title: Caregiver burden and preventive dental care use for US children with special health care needs: a stratified analysis based on functional limitation.
abstract: The objectives of this study were to evaluate the association between caregiver burden and preventive dental care use for children with special health care needs (CSHCN) and assess if caregiver burden explains the relationship between child- and family-level characteristics and preventive dental care use. Samples of US CSHCN ages 3-17 years with a functional limitation (n = 7,559) and those without (n = 26,345) were derived from the 2005-2006 National Survey of CSHCN. We generated structural equation models, stratified by functional limitation, to describe the relationships between caregiver burden and preventive dental utilization. We measured caregiver burden using six items on whether the child's health condition impacted work, time spent on health management, and finances. About 80.9 % of CSHCN used preventive dental care. Higher levels of caregiver burden were associated with significantly lower odds of preventive dental care use for CHSCN with a functional limitation (β = -0.06; P < 0.001) and those without (β = -0.07; P < 0.001). For CSHCN with a functional limitation, family poverty and being uninsured were significantly associated with greater caregiver burden and less preventive dental use. Findings were similar for CSHCN without a functional limitation, except that lower caregiver education was also associated with greater caregiver burden and less preventive dental care use. Caregiver burden is potential barrier to preventive dental care use for CSHCN and explains the relationship between child- and family-level characteristics and preventive dental care use. Interventions to improve the oral health of CSHCN should include strategies to reduce caregiver burden, especially within socioeconomically vulnerable families.
authors.affiliation: Department of Oral Health Sciences, School of Dentistry, University of Washington, Box 357475, Seattle, WA, 98195, USA, dchi@uw.edu.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: Beth M
authors.initials: BM
authors.lastname: McManus
authors.forename: Adam C
authors.initials: AC
authors.lastname: Carle
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017028:Caregivers / Q000191:economics* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children / Q000191:economics / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009909:Oral Health; D011313:Preventive Dentistry / Q000191:economics / Q000379:methods*; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States