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Delivery of fluoride varnish during pediatric medical visits by rurality
Ashley M Kranz1, Sarah L Goff2, Andrew W Dick3
1Health Care Unit, RAND, Arlington, Virginia, USA.
Insights
Pediatric well-child visits were more likely to include fluoride varnish in rural and remote rural areas compared to metropolitan areas. Despite recommendations, overall fluoride varnish application rates remain low for young children.
Area of Science:
- Public Health
- Pediatric Medicine
- Health Services Research
Background:
- Fluoride varnish application is recommended for all young children to prevent tooth decay.
- Delivery of preventive dental services in non-dental settings, like pediatric medical visits, is increasing.
- Variations in healthcare delivery based on geographic location are common.
Purpose of the Study:
- To examine how rurality affects the delivery of fluoride varnish during pediatric medical visits.
- To compare fluoride varnish application rates across metropolitan, rural, and remote rural counties.
Main Methods:
- Observational study using private health insurance claims from 2016-2018 for children aged 1-5 years.
- Linking insurance claims to county-level Rural-Urban Continuum codes (metropolitan, rural, remote rural).
- Logistic regression models were used to assess the odds of fluoride varnish inclusion in well-child visits, adjusting for covariates.
Main Results:
- Fluoride varnish was applied in 4.3% of visits in metropolitan, 6.2% in rural, and 10.3% in remote rural counties.
- Significantly higher odds of fluoride varnish use were observed in remote rural (OR=3.5) and rural (OR=2.4) counties compared to metropolitan counties.
- Rates of fluoride varnish application increased in metropolitan areas since 2016, while remaining stable in rural areas.
Conclusions:
- Pediatric well-child visits in rural and remote rural areas were more likely to include fluoride varnish application than those in metropolitan areas.
- Overall rates of fluoride varnish application remain low despite recommendations for all young children.
- Findings highlight geographic disparities in preventive dental care delivery within the medical setting.
Objectives:
To examine variation in the delivery of fluoride varnish during pediatric medical visits by rurality.
Methods:
This observational study used private health insurance claims (2016-2018) for children aged 1-5 years from Connecticut, Maine, New Hampshire, and Rhode Island linked to the county-level Rural-Urban Continuum codes. County-level Rural-Urban Continuum codes were categorized into three groups: metropolitan, rural, and remote rural. Logistic regression models were used to estimate the odds of a well-child medical visit including fluoride varnish by county rurality, adjusting for other individual and county characteristics.
Results:
Among 328,661 pediatric well-child visits paid by private insurance, fluoride varnish was included in 4.3% of visits in metropolitan counties, 6.2% of visits in rural counties, and 10.3% of visits in remote rural counties. There were significantly higher odds of a visit including fluoride varnish in rural remote counties (odds ratio [OR] = 3.5, 95% confidence interval [CI] = 2.3-5.3, p < 0.001) and in rural counties (OR = 2.4, 95% CI = 1.4-4.0, p < 0.001) compared to metropolitan counties. Rates of fluoride varnish during well-child visits increased since 2016 in metropolitan counties and remained stable in rural counties.
Conclusions:
All young children are recommended to receive fluoride varnish applications in medical settings, yet overall rates were low. For privately insured young children, pediatric well-child medical visits were more likely to include fluoride varnish in rural and rural remote counties than metropolitan counties.
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