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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Dental Service Use and Dental Insurance Coverage -- United States, Behavioral Risk Factor Surveillance System, 1995In the United States, 94% of adults have evidence of past or current tooth decay, and only one third of adults aged 35-44 years have all of their permanent teeth (1). Dental insurance is associated with increased use of dental services and improved oral health status (2,3). This report summarizes state-specific and aggregated state data on both private and public sources of dental insurance coverage and the use of dental services among adults in 25 states * who participated in the oral health module of the 1995 Behavioral Risk Factor Surveillance System (BRFSS). The findings indicate that nearly half (44.3%) of adults in this survey reported having no dental insurance coverage. The BRFSS is a continuous, state-based, random-digit-dialed telephone survey of the U.S. noninstitutionalized population aged greater than or equal to 18 years. In 1995, a total of 56,339 adults participated in the core BRFSS in the 25 states that included the oral health module. State response rates ranged from 52.3% to 84.5% (median: 68.4%). Participants were asked whether they had had a dental visit within the previous 12 months (a past-year visit), one of the national health objectives for the year 2000 for oral health (objective 13.4) (4); reasons for not having had a past-year visit; and whether they had any kind of insurance coverage that pays for some or all of their dental care, including dental insurance, prepaid plans such as health-maintenance organizations (HMOs), or government plans such as Medicaid. Persons who reported having no dental-care coverage at the time of the interview were considered to be uninsured. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated by sex, age, education level, annual household income, and dentate status (i.e., the presence or absence of natural teeth: edentate=no teeth, dentate=one or more teeth) by SUDAAN. Of respondents to the core BRFSS questionnaire, 93.3% participated in the oral health module. Of these, 69.0% (95% CI=plus or minus 0.8 percentage points) reported having had a past-year dental visit (range: 61.4% {Arkansas} to 74.5% {Wisconsin}) (Table_1). Women were more likely than men to report having had a past-year visit (70.7% {95% CI=plus or minus 1.0 percentage points} and 67.1% {95% CI=plus or minus 1.2 percentage points}, respectively) (Table_2). The highest prevalences of such visits were among dentate adults aged greater than or equal to 65 years (75.0%) and all persons aged 35-44 and 45-54 years; the lowest prevalences were among edentate adults aged greater than or equal to 65 years (18.5%). The percentage of adults reporting a past-year visit varied directly with education levels and family incomes. The prevalence of a past-year visit was higher among insured adults than among uninsured adults (78.3% compared with 57.6%) and higher among dentate adults than among edentate adults (72.5% compared with 24.3%). A total of 44.3% (95% CI=plus or minus 0.8 percentage points) of participants reported being uninsured at the time of interview (range: 31.8% {Alaska} to 60.4% {Maine}) (Table_1). This proportion was similar for both men (43.5% {95% CI=plus or minus 1.2 percentage points}) and women (45.2% {95% CI=plus or minus 1.0 percentage points}) (Table_2). The percentage of uninsured persons was lowest among persons aged 35-44 years and 45-54 years and highest among persons aged greater than or equal to 65 years and varied inversely with education level and family income. In addition, the likelihood of being uninsured was higher among edentate adults than dentate adults (67.1% compared with 42.4%) and higher among adults whose last dental visit was greater than or equal to 5 years ago than those with a past-year visit (69.4% compared with 36.5%). The two most common reasons cited by respondents who did not have a past-year visit were that they did not perceive they had a dental problem (44.6%) and cost (26.6%). Among edentate adults, however, 89.5% did not perceive a problem, and 2.5% cited cost as a reason for not having had a past-year visit. Similar percentages of insured respondents (42.9%) and uninsured respondents (45.6%) did not perceive the need to visit a dentist. However, 36.0% of uninsured adults cited cost as the reason for not having had a past-year visit compared with 11.9% of insured adults. Reported by: J Cook, MPA, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; E Pledger, MPA, Georgia; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; N Costello, MPA, Indiana; A Wineski, Iowa; D Maines, Maine; D Brooks, MPH, Massachusetts; P Smith, Montana; T Melnik, DrPH, New York; J Kaske, MPH, North Dakota; R Indian, MS, Ohio; J Grant-Worley, MS, Oregon; J Hesser, PhD, Rhode Island; K Condon, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; L Redman, Virginia; K Wynkoop-Simmons, PhD, Washington; E Cautley, MS, Wisconsin; M Futa, MA, Wyoming. Behavioral Surveillance Br, Div of Adult and Community Health; Surveillance, Investigations, and Research Br, Div of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The BRFSS oral health module generates state-specific estimates that for the first time document variation in past-year dental visits and dental insurance coverage for adults in participating states. Overall, state-specific prevalences of persons reporting a past-year visit varied inversely with prevalences of persons without dental insurance. This association is consistent with results of the National Health Interview Survey (2) and other previously published studies (5,6). However, in some states (e.g., Massachusetts, Ohio, and Vermont), use was high despite lower percentages of dental insurance coverage. Such differences may reflect differences in age distribution, income, or education level of adults in these states. Twelve states exceeded the national health objective of greater than or equal to 70% of adults aged greater than or equal to 35 years using the oral-health-care system during each year (4). Among specific population groups (e.g., younger and older age groups, lower income or education level groups, or edentate persons), lower percentages of adults reported dental insurance coverage and dental services use. Because dental insurance typically is provided as an employee benefit, groups less likely to have dental insurance include young adults and elderly retired persons. Overall, uninsured adults were three times more likely than insured adults to cite cost as the main reason for not having had a past-year visit. Infrequent use of dental services has been associated with poor oral health among adults with lower income and education levels; such persons have more decayed teeth requiring treatment, more severe periodontal disease, and are more likely to be edentate than adults with more education and higher incomes (7). Regardless of insurance status, however, almost half the adults who did not have a past-year visit in 1995 did not perceive the need for one. This finding was particularly evident among edentate adults and is of concern because adults without teeth are older, and the incidence of oral cancers that could be detected during an oral examination is higher among older adults (8-10). Interpretations of these survey results are subject to at least two limitations. First, because the BRFSS does not include households without a telephone, these findings may underestimate the prevalence of being uninsured in some population groups (e.g., lower income or education level). Second, adults who are eligible for Medicaid or who have Medicare who reported having dental insurance may not be aware that coverage for many dental services may be limited or nonexistent. The BRFSS can provide routinely available, timely, state-specific data on reported use of dental services and dental insurance coverage that may be used for monitoring trends over time and the effects of changes in the dental health-care delivery system. Changes may include the provision of coverage of some dental services offered to Medicare beneficiaries by HMOs; increasing proportions of the population, including those eligible for Medicaid, covered by managed-care versus fee-for-service dental insurance plans; and increases in the price of dental services relative to the Consumer Price Index. The BRFSS also can serve as the basis for planning and evaluating oral health promotion and disease prevention programs. Such programs are designed to enhance knowledge and behaviors that can maintain and improve oral health (e.g., routine oral examinations and primary and secondary prevention services). References
