Shoff Carla, Jones Christopher M, Qu Luping, Webster-Cyriaque Jennifer Y, Ling Shari M, Compton Wilson M, Chalmers Natalia I
Office of the Administrator, Centers for Medicare & Medicaid Services, Baltimore, Maryland.
Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, Maryland.
Am J Prev Med. 2025 Sep;69(3):107937. doi: 10.1016/j.amepre.2025.107937. Epub 2025 Jun 10.
Low-income Medicaid-enrolled adults are likely to have poor oral health and experience substance use disorders. Despite emerging evidence that comprehensive dental care can improve substance use disorder outcomes, there is a lack of evidence about the overlap of substance use disorder and dental care utilization. This study aims to fill that gap.
This cross-sectional study used 2019 data from the Transformed Medicaid Statistical Information System Analytic Files and included over 30 million nondually eligible Medicaid-enrolled adults aged 21-64 years. Clustered-robust SE logistic regression models were used to predict the odds of receiving early-stage dental care. Analyses were performed in 2024.
Nationally, 56.45 per 1,000 Medicaid-enrolled adults were diagnosed with substance use disorders. There was significant variation in substance use disorder prevalence across states, ranging from 27.11 to 103.45 per 1,000 adults. On average, 173.78 adults per 1,000 accessed dental care, although access varied significantly across states, ranging from 1.69 to 347.27 per 1,000. Adults living in states with extensive Medicaid dental coverage had the highest rates of dental care utilization: 270.38 per 1,000 adults with substance use disorders and 215.39 per 1,000 adults without substance use disorders. The odds of receiving early-stage dental care were 42% lower for Medicaid-enrolled adults with substance use disorders than for those without substance use disorders.
This study found considerable variation in the prevalence of substance use disorders and dental care utilization across states. Further research is needed to uncover the factors driving these variations and inform policy and clinical interventions to improve dental care access for Medicaid-enrolled adults, especially those with substance use disorders.
参加医疗补助计划的低收入成年人可能口腔健康状况较差且患有物质使用障碍。尽管越来越多的证据表明全面的牙科护理可以改善物质使用障碍的治疗效果,但关于物质使用障碍与牙科护理利用之间的重叠情况仍缺乏证据。本研究旨在填补这一空白。
这项横断面研究使用了来自转型医疗补助统计信息系统分析文件的2019年数据,纳入了超过3000万年龄在21至64岁之间的非双重资格参加医疗补助计划的成年人。采用聚类稳健标准误逻辑回归模型来预测接受早期牙科护理的几率。分析于2024年进行。
在全国范围内,每1000名参加医疗补助计划的成年人中有56.45人被诊断患有物质使用障碍。各州物质使用障碍的患病率存在显著差异,每1000名成年人中从27.11人到103.45人不等。平均而言,每1000名成年人中有173.78人接受牙科护理,不过各州之间的获得情况差异很大,每1000人从1.69人到347.27人不等。生活在医疗补助牙科覆盖范围广泛的州的成年人牙科护理利用率最高:每1000名患有物质使用障碍的成年人中有270.38人,每1000名没有物质使用障碍的成年人中有215.39人。患有物质使用障碍的参加医疗补助计划的成年人接受早期牙科护理的几率比没有物质使用障碍的成年人低42%。
本研究发现各州物质使用障碍的患病率和牙科护理利用率存在相当大的差异。需要进一步研究以揭示导致这些差异的因素,并为改善参加医疗补助计划的成年人,尤其是患有物质使用障碍的成年人获得牙科护理的政策和临床干预提供依据。