title: Determinants of Catastrophic Dental Health Expenditure in China.
abstract: This study explored catastrophic health expenditure in China, due to out-of-pocket payments for dental care, and its associated individual- and contextual-level factors. We pooled data from 31,566 adults who participated in the third National Oral Health Survey with province-level data from different sources. We defined catastrophic dental health expenditure (CDHE) as payments for dental services and/or medication for dental problems during the last year that exceeded the 10% and 20% of the household income. The association of individual and contextual factors with catastrophic dental health expenditure was evaluated using two-level logistic regression models with individuals nested within provinces. Socioeconomic position (education and household income), household size and dental status (pain in teeth or mouth and number of teeth) were the individual-level factors associated with CDHE among the full sample of participants; and, also, among those who used dental services in the past year. Greater gross domestic product per capita was the only contextual factor associated with CDHE, and only at the lower income threshold. This study shows that out-of-pocket expenses for dental services may put a considerable, and unnecessary, burden on households' finances. Our findings also help characterise those households more likely to face catastrophic expenditure on health if they have to pay for dental services.
authors.affiliation: Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, People's Republic of China.|King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Population and Patient Health Division, London, United Kingdom.
authors.forename: Xiangyu
authors.initials: X
authors.lastname: Sun
authors.affiliation: King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Population and Patient Health Division, London, United Kingdom.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bernabé
authors.affiliation: Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, People's Republic of China.
authors.forename: Xuenan
authors.initials: X
authors.lastname: Liu
authors.affiliation: King's College London Dental Institute at Guy's, King's College and St. Thomas' Hospitals, Population and Patient Health Division, London, United Kingdom.
authors.forename: Jennifer Elizabeth
authors.initials: JE
authors.lastname: Gallagher
authors.affiliation: Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, People's Republic of China.
authors.forename: Shuguo
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002388:Catastrophic Illness / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003729:Dental Care / Q000191:economics* / Q000706:statistics & numerical data*; D003753:Dental Health Surveys; D015981:Epidemiologic Factors; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D012959:Socioeconomic Factors; D055815:Young Adult