* Alabama, Alaska, Arizona, Arkansas, California, Georgia, Idaho, Illinois, Indiana, Iowa, Maine, Massachusetts, Montana, New York, North Dakota, Ohio, Oregon, Rhode Island, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming. Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 1. Weighted percentage of persons reporting a dental visit during the previous 12 months and persons reporting having no dental insurance, by state -- United States, Behavioral Risk Factor Surveillance System, 1995 * ==================================================================================================== Dental visit No dental during previous 12 insurance months ------------------------ -------------------------- State % (95% CI+) % (95% CI) ---------------------------------------------------------------------------------------------------- Alabama 64.1 (+/-2.7%) 49.8 (+/-2.8%) Alaska 73.3 (+/-3.2%) 31.8 (+/-3.2%) Arizona 66.5 (+/-3.2%) 43.9 (+/-3.2%) Arkansas 61.4 (+/-2.6%) 55.4 (+/-2.6%) California 66.5 (+/-2.4%) 43.7 (+/-2.3%) Georgia 71.8 (+/-2.2%) 36.4 (+/-2.3%) Idaho 65.9 (+/-2.0%) 46.6 (+/-2.1%) Illinois 73.5 (+/-2.6%) 39.4 (+/-3.1%) Indiana 65.2 (+/-2.2%) 43.7 (+/-2.2%) Iowa 68.1 (+/-1.8%) 46.0 (+/-1.9%) Maine 66.0 (+/-3.0%) 60.4 (+/-3.1%) Massachusetts 74.2 (+/-2.3%) 46.0 (+/-2.6%) Montana 65.6 (+/-3.0%) 57.3 (+/-3.1%) New York 71.1 (+/-3.3%) 44.5 (+/-3.4%) North Dakota 68.9 (+/-2.4%) 58.8 (+/-2.7%) Ohio 73.9 (+/-2.7%) 47.3 (+/-3.2%) Oregon 70.8 (+/-1.9%) 41.1 (+/-2.0%) Rhode Island 69.2 (+/-2.5%) 43.2 (+/-2.6%) Texas 65.1 (+/-2.7%) 47.0 (+/-2.7%) Utah 73.3 (+/-2.2%) 39.5 (+/-2.5%) Vermont 73.0 (+/-2.0%) 48.3 (+/-2.3%) Virginia 73.5 (+/-2.4%) 40.8 (+/-2.6%) Washington 68.8 (+/-1.8%) 40.6 (+/-1.9%) Wisconsin 74.5 (+/-2.3%) 42.0 (+/-2.6%) Wyoming 66.4 (+/-2.2%) 46.3 (+/-2.3%) Total 69.0 (+/-0.8%) 44.3 (+/-0.8%) ---------------------------------------------------------------------------------------------------- * n=56,339. Excludes persons who said they did not know or who refused to respond. + Confidence interval. ==================================================================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Weighted percentage of persons reporting a dental visit during the previous 12 months and persons reporting having no dental insurance, by selected characteristics -- United States, Behavioral Risk Factor Surveillance System, 1995 * ============================================================================================================= Dental visit No dental during previous 12 insurance months ---------------------------- --------------------------- Characteristic % (95% CI+) % (95% CI) ------------------------------------------------------------------------------------------------------------- Sex Men 67.1 (+/-1.2%) 43.5 (+/-1.2%) Women 70.7 (+/-1.0%) 45.2 (+/-1.0%) Age group (yrs) 18-24 67.4 (+/-2.5%) 44.3 (+/-2.7%) 25-34 67.1 (+/-1.6%) 39.8 (+/-1.8%) 35-44 72.5 (+/-1.8%) 34.2 (+/-1.8%) 45-54 75.0 (+/-1.8%) 35.9 (+/-2.2%) 55-64 69.8 (+/-2.0%) 49.7 (+/-2.2%) >=65 61.6 (+/-1.6%) 69.3 (+/-1.8%) Education level (yrs) <12 50.0 (+/-2.2%) 63.4 (+/-2.2%) 12 66.4 (+/-1.4%) 47.9 (+/-1.4%) >=13 75.6 (+/-0.9%) 36.9 (+/-1.0%) Annual household income <$15,000 51.2 (+/-2.5%) 67.2 (+/-2.5%) $15,000-$24,999 59.2 (+/-1.8%) 61.0 (+/-1.8%) $25,000-$34,999 67.6 (+/-1.8%) 43.4 (+/-1.8%) >=$35,000 79.4 (+/-1.0%) 28.2 (+/-1.2%) Insurance status Insured 78.3 (+/-1.0%) -- Uninsured 57.6 (+/-1.2%) -- Dentate status& Edentate 24.3 (+/-2.3%) 67.1 (+/-2.5%) Dentate 72.5 (+/-0.4%) 42.4 (+/-0.4%) Time since last visit <=1 year -- 36.5 (+/-1.0%) >=5 years -- 69.4 (+/-2.5%) Total 69.0 (+/-0.8%) 44.3 (+/-0.8%) ------------------------------------------------------------------------------------------------------------- * n=56,339. Excludes persons who said they did not know or who refused to respond. + Confidence interval. & Edentate=no teeth, dentate=one or more teeth. ============================================================================================================= Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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