Dental treatment needs in the Canadian population:analysis of a nationwide cross-sectional survey

BACKGROUND: Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. METHODS: A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. RESULTS: Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. CONCLUSIONS: It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk

Trends in Socioeconomic Inequalities in Ischemic Heart Disease, 2000-2012

Introduction Low socioeconomic position (SEP) is an important risk factor for ischemic heart disease (IHD). Current surveillance methods use area-based SEP measures to monitor trends in socioeconomic inequalities in IHD. The extent to which these methods underestimate individual-level socioeconomic inequalities in IHD is unclear. Objectives and Approach The study objective was to estimate socioeconomic trends in IHD by household income and material deprivation in Ontario from 2000 to 2012. A pooled cross-sectional study was conducted using data from 6 Canadian Community Health Survey (CCHS) cycles (2000-2012) linked to the Discharge Abstract Database (n= 119,529 over 35 years of age, 55% female). Relative-weighted Poisson regression models were used to estimate IHD prevalence rates (adjusted for age, sex, ethnicity and immigration) across quintiles of equivalized household income and area-level material deprivation. Socioeconomic inequalities were estimated using the slope index of inequality (SII) and relative index of inequality (RII). Results Socioeconomic inequalities in IHD were observed across income and material deprivation quintiles. Measured using the SII, adjusted IHD rates were 345 per 10,000 (95%CI: 207,483) higher at the bottom of the income distribution than the top in 2000, decreasing to 167 per 10,000 (95%CI: 40,293) by 2012. These differences represented 2.52 (95%CI: 1.58,3.46) times higher IHD rates in 2000, an increased risk that remained in 2012 (RII: 1.80, 95%CI: 0.97,2.63). A similar pattern was observed across material deprivation quintiles, however with smaller absolute and relative inequalities observed in 2000 (SII:195 per 10,000, 95%CI:79,312; RII:1.64, 95%CI:1.16,2.11) and 2012 (SII:142 per 10,000, 95%CI:16,268; RII:1.54, 95%CI:0.94,2.14). Conclusion/Implications Consistent socioeconomic inequalities in IHD were observed in Ontario, with an absolute reduction between 2000 and 2012. Area-level material deprivation underestimated individual-level socioeconomic inequalities in IHD

Dental Treatment Needs in the Canadian Population

Objective: To determine the dental treatment needs of Canadians and how they are distributed. Methods: A secondary analysis of data from the Canadian Health Measures Survey was undertaken. Weights were applied to make the data nationally representative. Bivariate and multivariate regressions were used to identify predictors of need. Sensitivity, specificity, positive and negative predictive values were calculated to compare self-reported and clinically determined needs. Results: Of the 34.2% who required dental treatment, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. A discrepancy was found between clinical and self-reported needs. Conclusions: Roughly 12 million Canadians have unmet dental needs. A number of factors are predictive of having unmet dental conditions. Program and policymakers now have information by which to assess if their programs match the dental needs of Canadians.MAS

Socioeconomic Inequalities in Distributions of Birth Outcomes: A Cross-National Comparative Study of Canada and the United States

