Comparing oral health care utilization estimates in the United States across three nationally representative surveys.
OBJECTIVE
To compare estimates of dental visits among adults using three national surveys.


METHODS
Cross-sectional data from the National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Health Expenditure surveys (NMCES, NMES, MEPS).


METHODS
This secondary data analysis assessed whether overall estimates and stratum-specific trends are different across surveys.


METHODS
Dental visit data are age standardized via the direct method to the 1990 population of the United States. Point estimates, standard errors, and test statistics are generated using SUDAAN.


RESULTS
Sociodemographic, stratum-specific trends are generally consistent across surveys; however, overall estimates differ (NHANES III [364-day estimate] versus 1993 NHIS: -17.5 percent difference, Z = 7.27, p value < 0.001; NHANES III [365-day estimate] vs. 1993 NHIS: 5.4 percent difference, Z = -2.50, p value = 0.006; MEPS vs. 1993 NHIS: -29.8 percent difference, Z = 16.71, p value < 0.001). MEPS is the least susceptible to intrusion, telescoping, and social desirability.


CONCLUSIONS
Possible explanations for discrepancies include different reference periods, lead-in statements, question format, and social desirability of responses. Choice of survey should depend on the hypothesis. If trends are necessary, choice of survey should not matter however, if health status or expenditure associations are necessary, then surveys that contain these variables should be used, and if accurate overall estimates are necessary, then MEPS should be used. A validation study should be conducted to establish "true" utilization estimates.
Macek
Mark D
MD
Department of Oral Health Care Delivery, Baltimore College of Dental Surgery Dental School, University of Maryland, 21201, USA.
Manski
Richard J
RJ
Vargas
Clemencia M
CM
Moeller
John F
JF
D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003625:Data Collection; D003752:Dental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D003753:Dental Health Surveys; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review