Catastrophic Oral Health Expenditures among Europeans Aged 50 y and Older

Access to affordable oral health care is central to achieving universal health coverage. While out-of-pocket expenditures can pose particular challenges for older population groups, little is known about catastrophic oral health expenditures (COHE) among people aged ≥50 y. The present study aimed to identify the extent and variation of COHE for persons aged ≥50 y from 12 European countries, for which dental expenditure data were available from the seventh wave of the Survey of Health, Ageing and Retirement in Europe. Specifically, information from 77,261 persons was included in the analysis. According to World Health Organization definitions, COHEs were calculated as out-of-pocket dental spendings exceeding 40% of the net total household expenditure on basic needs (ie, food, housing, and utilities). Descriptive and regression analyses were applied to test if COHEs at age ≥50 y differ across countries or regions and do not vary by demographic characteristics (age, gender, education, marital status, household size). On average across countries, >2.27% of study participants were identified to have COHE, with the highest observed population proportion of COHE in Spain (10.95%) and the lowest in Sweden (0.12%). Older age was associated with a significantly higher likelihood of experiencing COHE: the risk of people aged ≥70 y (2.6%) was significantly higher than for people aged 50 to 60 y (1.7%). There was a significant difference in COHE between males (1.7%) and females (2.6%). This study is the first to identify the extent and differences in COHE among people aged ≥50 y in European countries. Out-of-pocket oral health expenditures detrimentally affect older adults, with unequitable variations by gender, age, and country/region of residence. These findings are pivotal for policy makers to inform strategies to achieve equity in access to affordable oral health care.