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Productivity losses from dental problems

2012; Wiley; Volume: 57; Issue: 3 Linguagem: Inglês

10.1111/j.1834-7819.2012.01718.x

1834-7819

Jane Harford, Sergio Chrisopoulos,

Health disparities and outcomes

Australian Dental JournalVolume 57, Issue 3 p. 393-397 DATA WATCHFree Access Productivity losses from dental problems Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia., Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.Search for more papers by this author Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia., Australian Research Centre for Population Oral Health, The University of Adelaide, South Australia.Search for more papers by this author First published: 26 August 2012 https://doi.org/10.1111/j.1834-7819.2012.01718.xCitations: 7 Dr Jane Harford Australian Research Centre for Population Oral Health School of Dentistry The University of Adelaide Adelaide SA 5005 Email: jane.harford@adelaide.edu.au AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Introduction Dental disease experience is almost ubiquitous amongst middle-aged Australian adults with only 2.4% of 35–54 year olds having no experience of decay in their permanent teeth in 2004–06.1 Annually, Australians spend approximately $7690 million on dental care, accounting for 6.6% of total health expenditure.2 In addition to dental care provided in the dental sector, it is estimated that general medical practitioner care for dental problems costs approximately $245–350 million per year3 and the cost of treating dental problems in hospital is approximately $100 million.3 The cost of poor dental health includes these direct costs arising from dental care by dental health workers, dental care by other health workers and treatment of other oral health-induced illnesses as well as the indirect costs, including lost productivity resulting from time away from the workforce or from education for dental treatment and lost time because of illness attributable to oral ill health.4 While these estimates of the direct costs of dental care are significant, to date, there has been a paucity of recent, representative population based data on which estimates of the lost productivity associated with dental problems can be made. This report uses self-reported information on the number of days missed from work or study and days of reduced activity to estimate the cost of the lost productivity associated with oral problems and examines whether any demographic, oral health or dental visiting characteristics are associated with lost productivity. Methods Data presented in this report were sourced from the National Dental Telephone Interview Survey (NDTIS) 2010. The target population for NDTIS 2010 was Australian residents aged two years and over in all states and territories. To select a representative sample of residents, a two-stage stratified sampling design was implemented. In the first stage, the Australian Institute of Health and Welfare Dental Statistics and Research Unit (AIHW DSRU) requested the Australian Electoral Commission (AEC) to extract a sample of Australian adults aged 18 years and over from the electoral roll. These data were matched against the Sensis MacroMatch database to append a residential telephone number. Matched records that returned either a landline or mobile telephone number formed the basis of the sample frame for the 2010 NDTIS. The sample frame was stratified by state and region, where region was defined as metropolitan or non-metropolitan. Households were randomly selected from each stratum using the inbuilt features of the WINCATI software programme (WinCati 4.2 Sawtooth Technologies, Inc.) and contacted by telephone. If telephone contact was made with a household, the interviewer established whether the telephone number served a residential dwelling. If the household was in-scope of the survey, an adult aged 18 years or older usually resident in the household was randomly selected. If there was only one adult usually resident in the household then that person was selected as the target adult. If there were two or more adults usually resident in the household, the householder was asked to identify the person who was due to have the next birthday as well as the person who had the last birthday. The WINCATI programme then randomly selected one of the nominated adults as the target adult to