An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Morenike Oluwatoyin Folayan,Hamideh Daryanavard,Arheiam Arheiam,Simin Z Mohebbi,Ola B Al-Batayneh,Rita Villena,Robert J Schroth,Maher Rashwan,Balgis Gaffar,Rosa Amalia,Maha El Tantawi,Carlos Alberto Feldens,Arthur M Kemoli,Jorma I Virtanen,Ana Vukovic

doi:10.1186/s12903-021-01500-8

Abstract

BackgroundUniversal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC.MethodsHealth expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated.ResultsLinear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05).ConclusionsHigher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

Highlights

Universal health care (UHC) may assist families whose children are most prone to early childhood car‐ ies (ECC) in accessing dental treatment and prevention
Higher expenditure on health care may be associated with lower prevalence of Early childhood caries (ECC) and may be a more viable approach to reducing early childhood oral health disparities than UHC alone
The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC

Summary

Introduction

Universal health care (UHC) may assist families whose children are most prone to early childhood car‐ ies (ECC) in accessing dental treatment and prevention. El Tantawi et al [16] recently reported that universal health coverage (UHC) may be a global risk indicator for ECC as the prevalence of ECC in children 3–5-yearsold was lower in countries with good UHC. One explanation for this association was that countries with UHC may promote improved access to preventive oral health care for preschool children. Investments in health through health expenditures can directly improve the country’s economy through maintaining the health of individuals and increasing their life expectancy [17]

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