title: Dental Disparities and Psychological Distress Among Mobility-Impaired Adults.
abstract: BACKGROUND
  More than one in five American adults has a disability, the most common being mobility impairment (MI). People with MI face significant barriers to healthcare access and are more likely to experience psychological distress. This study examined disparities in access to medical and dental care among people with MI and examine the mediational role of psychological distress on this relationship.
  
  
  METHODS
  Analyses were conducted on 36,697 adults (aged ≥18 years) responding to the 2014 National Health Interview Survey (analyzed in 2015). MI was defined as needing special equipment and having difficulty walking a quarter mile without equipment. Outcomes included having lost all natural teeth (edentulous), unmet dental needs, annual dental visit, and annual medical visit. Psychological distress was measured using the Kessler psychological distress (K6) scale.
  
  
  RESULTS
  Compared with adults without MI, adults with MI had greater odds of being edentulous (OR=2.10, 95% CI=1.82, 2.43), having unmet dental needs (OR=1.99, 95% CI=1.66, 2.40), and lower odds of having annual dental visits (OR=0.62, 95% CI=0.54, 0.71). However, adults with MI were significantly more likely to have annual medical visits (OR=2.31, 95% CI=1.90, 2.81) than adults without MI. Psychological distress partially, yet significantly, mediated the relationship between MI and outcomes.
  
  
  CONCLUSIONS
  People with MI have significant oral health needs and poor access to dental care, which are partially mediated by psychological distress. Results suggest that mental health services should be considered for inclusion in interventions and medical visits can be leveraged to improve oral health outcomes in this population.
authors.affiliation: Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts;. Electronic address: asinghal@bu.edu.
authors.forename: Astha
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Division of Behavioral Science Research, Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, Boston, Massachusetts.
authors.forename: Belinda
authors.initials: B
authors.lastname: Borrelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003730:Dental Care for Persons with Disabilities / Q000458:organization & administration*; D004185:Disability Evaluation; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D020380:Needs Assessment; D016017:Odds Ratio; D013315:Stress, Psychological; D014481:United States; D055815:Young Adult