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Dental attendance patterns of Australian adults

2014; Wiley; Volume: 59; Issue: 1 Linguagem: Inglês

10.1111/adj.12151

1834-7819

Anne Ellershaw,

Oral microbiology and periodontitis research

Australian Dental JournalVolume 59, Issue 1 p. 129-134 Data WatchFree Access Dental attendance patterns of Australian adults† First published: 14 February 2014 https://doi.org/10.1111/adj.12151Citations: 7 Address for correspondence: Australian Research Centre for Population Oral Health School of Dentistry Faculty of Health Sciences The University of Adelaide Adelaide SA 5005 Email: anne.ellershaw@adelaide.edu.au †Australian Research Centre for Population Oral Health The University of Adelaide South Australia. ‡This article is a solicited opinion piece and did not undergo peer review. 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Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Introduction A person's usual attendance behaviour is frequently described by reference to individual characteristics of their dental visits including their frequency of dental visiting, their usual reason for making a dental visit and whether they visit a usual dental care provider.1 The concept of developing a composite indicator to reflect a person's usual dental attendance behaviour was initially explored using data from the 2004–06 National Survey of Adult Oral Health (NSAOH).1, 2 Adults were described as having a ‘favourable’ pattern of dental attendance if they had a usual dental provider they visited once a year for the purpose of a dental check-up. An ‘unfavourable’ pattern of dental attendance was defined as adults who visited the dentist infrequently (less often than once every two years) for the purpose of a dental problem and did not have a usual dental care provider. The remaining adults were classified to an ‘intermediate’ category to reflect their mixed pattern of dental attendance. The concept of a ‘favourable’ through to ‘unfavourable’ pattern of dental attendance was formed to reflect how closely a person's pattern of dental attendance aligned with that recommended by the dental profession. In 2004–06 it was estimated that 39.3% of Australian dentate adults had a favourable pattern of dental attendance and nearly 29% had an unfavourable attendance pattern.1 The purpose of this report is to further develop the previous research undertaken using more recent data from the 2010 National Dental Telephone Interview Survey (NDTIS). Firstly, the report will focus on comparisons between the sociodemographic and socioeconomic characteristics of Australian dentate adults described as having a ‘favourable’ or ‘unfavourable’ pattern of dental attendance. Secondly, the report will explore the relationship between patterns of dental attendance and a range of indicators collected in NDTIS including oral health status, the social impact of dental problems and the type of dental treatment received. Lastly, the report will investigate the impact of the cost of dental care on the dental attendance patterns of Australian dentate adults. Survey Methodology Data presented in this report were sourced from the National Dental Telephone Interview Survey (NDTIS) 2010. This survey is the seventh in a series that commenced in 1994. The purpose of this survey is to collect data on access to dental care and the oral health of Australians. The target population for NDTIS 2010 was Australian residents aged two years and over in all states and territories. Survey design A representative sample of residents was selected using a two-stage stratified sampling design. For the first stage, a random sample of households was selected from the Electronic White Pages (EWP). To be able to access the latest version of the EWP, the Australian Institute of Health and Welfare's Dental Statistics and Research Unit (AIHW DSRU) requested the Australian Electoral Commission (AEC) 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. For households in-scope of the survey, an adult aged 18 years or older who was usually resident in the household was randomly selected. If there was only one adult 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. Data collected A total of 6765 adults and 3472 children were interviewed and asked a range of questions relating to their access to dental care, dental treatment received, affordability of dental care and self-reported oral health status. In