Influence of disabilities on state-level disparity in dental care utilization and tooth loss: Findings from the 2020 Behavioral Risk Factor Surveillance System.

Abstract

The aim of this study is to describe the prevalence of disparity in access to dental care and tooth loss between US adults with and without disabilities at the state level. This secondary analysis included data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional state-run annual telephone survey of noninstitutionalized US adults aged 18 years or older. The primary predictor, having any disability, was defined as reported difficulty in hearing, vision, cognition, mobility, self-care, or independent living. The two dental outcomes used were reported time since last dental visit and missing teeth status. We conducted descriptive analysis and multinomial regression models on weighted data to report the prevalence and state-level disparity in dental outcomes between individuals with and without disability. Nationally, one in four adults reported a disability, with a disproportionately higher prevalence among females, Native Americans and lower education and income groups. The highest utilization of dental services within a year among individuals with disabilities was found in the Northwestern and Midwestern states. Western states had the highest proportion of individuals with disability to have had a recent dental visit and a complete dentition, while the Southern states had the lowest proportions. After adjusting for sociodemographic factors, 59.1% of individuals with disabilities had dental visits within a year, which is 8.0% points less than those without disabilities. Similarly, only 50.8% of individuals with a disability had complete tooth retention, which is 10.1% points less than individuals without disability. Regardless of the type of disability, adults with a disability were less likely to have visited the dentist in the past year or to have retained all of their teeth. Those with self-care disabilities had the lowest rates of both. There were clear disparities in the utilization of dental care and dentate status among adults with disabilities at the state level. The findings from this study highlighted the necessity of finding local solutions to address the gap in dental care utilization and tooth loss between those with and without disability among the US population.