Community factors predicting dental care utilization among older adults.
BACKGROUND
Few investigators have studied the influence of community factors on dental care utilization among older adults. The authors' objective in this study was to investigate the effect of community factors on dental care utilization after adjustment for individual factors.


METHODS
Using data from a cross-sectional survey of Ohio residents, the authors assessed dental care utilization in a sample of 2,166 adults 65 years or older. They linked individual-level dental care utilization, predisposing factors (age, sex, race or ethnicity, marital status, education), enabling factors (poverty, dental insurance) and need-related factors (physical and mental health problems) with county-level data (socioeconomic environment and health resource environment) from the 2010 Area Health Resource Files (from the U.S. Department of Health and Human Services) and the American Community Survey (from the 2006-2010 U.S. census). By using multilevel logistic regression models, the authors evaluated the association between dental care utilization and community factors after adjustment for individual factors.


RESULTS
The results indicated that individual factors such as being female, married and nonpoor and having a higher educational level and private dental insurance were associated with higher odds of having utilized dental care. Furthermore, older adults living in a county with a higher dentist-to-population ratio were more likely to use dental services even after the authors adjusted the results for the individual-level factors (odds ratio = 1.10; P = .03).


CONCLUSIONS
County-level dentist-to-population ratio has independent effects on older adults' dental care utilization even after adjustment for individual-level characteristics. Practical Implications. A comprehensive policy plan is required to intervene at both the individual and community levels to improve dental care utilization among older adults. By understanding the factors influencing dental care utilization among older adults, U.S. dentists will be better positioned to meet the dental needs of this population.
Dr. Lee is a research associate, Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Road, Cleveland, Ohio 44106, wxl219@case.edu.
Wonik
W
Lee
Seok-Joo
SJ
Kim
Jeffrey M
JM
Albert
Suchitra
S
Nelson
D000368:Aged; D003430:Cross-Sectional Studies; D003710:Demography; D016321:Dental Care for Aged / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D007347:Insurance, Dental / Q000706:statistics & numerical data; D008297:Male; D009820:Ohio; D012307:Risk Factors; D012737:Sex Factors
Dental care for elderly patients; community dentistry; public policy; socioeconomic status