Avoidance dental visit, the impact of predictor factors: A cross-sectional study in Kerman, Iran

BACKGROUND AND AIM: In spite of different reforms and programs, the evidence indicates that Iran dental health sector has not been able to improve the dental situation and decrease the unmet needs. This study assessed the factors which affect the avoiding dental visit during one year ago because of its costs. METHODS: This cross-sectional study was performed on 1158 household heads which were selected through multi-stage sampling in Kerman, Iran, and questioned house by house using trained interviewers. The association of dichotomous outcome variables of “have you avoided or postponed dental visit during 1 years ago in spite of need because of its costs?” with 3 types of predictor variables of household heads including sex as binary predictor, age as continuous predictor, and income and education as categorical variables studied using regression logistics. RESULTS: The odds ratio (OR) of avoiding dental visit because of its costs in men was 1.4 times more than women (P = 0.035). The OR decreased by 0.01 with each year increase in age (P = 0.017). Furthermore, the OR is people with incomes 267-803, 803-1339 and > 1339 USD in comparison with the heads incomes under 267 USD was 0.31, 0.02, 0.01, respectively (P = 0.001), and in people with educational level < diploma, diploma, Bachelor of Science (BSc), Master of Science (MSc) and Doctor of Medicine (MD)/Doctor of Philosophy (PhD) in comparison with illiterate/elementary decreased by 0.51, 0.13, 0.04, 0.01 and 0.02, respectively (P < 0.001). CONCLUSION: The factors of older ages, being a woman, increasing education and income level decrease the rate of avoiding a dental visit. In the absence of strong dental health insurance, these factors determine the utilization of the services which lead to horizontal inequality. KEYWORDS: Odds Ratio; Utilization; Dental Car

What determines utilization of dental care services? The case of Iran

BACKGROUND AND AIM: Identifying the factors affecting utilization of dental services is one of the best ways to improve the health status. This study aimed to investigate the effective factors on utilization of dental services. METHODS: In this cross-sectional study, 1185 household heads were selected randomly, and using a researcher-made questionnaire based on World Health Organization (WHO) Global Health Survey and Andersen behavioral model, and through multivariate logistic regression, the predictors of visiting a dentist during 1 year ago were investigated in 2017. The households’ income inequality in utilization of dental services was analyzed using concentration indices (CIs) and Pearson chi2 in STATA software. RESULTS: The predictor of dental visit during 1 year ago for men was having decayed teeth [odds ratio (OR) = 1.3, P = 0.030], and the predictors for women were lower ages (OR = 0.8, P = 0.001 for 19-29 years old and so on), having 32 natural teeth (OR = 0.7, P = 0.020), and employment (OR = 1.3, P = 0.048). The common predictors were increase in education level (OR = 1.4, P = 0.001 for men, and OR = 1.7, P = 0.001 for women with university degree), brushing (OR = 1.9; P = 0.001 for women, and OR = 1.3; P = 0.040 for men), and having supplementary insurance (OR = 1.7, P = 0.001 for men, and OR = 1.9, P = 0.001 for women). Being burdensome of dental care costs during 3 years ago (CI: -0.074, P = 0.001), avoiding visiting a dentist during 1 (CI: -0.501, P = 0.001) and 3 (CI: -0.501, P = 0.001) years ago because of its costs, and failure to do all dentistry recommendations during 3 years ago (CI: -0.516, P = 0.001) happen more frequently among the poor. Moreover, the poor used all dental services such as scaling (CI: -0.638, P = 0.001), filling (CI: -0.458, P = 0.001), and root canal (CI: -0.524, P = 0.001) less than the rich. CONCLUSION: Dental health status is negatively affected by population socio-economic situation; therefore, it is necessary to implement policies to improve access to dental services among the undeserved. KEYWORDS: Utilization; Dental Care; Iran Citation: Amiresmaili M, Amini S, Shahrava

Relation between socioeconomic indicators and children dental caries in Iran: A systematic review and meta-analysis

The relationship between households' socioeconomic situation (SES) and children dental caries has been assessed in many Iranian studies to evaluate the effect of public dental care programs supporting the poor. Hence, this study through systematic review and meta-analysis has presented a conclusion in this regard. Domestic and foreign databases were searched using keywords designed by concept map. Time limit to search the databases included articles published from 1994 to 2017. Twenty-five articles were entered to the final step of the study, in which 49 relationships between SES and dental caries were assessed. Heterogeneity between studies was assessed using I2. Publication bias has been assessed using funnel plot and Egger's test. The data were assessed by STATA 13.1. Odds ratio and mean difference of children dental caries in high SES households in comparison with low SES households were 0.41 (confidence interval [CI]: 0.30, 0.52) and −0.49 (CI: −0.85, −0.13), respectively. The CI in both cases did not include “null or no effect line,” so there was a significant inverse relation between SES and dental caries. Despite the emphasis on upstream documents on equity in access to dental health services, there was high difference between SES groups in this regard. It is necessary to revise dental health programs at the country level to decrease these differences