addition, a range of sociodemographic and socioeconomic characteristics were collected. For the purpose of this report, cardholders are defined as persons eligible for public dental care and include persons with either a Pensioner Concession Card or an Australian Government Health Care Card at the time of the survey. Insured refers to adults with ancillary/extras cover that pays for some or all of the cost of dental care. Data on a range of indicators relating to general health, oral health and the impact of dental problems on everyday life were collected. Respondents were asked to rate their general health and oral health using the scale ‘excellent’, ‘very good’, ‘good’, ‘fair’ or ‘poor’. Response categories were combined into two groups defined by ‘excellent/very good/good’ and ‘fair/poor’. To measure the impact of dental problems on everyday life, respondents were asked if they had felt uncomfortable about the appearance of their teeth, mouth or dentures in the previous 12 months, and whether they had avoided eating certain foods in the previous 12 months because of problems with their teeth, mouth or dentures. Response categories for both questions were ‘very often’, ‘often’, ‘sometimes’, ‘hardly ever’ and ‘never’. These categories were combined into two groups defined by ‘very often/often/sometimes’ and ‘hardly ever/never’ for this report. To explore the relationship between the cost of dental care and dental attendance patterns respondents were asked if they had avoided or delayed dental care in the previous 12 months due to the cost. To measure the affordability of dental care, respondents were also asked to rate how much difficulty they would have in paying a $100 and $150 dental bill out of their own pocket. Response categories were ‘none’, ‘hardly any difficulty’, ‘a little difficulty’ and ‘a lot of difficulty’. Statistical analysis Data were weighted to account for the different probabilities of selection inherent in the survey design and to ensure the survey estimates were consistent with the 2009 estimated residential population age/gender distribution.3 Estimates of dental attendance patterns by socioeconomic and sociodemographic characteristics provided in Table 2 have been standardized to the 2011 Census age-gender estimated residential population.4 The direct method of standardization using SAS callable SUDAAN procedure ‘proc descript’ was used to derive the adjusted estimates. Statistical significance for comparisons of estimates of proportions was determined by non-overlapping 95% confidence intervals. Results For the 6397 dentate adults who participated in the 2010 NDTIS, 3007 were classified as having a favourable dental attendance pattern, 1980 were classified to the intermediate category, and 1329 were classified as having an unfavourable dental attendance pattern. A dental attendance category could not be derived for 81 adults due to missing data in one or more of the data items used to derive this composite classification. A detailed description of the derivation of each dental attendance category is available in the report ‘Dental attendance patterns and oral health status’.1 In 2010, it was estimated that 45.5% of Australian dentate adults had a favourable pattern of dental attendance, 21.9% had an unfavourable attendance pattern and 32.5% had a mixed pattern of dental attendance that could not be described as either favourable or unfavourable (Table 1). Table 1. Dental attendance patterns by age and gender Characteristic n Type of dental attendance pattern Favourable Intermediate Unfavourable % % % Age (years) * Satterthwaite ADJ chi square: * p < 0.001. 18–24 640 45.4 39.0 15.6 25–34 757 41.4 35.6 23.0 35–44 1320 43.0 33.3 23.7 45–54 1469 46.0 29.1 24.9 55–64 1259 48.7 32.3 19.0 65+ 871 50.9 25.8 23.3 Gender * Satterthwaite ADJ chi square: * p < 0.001. Male 2830 40.8 34.2 25.0 Female 3486 50.2 30.9 18.9 Total 6316 45.5 32.5 21.9 95% CI 43.8,47.3 30.9,34.2 20.5,23.4 Satterthwaite ADJ chi square: * p < 0.001. Comparisons of dental attendance patterns by age and gender showed significant variation. The proportion of adults with a favourable pattern of dental attendance was lowest among those aged 25–34 years (41.4%) and highest among those aged 65 years or more (50.9%). Males were less likely to have a favourable dental attendance pattern than females (40.8% compared with 50.2%). Insured non-cardholders had the highest proportion of adults with a favourable dental attendance pattern (62.9%), while only 10% were classified as having an unfavourable attendance pattern (Table 2). The dental visiting behaviour of cardholders who were insured was similar to that for insured non-cardholders. Furthermore, insured cardholders were significantly more likely to have a favourable pattern of dental attendance than uninsured cardholders (56.7% compared with 18.9%). Over 4 in 10 (41.4%) uninsured cardholders and 31.4% of uninsured non-cardholders were classified as having an unfavourable attendance pattern, significantly higher than those with dental insurance. Table 2. Dental attendance pattern by socioeconomic and sociodemographic characteristicsaa Row percentages are age- and gender-standardized to the 2011 Australian adult population via direct standardization method. Characteristic n Dental attendance pattern Favourable Intermediate Unfavourable % 95% CI % 95% CI % 95% CI Cardholder and insurance status Insured cardholder 517 56.7 48.4, 64.7 25.9 19.7, 33.2 17.4 11.4, 25.7 Insured non-cardholder 3221 62.9 60.4, 65.4 27.1 24.8, 29.4 10.0 8.6, 11.5 Uninsured cardholder 838 18.9 15.9, 22.2 39.8 35.1, 44.5 41.4 36.8, 46.1 Uninsured non-cardholder 1675 33.8 30.5, 37.3 34.8 31.6, 38.2 31.4 28.2, 34.8 Annual household Income Less than $30 000 904 29.4 24.7, 34.4 31.8 26.9, 37.1 38.9 34.1, 43.9 $30 000 – < $50 000 836 34.0 30.1, 38.1 37.7 33.2, 42.4 28.3 24.2, 32.8 $50 000 – < $70 000 859 45.6 41.4, 49.9 32.8 28.7, 37.2 21.5 18.1, 25.4 $70 000 – < $90 000 834 50.6 45.2, 56.0 30.4 26.3, 34.8 19.0 14.9, 24.0 $90 000 – < $110 000 739 59.6 54.1, 64.8 22.5 18.8, 26.7 17.9 13.5, 23.4 $110 000 or more 1609 55.1 49.6, 60.4 26.4 23.2, 29.8 18.5 14.1, 23.9 Work status Full-time employed 2922 49.7 46.2, 53.3 31.6 28.2, 35.3 18.6 16.5, 21.0 Part-time employed 1558 45.0 40.2, 49.9 33.1 28.2, 38.4 21.9 18.4, 25.8 Unemployedbb Unemployed includes adults looking for work and not looking for work; excludes retirees, home duties and students. 1833 23.9 18.0, 31.0 44.7 37.4, 52.2 31.5 24.5, 39.4 Dwelling ownership Owned outright 2788 51.6 48.7, 54.4 29.7 27.1, 32.5 18.7 16.5, 21.1 Being purchased 2577 47.7 43.5, 51.8 33.5 29.8, 37.5 18.8 15.9, 22.1 Rented 860 31.0 26.8, 35.4 36.5 32.0, 41.3 32.5 28.2, 37.1 Highest qualification attained Postgraduate/graduate diploma 732 61.9 55.8, 67.7 25.3 19.9, 31.6 12.8 9.4, 17.1 Bachelor degree 1123 56.6 52.4, 60.7 32.9 29.0, 37.1 10.5 8.4, 13.0 Diploma level 667 47.6 42.7, 52.6 30.5 25.7, 35.9 21.8 17.3, 27.2 Certificate level 1695 38.0 34.9, 41.2 34.3 31.1, 37.6 27.7 24.7, 30.9 None completed and not studying 1638 37.5 34.2, 40.9 33.7 30.4, 37.2 28.8 25.6, 32.2 Country of birth Australia 5086 44.7 42.8, 46.6 32.7 30.9, 34.6 22.5 21.0, 24.2 Overseas 1222 50.4 46.2, 54.5 31.0 27.1, 35.1 18.7 15.7, 22.0 Region Capital city 3775 50.1 47.9, 52.3 31.4 29.3, 33.5 18.5 16.9, 20.3 Rest of state 2541 38.2 35.8, 40.8 33.6 31.2, 36.1 28.2 25.8, 30.7 Total 6316 45.9 44.2, 47.6 32.1 30.5, 33.8 22.0 20.6, 23.4 a Row percentages are age- and gender-standardized to the 2011 Australian adult population via direct standardization method. b Unemployed includes adults looking for work and not looking for work; excludes retirees, home duties and students. Household income was significantly associated with dental attendance patterns. The proportion of adults with a favourable dental attendance pattern rose steadily with increasing annual household income. For adults living in households earning less than $30 000, only 29.4% had a favourable dental attendance pattern compared with over 55% of adults from households earning $90 000 or more. Adults in the two lowest income groups were significantly more likely to have an unfavourable dental attendance pattern (38.9% and 28.3% respectively) than those in the two highest income groups (17.9% and 18.5% respectively). Adults working full-time were twice as likely as unemployed adults to have a favourable dental attendance pattern (49.7% compared with 23.9%). Those employed part-time were also significantly more likely to have a favourable attendance pattern (45%) than unemployed adults. Over 3 in 10 unemployed adults (31.5%) visited the dentist infrequently and usually for a dental problem. An unfavourable dental attendance pattern was significantly more common among adults living in rental accommodation (32.5%) than those who owned their house outright or were purchasing their home (nearly 