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Income-based inequalities in dental service utilization: A multiple mediation analysis.
Arash Ghanbarzadegan1, Murthy Mittinty2, David S Brennan1
1Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
Community Dentistry and Oral Epidemiology
|June 10, 2022
Summary
Financial barriers significantly impact dental service use. Household income directly affects dental care access, independent of insurance or service type, highlighting income as a key factor in dental care utilization.
Area of Science:
- Public Health
- Health Economics
- Dental Public Health
Background:
- Financial barriers are a significant impediment to accessing dental services.
- Understanding the mechanisms of these barriers is crucial for improving dental care utilization.
- Previous research suggests income plays a role, but the direct vs. indirect effects need clarification.
Purpose of the Study:
- To investigate the direct and indirect effects of financial barriers on dental service utilization in Australian adults.
- To identify the key mediators (insurance, concession card, service sector) through which income influences dental care access.
- To quantify the impact of financial burden on visit avoidance and treatment prevention.
Main Methods:
- Analysis of South Australian survey data from the Dental Care and Oral Health Study (2015).
- Application of a flexible mediation approach to assess direct and indirect effects of income.
- Calculation of odds ratios for visit avoidance and treatment prevention based on income levels.
Main Results:
- Approximately half of low-income and one-third of high-income individuals reported financial burdens for dental services.
- The indirect effect of income through mediators was negligible; the direct effect was significant.
- Higher income was associated with significantly lower odds of visit avoidance (OR: 2.13) and treatment prevention (OR: 1.98) due to cost.
Conclusions:
- Household income directly impacts the financial burden of dental service utilization.
- This direct effect is independent of insurance status, concession card ownership, or the public/private service sector.
- Policy interventions should focus on addressing income-related financial barriers to improve dental care access.
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