title: Associations between health  insurance and generalized  periodontal disease in a study  population of Gullah African  Americans with type-2 diabetes.
abstract: OBJECTIVE
  To explore the relationship between health insurance status (Medicare, Medicaid, private, and uninsured) and generalized periodontal disease (GPD) among a study population (N = 245) of adult Gullah African Americans with type-2 diabetes mellitus (T2DM) ages <65 years.
  
  
  METHODS
  We used multivariable logistic regression to assess GPD [using three different and increasingly severe clinical assessments: 3, 4, and 5 mm clinical attachment level (CAL) at 30% of sites] according to health insurance status.
  
  
  RESULTS
  Prevalence of GPD was 33.06% for 3, 18.78% for 4, and 9.80% for 5 mm CAL. Age ranged 26-64 years (mean = 52.11, SD = 8.53, median = 53). Private insurance was most prevalent (39.59%), followed by uninsured (30.61%), Medicaid (16.33%), and Medicare (13.47%). Results showed increased odds (versus private insurance) for GPD at 3 mm among Medicaid (OR = 1.82, P = 0.2404), Medicare (OR = 3.34, P = 0.0103), and uninsured (OR = 1.96, P = 0.0956) groups; GPD at 4 mm among Medicaid (OR = 1.97, P = 0.3303), Medicare (OR = 5.02, P = 0.0121), and uninsured (OR = 3.38, P = 0.0319) groups; and GPD at 5 mm among Medicaid (OR = 1.21, P = 0.8507), Medicare (OR = 12.62, P = 0.0038), and uninsured (OR = 4.00, P = 0.0763) groups.
  
  
  CONCLUSIONS
  We observed substantial disparities for GPD severity among those without private health insurance even after adjusting for glycemic control, income, dental health behaviors, and other covariates. Improved insurance benefits as well as individualized oral health educational interventions may decrease GPD severity for this study population of younger (ages <65 years) Gullah African Americans with T2DM, particularly those with Medicare insurance.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Marlow
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Slate
authors.forename: Jyotika K
authors.initials: JK
authors.lastname: Fernandes
authors.forename: Renata S
authors.initials: RS
authors.lastname: Leite
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence