Dental Insurance Status Among Formerly Incarcerated Older Adults.

Time to rethink dental “insurance”

We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status. Linked data from the National Survey of Children's Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders. A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US-born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US- and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status. Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.

This study examines the relationship between prior incarceration and dental insurance trajectories throughout older adulthood. A nationally representative sample of adults aged 55 y and older who participated in the 2012-2020 Health and Retirement Survey was analyzed (n = 6,383). Group-based trajectory modeling was used to identify distinct patterns of dental insurance coverage across the 8 survey waves. Multinomial logistic regression was used to assess the association between prior incarceration and dental insurance trajectory group membership. Four dental insurance trajectories were identified: persistent dental insurance (30.0%), intermittent high insurance (16.4%), intermittent low insurance (20.4%), and no insurance (33.3%). Bivariate analyses revealed that formerly incarcerated older adults were significantly more likely to be in the intermittent low dental insurance (relative risk ratio [RRR] = 2.31, 95% confidence interval [CI] = 1.67-3.20) and no dental insurance (RRR = 1.51, 95% CI = 1.09-2.11) groups relative to the persistent dental insurance group. Covariate-adjusted models that accounted for sociodemographic, health, and economic covariates found a significant association between prior incarceration and membership in the intermittent low dental insurance group (RRR = 1.48, 95% CI = 1.03-2.11). Formerly incarcerated older adults were less likely to have consistent dental insurance coverage over time. Additional research is needed to understand why formerly incarcerated individuals are less likely to have consistent dental insurance over time and what policy and programmatic responses may increase access to dental care coverage for this population.Knowledge Transfer Statement:This study shows that formerly incarcerated older adults are more likely to experience periods without dental insurance over time. These findings can inform efforts by dental care providers, policymakers, and community health programs to improve dental care access by expanding insurance coverage and tailoring oral health services to meet the needs of individuals with incarceration histories.

Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self-select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a "marker" for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. Participants (South Australians aged 45-54 years) of a 2-year prospective cohort study (2005-2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23-item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n=529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a "marker" for predisposing attitudes.

The final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT). To determine the extent to which individuals' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT. A hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval. Two hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT. Dental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.

Private Dental and Prescription-Drug Coverage in Children: Data From the Medical Expenditure Panel Survey

Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their child's health. Nursing interventions to improve the oral health of at-risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions. This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003-2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women. The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted. A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low-income women should educate the population about oral health and advocate for policies to increase dental insurance coverage.

Disparity in dental coverage among older adult populations: a comparative analysis across selected European countries and the USA

To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS). We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables. Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status. Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS). We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables. We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage. Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

Oral health trends for older Americans

History of Incarceration and Dental Care Use Among Older Adults in the United States

Disparities in dental insurance coverage among hospitalised Western Australian children

Dental attendance by insurance status among adults in Tehran, Iran

ObjectivesTo analyze response inconsistency to survey questions within the Health and Retirement Study regarding insurance coverage of dental services.MethodsSelf-reports of dental coverage in the dental services section were compared with those in the insurance section of the 2002 HRS to identify inconsistent responses. Logistic regression identified characteristics of persons reporting discrepancies and assessed the effect of measurement error on dental coverage coefficient estimates in dental utilization models.ResultsIn 18% of cases, data reported in the insurance section contradicted data reported in the dental use section of the HRS by those who said insurance at least partially covered (or would have covered) their (hypothetical) dental use. Additional findings included distinct characteristics of persons with potential reporting errors and a downward bias to the regression coefficient for coverage in a dental use model without controls for inconsistent self-reports of coverage.DiscussionThis study offers evidence for the need to validate self-reports of dental insurance coverage among a survey population of older Americans in order to obtain more accurate estimates of coverage and its impact on dental utilization.