title: Rural-urban differences in dental service use among children enrolled in a private dental insurance plan in Wisconsin: analysis of administrative data.
abstract: BACKGROUND
  Studies on rural-urban differences in dental care have primarily focused on differences in utilization rates and preventive dental services. Little is known about rural-urban differences in the use of wider range of dental procedures. This study examined patterns of preventive, restorative, endodontic, and extraction procedures provided to children enrolled in Delta Dental of Wisconsin (DDWI).
  
  
  METHODS
  We analyzed DDWI enrollment and claims data for children aged 0-18 years from 2002 to 2008. We modified and used a rural and urban classification based on ZIP codes developed by the Wisconsin Area Health Education Center (AHEC). We categorized the ZIP codes into 6 AHEC categories (3 rural and 3 urban). Descriptive and multivariable analysis using generalized linear mixed models (GLMM) were used to examine the patterns of dental procedures provided to children. Tukey-Kramer adjustment was used to control for multiple comparisons.
  
  
  RESULTS
  Approximately, 50%, 67% and 68% of enrollees in inner-city Milwaukee, Rural 1 (less than 2500 people), and suburban-Milwaukee had at least one annual dental visit, respectively. Children in inner city-Milwaukee had the lowest utilization rates for all procedures examined, except for endodontic procedures. Compared to children from inner-city Milwaukee, children in other locations had significantly more preventive procedures. Children in Rural 1-ZIP codes had more restorative, endodontic and extraction procedures, compared to children from all other regions.
  
  
  CONCLUSIONS
  We found significant geographic variation in dental procedures received by children enrolled in DDWI.
authors.affiliation: Department of Clinical Services, Marquette University School of Dentistry, Milwaukee, WI 53201-1881, USA. pradeep.bhagavatula@mu.edu
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhagavatula
authors.forename: Qun
authors.initials: Q
authors.lastname: Xiang
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Fredrick
authors.initials: F
authors.lastname: Eichmiller
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Kuthy
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Okunseri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children / Q000706:statistics & numerical data; D003752:Dental Health Services / Q000706:statistics & numerical data*; D003793:Dental Restoration, Permanent / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007347:Insurance, Dental; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011204:Poverty Areas; D012424:Rural Population / Q000706:statistics & numerical data*; D013383:Suburban Population; D014505:Urban Population / Q000706:statistics & numerical data*; D014922:Wisconsin