title: Is accessing dental care becoming more difficult? Evidence from Canada's middle-income population.
abstract: OBJECTIVE
  To explore trends in access to dental care among middle-income Canadians.
  
  
  METHODS
  A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages.
  
  
  RESULTS
  By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978.
  
  
  CONCLUSIONS
  This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance.
authors: Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada. chantel.ramraj@utoronto.ca
authors: Chantel
authors: C
authors: Ramraj
authors: Laleh
authors: L
authors: Sadeghi
authors: Herenia P
authors: HP
authors: Lawrence
authors: Laura
authors: L
authors: Dempster
authors: Carlos
authors: C
authors: Quiñonez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada; D002648:Child; D003729:Dental Care / Q000191:economics / Q000639:trends*; D003753:Dental Health Surveys / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000191:economics / Q000639:trends*; D007347:Insurance, Dental / Q000191:economics / Q000639:trends*; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000639:trends*; D008297:Male; D008875:Middle Aged