title: Cost-related dental non-attendance in older adulthood: evidence from eleven European countries and Israel.
abstract: BACKGROUND
  Although relevant for health policy, so far only little is known about the extent to which persons avoid dental attendance because of associated costs.
  
  
  OBJECTIVE
  To examine the cost-relatedness of dental non-attendance in various older adulthood populations.
  
  
  METHODS
  Secondary analyses were conducted of data from wave 1 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes unique information on recent dental non-attendance and care foregone due to costs by persons aged 50+ from eleven European countries and Israel. Multivariate logistic regression analysis was used to detect differences in the extent to which dental non-attendance is attributable to associated costs.
  
  
  RESULTS
  The study sample comprised 13 935 persons who did not access dental care within the past year. Levels of cost-related non-attendance differed between the twelve examined countries, ranging from 6.8% in Israel to 0.5% in Austria. Cost-related non-attendance was 47% less likely among persons with good as compared to compromised chewing ability (Odds Ratio: 0.53; 95% CI: 0.43-0.66). Cost-related non-attendance was 33% less likely among persons with tertiary as compared to (pre-) primary educational attainment (Odds Ratio: 0.67; 95% CI: 0.47-0.96). Cost-related dental non-attendance was significantly more likely among persons with low levels of general health (Odds Ratio for lowest vs. highest level of general health: 3.05; 95% CI: 1.88-4.95).
  
  
  CONCLUSIONS
  The findings of the present study suggest that a relatively small proportion of dental non-attendance in older adulthood is cost-related. For specific population subgroups in various countries, however, dental care costs may still pose a relevant barrier to dental care.
authors.affiliation: Department of Conservative Dentistry, Heidelberg University, Heidelberg, Germany.|Max Planck Institute for Social Law and Social Policy, Munich Center for the Economics of Aging, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Listl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data*; D016321:Dental Care for Aged / Q000191:economics / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: costs; dental care; dental non-attendance; elders