 pp；95%置信区间，2.1 - 9.5）在获得牙科诊所服务方面更有可能存在不平等情况。
在这项对美国牙科诊所的横断面研究中，牙科劳动力存在地理短缺和分布不均的情况。这些发现可为联邦和州层面的牙科劳动力规划工作提供支持，以鼓励牙医在服务不足地区执业，减少获得牙科护理的差距。
