Intersections of Class and Colonisation: Access to Dental Care for Indigenous Peoples in Canada

Inequitable access to healthcare is a central driver of the disproportionate burden of disease in Indigenous peoples. The aim of this study is to investigate inequities in access to dental care, accounting for supra-additive effects at the intersections of educational attainment, household income, and Indigeneity.

Data were extracted from the 2017 to 2018 Canadian Community Health Survey, a national survey of Canada's ten provinces and three territories. A multilevel analysis of individual heterogeneity and discriminatory accuracy was performed, defining 18 intersectional strata by educational attainment, household income, and Indigenous status. Three outcomes pertaining to dental care access were assessed: (i) dental attendance in the past 12 months, (ii) attending the dentist never or only for emergencies, and (iii) avoiding attending the dentist due to cost.

There was evidence of substantial between-stratum heterogeneity in access to dental care. Fixed effects of age, sex, educational attainment, household income, and Indigeneity explained 91.0%-98.2% of the between-stratum variance. The median odds ratio (MOR) indicated that, depending on intersectional identity, the odds increased by 80% for having visited the dentist in the past 12 months (MOR: 1.80; 95% CI: 1.71-2.08), 118% for attending never or only for emergencies (MOR: 2.18; 95% CI: 2.04-2.50), and 83% for avoiding visits due to cost (MOR: 1.83; 95% CI: 1.68-2.22).

Indigenous status and socioeconomic position greatly concentrate the risk of poor access to dental care, but there is little evidence for supra-additive interactions between these factors.