complete the telephone interview. Once the interview was completed with the target adult, if there were children aged 2–17 years usually residing in the household, one child was randomly selected to participate in the survey. A total of 10 237 people aged 2 or more years were interviewed and asked a range of questions relating to their oral health, access to dental care, dental treatment received and affordability of dental care. Data were weighted to the 2009 estimated resident population.5 This report presents findings from 6284 adults aged 18 years or older who were directly interviewed. The telephone interview proceeded in a set order of questions and dentate participants were initially asked to describe their current employment status. For respondents who reported that they were employed or not working but studying, further questions were asked about the number of days missed from work or study for more than half a day due to dental problems and the number of 'other days' they reduced their usual activities due to dental problems. Percentages of persons missing time and reducing activity are reported overall and by demographic, dental health, dental visiting characteristics, as well as the mean occasions of time missed or reduced activity. All estimates include 95% confidence intervals (95% CIs). Differences in estimates are reported as statistically significant when 95% CIs do not overlap. The cost to the economy of that missed time is calculated using average weekly earnings (AWE) estimated by the Australian Bureau of Statistics (ABS) in March 2012 at $1345.20.6 Consequently, for days lost, average daily earnings (ADE) were estimated at 20% of AWE. Days where more than half a day was missed were estimated at 75% of ADE (our best estimate). This assumes that the time taken was equally distributed across one half to one full day missed. Estimates were also made at 50% (our lowest estimate) and 100% (our highest estimate) to show the highest (if all persons missed a full day) and lowest estimates (if all persons missed a half day). For days of reduced activity, the cost to the economy was estimated at 25% of ADE (our best estimate). Estimates were also made at 10% (our lowest estimate) and 50% (our highest estimate). Results Percentages of persons reporting that they had one or more occasions of missed work and the mean number of days missed are shown in Table 1. Overall, 9% of dentate persons aged 18 and over who were employed or studying reported that they had missed one or more half days from work or study due to dental problems. There were no statistically significant differences across any of the demographic characteristics reported. Table 1. Persons who missed one half day or more due to dental problems Missed one half day or more due to dental problems % of people (95% CI) Mean number of occasions (95% CI) 9.06 (7.79–10.32) 0.23 (0.19–0.26) Demographic characteristics Age (years) 18–34 9.77 (7.33–12.22) 0.25 (0.18–0.32) 35–44 9.82 (7.17–12.48) 0.26 (0.18–0.34) 45–54 8.08 (6.15–10.01) 0.16 (0.12–0.20) 55–64 7.44 (5.21–9.67) 0.18 (0.10–0.25) 65+ 7.52 (2.28–12.77) 0.43 (0.00–1.01) Gender Male 8.6 (6.74–10.46) 0.19 (0.14–0.23) Female 9.54 (7.85–11.24) 0.27 (0.21–0.33) Household Income <$60 000 10.6 (7.86–13.34) 0.23 (0.15–0.32) $60–<$100 000 9.02 (6.62–11.42) 0.24 (0.17–0.32) $100 000+ 8.81 (6.79–10.83) 0.22 (0.16–0.29) Cardholder status Cardholder 7.56 (4.27–10.85) 0.21 (0.11–0.31) Non-cardholder 9.22 (7.87–10.57) 0.23 (0.19–0.27) Insurance status Insured 8.72 (7.19–10.24) 0.23 (0.18–0.29) Uninsured 9.66 (7.46–11.87) 0.22 (0.17–0.27) Remoteness location Major cities 8.87 (7.30–10.43) 0.22 (0.17–0.26) Inner regional 9.91 (7.24–12.57) 0.26 (0.16–0.36) Outer regional 8.03 (5.12–10.94) 0.2 (0.12–0.29) Remote/Very remote 11.65 (4.55–18.74) 0.39 (0.11–0.67) Dental visiting patterns Reason for last visit Check-up 5.56 (4.10–7.02) 0.14 (0.10–0.19) Problem 19.3 (16.22–22.37) 0.49 (0.39–0.58) Usual reason for dental visit Check-up 7.66 (6.28–9.03) 0.21 (0.16–0.26) Problem 11.89 (9.31–14.46) 0.25 (0.19–0.32) Time since last visit <12 months 13.14 (11.36–15.15) 0.34 (0.27–0.4) 1–<2 years 3.51 (2.07–5.89) 0.08 (0.04–0.12) 2–<5 years 3.85 (1.93–7.53) 0.06 (0.01–0.11) 5–<10 years 0.15 (0.02–1.08) 0.0 (0–0.01) 10+ years 0.51 (0.07–3.57) 0.03 (0–0.08) Usual frequency of dental visiting Two or more times per year 14.36 (11.23–17.49) 0.39 (0.28–0.49) Once a year 8.66 (6.52–10.79) 0.22 (0.15–0.29) Once in two years 7.54 (4.64–10.44) 0.17 (0.09–0.24) Less often 5.05 (3.38–6.72) 0.09 (0.06–0.13) Has usual source of dental care Yes 9.93 (8.44–11.43) 0.25 (0.20–0.30) No 9.18 (5.92–12.44) 0.2 (0.12–0.28) Self-rated dental health Excellent/Very Good/Good 7.73 (6.48–8.98) 0.19 (0.15–0.23) Fair/Poor 15.71 (11.52–19.91) 0.41 (0.28–0.55) Number of occasions for persons who one or more occasions of missed work or study All with one or more occasions of missed work or study n/a 2.49 (2.19–2.80) Persons whose last dental visit was for a problem were more likely to have missed one or more days from work or study than persons who had last visited for a check-up (19.3% compared to 5.6%). Persons who usually visit for a problem were also more likely to have missed days from work/study than those who usually visit for a check-up (11.9% compared to 7.7%). Persons who made a dental visit in the last 12 months (13.1%) were also more likely to have missed time than those whose last visit was more than 12 months ago (ranging from 0.2% for those who visited between 5 and 10 years ago to 3.9% for those visiting between 2 and 5 years ago). Those who usually visit two or more times a year (14.4%) were more likely to have missed time compared to those who usually visit less frequently (ranging from 5.1% for those visiting less than once every two years to 8.7% for those usually visiting once a year). Individuals who reported fair or poor oral health were more likely than those reporting Excellent/Good/Very good oral health to have missed time from work or study (15.7% compared to 7.7%). Percentages of persons reporting that they had one or more occasions of reduced activity and the mean number of days missed are shown in Table 2. Overall, 4.6% of dentate persons aged 18 and over who were employed or studying reported that they had reduced their activities due to dental problems. There were no statistically significant differences across any of the demographic characteristics reported. Table 2. Persons who had reduced activity due to dental problems Days with reduced activity due to dental problems % of people (95% CI) Mean number of occasions (95% CI) 4.64 (3.78–5.50) 0.15 (0.11–0.20) Demographic characteristics Age (years) 18–34 4.72 (3.11–6.33) 0.19 (0.10–0.27) 35–44 3.83 (2.33–5.33) 0.11 (0.05–0.18) 45–54 5.26 (3.54–6.98) 0.15 (0.08–0.22) 55–64 4.32 (2.56–6.09) 0.14 (0.06–0.22) 65+ 7.03 (1.27–12.78) 0.11 (0.02–0.20) Gender Male 4.4 (3.17–5.62) 0.13 (0.08–0.17) Female 4.9 (3.69–6.10) 0.18 (0.12–0.25) Household income <$60 000 5.57 (3.46–7.68) 0.22 (0.11–0.33) $60–<$100 000 4.92 (3.23–6.60) 0.12 (0.07–0.18) $100 000+ 4.05 (2.89–5.21) 0.15 (0.08–0.22) Cardholder status Cardholder 3.36 (1.54–5.19) 0.13 (0.04–0.22) Non-cardholder 4.78 (3.84–5.71) 0.16 (0.11–0.20) Insurance status Insured 4.76 (3.61–5.92) 0.16 (0.10–0.21) Uninsured 4.44 (3.14–5.74) 0.15 (0.09–0.21) Remoteness location Major cities 4.18 (3.23–5.13) 0.14 (0.09–0.19) Inner regional 6.21 (3.86–8.55) 0.19 (0.08–0.30) Outer regional 4.04 (1.57–6.51) 0.15 (0.02–0.27) Remote/Very remote 8.95 (0.00–19.13) 0.42 (0.06–0.78) Dental visiting characteristics Reason for last visit Check-up 2.66 (1.76–3.55) 0.06 (0.04–0.07) Problem 9.87 (7.64–12.09) 0.37 (0.25–0.49) Usual reason for dental visit Check-up 4.32 (3.32–5.32) 0.12 (0.08–0.17) Problem 5.32 (3.67–6.97) 0.21 (0.13–0.30) Time since last visit <12 months 6.52 (5.33–7.95) 0.21 (0.15–0.27) 1–<2 years 1.93 (1.11–3.34) 0.07 (0.02–0.11) 2–<5 years 2.27 (0.91–5.57) 0.04 (0–0.08) 5–<10 years 1.79 (0.48–6.46) 0.23 (0–0.65) 10 or more years 0 (0–0) 0 (0–0) Usual frequency of dental visiting Two or more times per year 6.49 (4.69–8.29) 0.22 (0.14–0.29) Once a year 4.51 (3.11–5.90) 0.13 (0.05–0.21) Once in two years 4.07 (1.89–6.25) 0.14 (0.05–0.23) Less often 2.93 (1.34–4.52) 0.12 (0.04–0.21) Has usual source of dental care Yes 5.23 (4.19–6.26) 0.17 (0.12–0.22) No 3.71 (1.61–5.81) 0.09 (0.04–0.14) Self-rated dental health Excellent/Very Good/Good 3.93 (3.04–4.82) 0.11 (0.07–0.14) Fair/Poor 8.25 (5.61–10.89) 0.39 (0.22–0.56) Number of occasions for persons who had one or more occasions of reduced activity All with one or more occasions of reduced activity n/a 3.32 (2.63–4.00) Persons whose last dental visit was for a problem were more likely to have reduced activity than persons who had last visited for a check-up (9.9% compared to 2.7%). Persons who visited in the last 12 months were also more likely to have reduced activity than those who last visited between 1 and 2 years ago (6.5% compared to 1.9%). Those who usually visited two or more times per year were more likely than those who visited less often than once every two years to do so (6.5% compared to 2.9%). Having last visited for a problem, rather than a check-up was associated with a higher number of days missed from work or study (0.49 compared to 0.14) (Table 1). Those who had made a dental visit in the last 12 months rather than between 1 and 2 years ago, and between 2 and 5 years ago had a higher number of days missed from work or study (0.34 compared to 0.08 and 0.06 occasions, respectively) as did those who usually visited two or more times per year rather than once every two years or less often (0.39 compared to 0.17 and 0.09, respectively). In addition, those who reported having Fair/Poor rather than Excellent/Very good/Good oral health had a higher number of days of missed work or study (0.41 compared to 0.19). Having last visited for a problem, rather than a check-up was associated with a higher number of days of reduced activity (0.37 compared to 0.06), as was having made a dental visit in the last 12 months rather than visited between 1 and 2 years ago, and between 5 and 5 years ago (0.21 compared to 0.07 and 0.04 occasions, respectively) (Table 2). In addition, those who reported having Fair/Poor rather than Excellent/ Very good/Good oral health had a higher number of days of reduced activity (0.39 compared to 0.11). Overall, there was an average of 0.23 occasions of missed work across all workers, and those who did miss work or study, did so an average of 2.49 times (Table 1). In addition, there was an average of 0.15 occasions of reduced activity across all workers and those who reduced activity did so an average of 3.32 times (Table 2). Persons who had to take time off work for dental problems were also more likely to report that they had at least one occasion of reduced activity than those who did not take time off work (25.2% of those who missed work also reported occasions of reduced activity, compared to 2.6% of persons who did not take time off work for dental problems). Estimates of the cost in lost productivity are shown in Table 3. Overall, there were approximately 2.4 million occasions of persons taking half a day or more from work or study. Assuming that the average amount of time for these occasions is 75% of a full day (our best estimate), the mean cost to the economy in lost productivity is estimated to be approximately $453 million annually. At 50% of a full day (our minimum cost), the estimate is approximately $302 million and at a full day (our maximum cost), it is approximately $604 million. Overall, there were approximately 1.6 million occasions of a person cutting down on their usual activity. Assuming that the average amount of time for these occasions is 25% of a full day (our best estimate), the mean cost to the economy in lost productivity is estimated to be approximately $103 million annually. At 10% of a full day (our minimum cost), the estimate is approximately $41 million and at a half day (our maximum cost), it is approximately $206 million. Table 3. Estimated value of lost productivity due to dental problems Mean (all persons) Mean (persons with one or more missed days) Total Occasions of missed time Occasions 0.23 (0.19–0.26) 2.49 (2.19–2.80) 2 400 512 (1 979 503–2 821 521) Minimum hours(a,g) 0.85 (0.70, 099) 9.35 (8.21, 10.49) 9 001 919 Mean hours (best estimate)(b,g) 1.27 (1.05, 1.49) 14.03 (12.32, 15.73) 13 502 878 Maximum hours(c,g) 1.69 (1.40, 1.99) 18.70 (16.43, 20.97) 18 003 837 Minimum cost($)(a) 28.4 313 301 792 326 Mean cost (best estimate)($)(b) 42.6 470 452 688 488 Maximum cost ($)(c) 56.8 627 603 584 651 Occasions of reduced activity Occasions 0.15 (0.11–0.20) 3.32 (2.63–4.00) 1 635 205 (1 194 265.29–2 076 144.52) Minimum hours(d,g) 0.12 (0.08, 0.15) 2.49 (1.97, 3.00) 1 226 404 Mean hours (best estimate)(e,g) 0.29 (0.21, 0.37) 6.22 (4.93, 7.51) 3 066 009 Maximum hours(f,g) 0.58 (0.42, 073) 12.44 (9.87, 15.01) 6 132 018 Minimum cost(d) 3.9 83 41 115 592 Mean cost (best estimate)(e) 9.7 209 102 788 980 Maximum cost(f) 19.3 417 205 577 961 (a)Assumes mean of half day missed. (b)Assumes mean of 75% day missed. (c)Assumes