title: Child- and state-level characteristics associated with preventive dental care access among U.S. children 5-17 years of age.
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.
authors.affiliation: Maternal and Child Health Epidemiology Program, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA. hru3@cdc.gov
authors.forename: Mei
authors.initials: M
authors.lastname: Lin
authors.forename: William
authors.initials: W
authors.lastname: Sappenfield
authors.forename: Leticia
authors.initials: L
authors.lastname: Hernandez
authors.forename: Cheryl
authors.initials: C
authors.lastname: Clark
authors.forename: Jihong
authors.initials: J
authors.lastname: Liu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Collins
authors.forename: Adam C
authors.initials: AC
authors.lastname: Carle
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008913:Minority Groups / Q000706:statistics & numerical data; D055361:Multilevel Analysis; D011313:Preventive Dentistry; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States