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Child- and State-Level Characteristics Associated with Preventive Dental Care Access Among U.S. Children 5–17 Years of Age

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Abstract

The objectives of this study is to identify factors associated with lack of preventive dental care among U.S. children and state-level factors that explain variation in preventive dental care access across states. We performed bivariate analyses and multilevel regression analyses among 68,350 children aged 5–17 years using the 2007 National Survey of Children’s Health data and relevant state-level data. Odds ratios (ORs) for child- and state-level variables were calculated to estimate associations with preventive dental care. We calculated interval odds ratios (IOR), median odds ratios (MOR), and intraclass correlation coefficients (ICC) to quantify variation in preventive dental care across states. Lack of preventive dental care was associated with various child-level factors. For state-level factors, a higher odds of lack of preventive dental care was associated with a higher percentage of Medicaid-enrolled children not receiving dental services (OR = 1.30, 95 % confidence interval (CI): 1.15–1.47); higher percentage of children uninsured (OR = 1.48, 95 % CI: 1.29–1.69); lower dentist-to-population ratio (OR = 1.36, 95 % CI: 1.03–1.80); and lower percentage of dentists submitting Medicaid/State Children’s Health Insurance Program claims (OR = 1.04, 95 % CI: 1.01–1.06). IORs for the first three state-level factors did not contain one, indicating that these state-level characteristics were important in understanding variation across states. Lack of preventive dental care varied by state (MOR = 1.40). The state-level variation (ICC = 3.66 %) accounted for a small percentage of child- and state-level variation combined. Child- and state-level characteristics were associated with preventive dental care access among U.S. children aged 5–17 years. State-level factors contribute to variation in dental care access across states and need to be considered in state-level planning.

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Acknowledgments

We deeply thank Drs. Kristin Rankin and Deborah Rosenberg with the University of Illinois at Chicago for their generous and invaluable suggestions and technical consultations on this study. We acknowledge great comments and suggestions provided by CDC: Drs. Deborah Dee and Charlan Kroelinger, Division of Reproductive Health; Drs. Susan Griffin, Gina Thornton-Evans, Valerie Robison, and Barbara Gooch, Division of Oral Health; and NCHS. We thank Ray Shell with the Missouri Department of Health and Senior Services for his assistance in linking state-level data with the NSCH data. Adam Carle would like to thank Tara J. Carle and Lyla S. B. Carle whose unending support and thoughtful comments make his work possible. Jennifer Collins would like to thank Applied Epidemiology Fellowship program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 5U38HM000414.

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Authors and Affiliations

  1. Maternal and Child Health Epidemiology Program, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-10, Atlanta, GA, 30341, USA

    Mei Lin

  2. Section of Epidemiology for Public Health Practice, Missouri Department of Health and Senior Services, Jefferson City, MO, USA

    Mei Lin & Jennifer Collins

  3. Division of Family Health Services, Florida Department of Health, Tallahassee, FL, USA

    William Sappenfield, Leticia Hernandez & Cheryl Clark

  4. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Jihong Liu

  5. University of Cincinnati School of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Adam C. Carle

  6. University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA

    Adam C. Carle

Authors
  1. Mei Lin
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  2. William Sappenfield
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  3. Leticia Hernandez
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  4. Cheryl Clark
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  5. Jihong Liu
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  6. Jennifer Collins
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  7. Adam C. Carle
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Correspondence to Mei Lin.

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CDC Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Lin, M., Sappenfield, W., Hernandez, L. et al. Child- and State-Level Characteristics Associated with Preventive Dental Care Access Among U.S. Children 5–17 Years of Age. Matern Child Health J 16 (Suppl 2), 320–329 (2012). https://doi.org/10.1007/s10995-012-1099-3

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