mean of 100% day missed. (d)Assumes 10% reduced activity. (e)Assumes 25% reduced activity. (f)Assumes 50% reduced activity. (g)Based on average working day of 7.5 hours. Discussion Recent attempts to estimate indirect costs of dental problems in the Australian population have been limited by the lack of recent, local, population based data on which to base those estimates. This report confirms the general findings of other estimates of considerable economic impact of dental problems. However, this is a conservative estimate as it does not include an imputed value of missed time and reduced activity for persons not in paid employment or study. Nor does it take account of time missed for asymptomatic care (dental check-ups or cleans). Spencer and Lewis7 argue that 'rather than leading to a restriction in activity, most dental diseases will have their greatest impact on eating, sleeping and resting … (so that)… schooling or job performance, social contacts, emotional behaviour and mobility are likely to be more widely affected' (p. 17). This could lead to further reductions in productivity without actually missing time or reducing activity. Based on our best (or mid-range) estimate, the number of hours per worker either missed or in reduced activity is 1.56 hours (1.27 plus 0.29) per worker. This is slightly more than Gift and Reisine's8 estimate that on average working Americans missed 1.48 hours of work for their own dental problem or visiting in 1989. Our estimates only refer to time missed or reduced for dental problems and does not explicitly include time for dental visits such as for a check-up or a clean. Based on Gift and Reisine's findings, Richardson and Richardson4 estimated a productivity loss among Australian workers in 2011 of $660 million. Richardson and Richardson's estimate is higher than our best estimate, but well below our highest estimate of the combined cost of both time missed and time of reduced activity ($808 million). The pattern of higher proportion of people missing work or study amongst those who usually visit for a problem and among those who usually visit 2 or more times per year suggests that a segment of the population who are in poor oral health and making a relatively large number of visits to deal with dental problems are most likely to miss work or study due to dental problems. This is supported by the finding that persons who rate their oral health as Fair/Poor also miss more work or study and have more occasions of reduced activity. If, as these findings suggest, this is a group of persons who are caught in a vicious cycle of poor oral health and problem oriented visiting, further work to identify these persons as high risk for this cycle may be warranted. Acknowledgements This report was produced by Jane Harford and Sergio Chrisopoulos. NDTIS is supported by the Australian Government Department of Health and Ageing. References 1 Roberts-Thomson KF, Do L. Oral health status. In: GD Slade, AJ Spencer, KF Roberts-Thomson, eds. Australia's dental generations: the National Survey of Adult Oral Health 2004–06. AIHW cat. no. DEN 165. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 34), 2007: 81– 142. Google Scholar 2 Australian Institute of Health and Welfare. Health expenditure Australia 2009–10. Health and welfare expenditure series no. 46. Cat. no. HWE 55. Canberra: AIHW, 2011. Google Scholar 3 Leeder SL, Russell L. Dental and oral health policy issue paper. The Menzies Centre for Health Policy, Sydney, 2007. Google Scholar 4 Richardson B, Richardson J. End the decay: the cost of poor dental care and what should be done about it. Melbourne: The Brotherhood of St Laurence, 2011. Google Scholar 5 Australian Bureau of Statistics (ABS) Super CUBE dataset Population estimates by age and sex, Australia, by geographical classification (ASGC 2009) at 30 June 2009, Table 1. Google Scholar 6 Australian Bureau of Statistics (ABS) (2012) Average Weekly Earning Australia. ABS Cat. No. 6302.0. February 2012. Google Scholar 7 Spencer AJ, Lewis JM. The delivery of dental services: information, issues and directions. Community Health Stud 1988; 12: 16– 30. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 8 Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992; 82: 1663– 1668. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume57, Issue3September 2012Pages 393-397 ReferencesRelatedInformation