Background: Despite well-established associations between entire distributions of birth outcomes (i.e., birth weight and gestational age) and health outcomes across the life course, the extant literature on socioeconomic inequalities has focused almost exclusively on examining inequalities in their high-risk range (i.e., low birth weight and preterm birth). Objective: To examine if, and why, socioeconomic inequalities in low birth weight and preterm birth extend to inequalities over the entire distributions of birth weight and gestational age, in Canada and its peer nations. Methods and aims: A scoping review was conducted to understand how researchers have conceptualized and analyzed social inequalities in distributions of birth outcomes (Aim 1). Data from the U.S. 2006 Pregnancy Risk Assessment Monitoring System (PRAMS) (N=892,635) were used to measure and explain socioeconomic inequalities across distributions of birth outcomes (Aim 2). Harmonized data from the 2006 U.S. PRAMS and the 2006 Canadian Maternity Experiences Survey (MES) (N=61,230) were used to examine whether socioeconomic inequalities in distributions of birth weight and gestational age vary between two comparable countries, Canada and the United States. Results: This dissertation uncovered the presence of socioeconomic inequalities not only in low birth weight and preterm birth, but also over the entire distributions of birth weight and gestational age. Compared to the United States, Canada was characterized by more favourable birth-outcome distributions (i.e., a greater proportion of infants weighing between 2500 and 4000 grams and born between 37 and 41 weeks of gestation), both for the full populations and between similar socioeconomic groups. Observed individual level characteristics could not fully explain cross-national disparities, pointing to the explanatory power of unobserved (and perhaps structural) factors. Conclusions: Applying a distributional lens to investigate health inequalities within and between societies provides further insights regarding the population-level scope of the problem of health inequalities. Socioeconomic inequalities are present over the entire birth outcome distributions, which have implications both for clinical guidelines and population health prevention strategies.Ph.D.2020-11-19 00:00:0

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey

Abstract Background Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. Methods A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. Results Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. Conclusions It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey

Abstract Background Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. Methods A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. Results Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. Conclusions It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.</p

Is accessing dental care becoming more difficult? Evidence from Canada's middle-income population.

OBJECTIVE: To explore trends in access to dental care among middle-income Canadians. METHODS: A secondary data analysis of six Canadian surveys that collected information on dental insurance coverage, cost-barriers to dental care, and out-of-pocket expenditures for dental care was conducted for select years from 1978 to 2009. Descriptive analyses were used to outline and compare trends among middle-income Canadians with other levels of income as well as national averages. RESULTS: By 2009, middle-income Canadians had the lowest levels of dental insurance coverage (48.7%) compared to all other income groups. They reported the greatest increase in cost-barriers to dental care, from 12.6% in 1996 to 34.1% by 2009. Middle-income Canadians had the largest rise in out-of-pocket expenditures for dental care since 1978. CONCLUSIONS: This study suggests that affordability issues in accessing dental care are no longer just a problem for the lowest income groups in Canada, but are now impacting middle-income earners as a consequence of their lack of, or decreased access to, comprehensive dental insurance

The impact of social assistance programs on population health: a systematic review of research in high-income countries

Abstract Background Socioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries. Methods We systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature. Results Seventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends. Conclusions Evidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage

Equally inequitable? A cross-national comparative study of racial health inequalities in the United States and Canada

This is an accepted manuscript of an article published by Elsevier.Prior research suggests that racial inequalities in health vary in magnitude across societies. This paper uses the largest nationally representative samples available to compare racial inequalities in health in the United States and Canada. Data were obtained from ten waves of the National Health Interview Survey (n = 162,271,885) and the Canadian Community Health Survey (n = 19,906,131) from 2000 to 2010. We estimated crude and adjusted odds ratios, and risk differences across racial groups for a range of health outcomes in each country. Patterns of racial health inequalities differed across the United States and Canada. After adjusting for covariates, black-white and Hispanic-white inequalities were relatively larger in the United States, while aboriginal-white inequalities were larger in Canada. In both countries, socioeconomic factors did not explain inequalities across racial groups to the same extent. In conclusion, while racial inequalities in health exist in both the United States and Canada, the magnitudes of these inequalities as well as the racial groups affected by them, differ considerably across the two countries. This suggests that the relationship between race and health varies as a function of the societal context in which it operates.Financial support was provided from the Canadian Institute for Health Research (Grant number: 120259): Operating Grant and the Canada Research Chair in Population Health Equity from the Gov- ernment of Canada

Self-reported cost-barriers to dental care among middle-income Canadians, by insurance status, select years.

<p>While the proportion of insured persons reporting cost-barriers to dental care grew from 6.0% in 1996 to 17.1% by 2009, the proportion of uninsured persons who made such reports rose from 14.0% to 50.0%.</p