title: Caregivers' health literacy and their young children's oral-health-related expenditures.
abstract: Caregivers' health literacy has emerged as an important determinant of young children's health care and outcomes. We examined the hypothesis that caregivers' health literacy influences children's oral-health-care-related expenditures. This was a prospective cohort study of 1,132 child/caregiver dyads (children's mean age = 19 months), participating in the Carolina Oral Health Literacy Project. Health literacy was measured by the REALD-30 (word recognition based) and NVS (comprehension based) instruments. Follow-up data included child Medicaid claims for CY2008-10. We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health-related visits involving preventive, restorative, and emergency care. We used descriptive, bivariate, and multivariate statistical methods based on generalized gamma models. Mean oral-health-related annual expenditures totaled $203: preventive--$81, restorative--$99, and emergency care--$22. Among children who received services, mean expenditures were: emergency hospital-based--$1282, preventive--$106, and restorative care--$343. Caregivers' low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures (average annual difference = $40; 95% confidence interval, -32, 111). Nevertheless, with both instruments, emergency dental care expenditures were consistently elevated among children of low-literacy caregivers. These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA. ll_vann@dentistry.unc.edu
authors.forename: W F
authors.initials: WF
authors.lastname: Vann
authors.forename: K
authors.initials: K
authors.lastname: Divaris
authors.forename: Z
authors.initials: Z
authors.lastname: Gizlice
authors.forename: A D
authors.initials: AD
authors.lastname: Baker
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers; D002675:Child, Preschool; D015331:Cohort Studies; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data; D003796:Dental Service, Hospital / Q000191:economics; D003814:Dentistry, Operative / Q000191:economics; D004522:Educational Status; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D005382:Financing, Personal; D005500:Follow-Up Studies; D005102:Health Expenditures; D057220:Health Literacy; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D009657:North Carolina; D011313:Preventive Dentistry / Q000191:economics; D011446:Prospective Studies; D014481:United States; D055815:Young Adult
keywords: Medicaid; WIC; cohort studies; dental care; health expenditures; health services