title: Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study.
abstract: BACKGROUND
  While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years.
  
  
  METHODS
  Repeated population-based surveys (2007-2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.
  
  
  RESULTS
  A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥ 13,000 CHF, 1 CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000 CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000 CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy.
  
  
  CONCLUSIONS
  In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.
authors.affiliation: Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland. Idris.Guessous@hcuge.ch.
authors.forename: Idris
authors.initials: I
authors.lastname: Guessous
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Theler
authors.forename: Claire
authors.initials: C
authors.lastname: Durosier Izart
authors.forename: Silvia
authors.initials: S
authors.lastname: Stringhini
authors.forename: Patrick
authors.initials: P
authors.lastname: Bodenmann
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
authors.forename: Hans
authors.initials: H
authors.lastname: Wolff
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data; D004243:Divorce / Q000191:economics / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data; D005190:Family; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics; D008297:Male; D017533:Marital Status; D008483:Medical Assistance / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D009790:Occupations / Q000191:economics; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data; D012737:Sex Factors; D020954:Single-Parent Family; D012907:Smoking; D012923:Social Class; D013557:Switzerland