Predictors of dental care utilization in north-central Appalachia in the USA.

Abstract

Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR=2.20, 95% CI=1.54, 3.14). When stratified by state, the association held for only West Virginia (OR=2.41, 95% CI=1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR=1.50, 95% CI=0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI=1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR=1.44, 95% CI=1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR=1.21, 95% CI=1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR=1.18, 95% CI=1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR=0.87, 95% CI=0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR=1.18, 95% CI=1.13, 1.23). Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.