19%). Educational attainment was significantly associated with dental attendance behaviour. The higher the level of education the more likely adults were to have a favourable pattern of dental attendance. Nearly 62% of adults with a postgraduate degree or diploma and 56.6% of adults with a bachelor degree usually made an annual dental visit for the purpose of a check-up. This compared to less than 38% of adults who had not completed any post-secondary education. Adults who had completed a post-secondary certificate (levels 1–4) had very similar dental attendance behaviour to those who had not completed any post-secondary education. There were no significant differences in the dental attendance patterns of adults born overseas compared to Australian born adults. However, adults living in capital cities were significantly more likely to have favourable dental attendance patterns than those living elsewhere (50.1% compared with 38.2%). Approximately 28% of adults who lived outside of capital cities visited the dentist infrequently and usually for a dental problem. Self-reported health status and social impact of dental problems The relationship between dental attendance patterns and oral health status is explored in Table 3. Of particular interest are comparisons between the favourable and unfavourable dental attendance groups. Adults with an unfavourable dental attendance pattern were twice as likely to rate their general health as ‘fair/poor’ as those in the favourable attendance group (15.8% compared with 7.4%). In terms of oral health, the difference between the favourable and unfavourable dental attendance groups increased significantly. Adults with an unfavourable dental attendance pattern were 3.7 times as likely to report their oral health as ‘fair/poor’ as those in the favourable attendance group (32% compared with 8.7%). Table 3. Self-reported health status and social impact of dental problems by dental attendance patternaa Column percentages are age- and gender-standardized to the 2011 Australian adult population via the direct standardization method. Characteristic n Dental attendance pattern Favourable Intermediate Unfavourable % 95% CI % 95% CI % 95% CI General health bb Excludes 452 adults where an adult proxy interview was conducted to collect the respondent data. Excellent/Very good/Good 5248 92.6 91.1, 93.9 87.7 85.3, 89.7 84.2 81.4, 86.7 Fair/Poor 611 7.4 6.1, 8.9 12.3 10.3, 14.7 15.8 13.3, 18.6 Dental health bb Excludes 452 adults where an adult proxy interview was conducted to collect the respondent data. Excellent/Very good/Good 4814 91.3 89.6, 92.7 77.0 74.1, 79.6 68.0 64.4, 71.4 Fair/Poor 1047 8.7 7.3, 10.4 23.0 20.4, 25.9 32.0 28.6, 35.6 Experienced toothache cc Refers to the previous 12-month period. Very often/Often/Sometimes 906 11.0 9.4, 12.8 17.8 15.6, 20.3 18.8 16.1, 21.9 Hardly ever/Never 5406 89.0 87.2, 90.6 82.2 79.7, 84.4 81.2 78.1, 83.9 Uncomfortable with dental appearance bb Excludes 452 adults where an adult proxy interview was conducted to collect the respondent data. Very often/Often/Sometimes 1431 18.6 16.6, 20.9 28.6 25.7, 31.6 34.9 31.2, 38.7 Hardly ever/Never 4417 81.4 79.1, 83.4 71.4 68.4, 74.3 65.1 61.3, 68.8 Avoided certain foods cc Refers to the previous 12-month period. Very often/Often/Sometimes 1055 12.3 10.7, 14.1 20.1 17.7, 22.8 22.9 20.1, 26.0 Hardly ever/Never 5253 87.7 85.9, 89.3 79.9 77.2, 82.3 77.1 74.0, 79.9 a Column percentages are age- and gender-standardized to the 2011 Australian adult population via the direct standardization method. b Excludes 452 adults where an adult proxy interview was conducted to collect the respondent data. c Refers to the previous 12-month period. The proportion of adults who had experienced toothache either sometimes, often or very often in the previous 12 months was also higher for adults with an unfavourable attendance pattern compared to those in the favourable attendance group (18.8% compared to 11%). There was significant variation by dental attendance pattern in the proportion of adults who reported they had felt uncomfortable about their dental appearance either sometimes, often or very often in the previous 12 months. Adults with an unfavourable pattern of dental attendance were nearly twice as likely to report this problem as those in the favourable attendance group (34.9% compared with 18.6%). Similarly, infrequent problem visitors were nearly twice as likely to report they had avoided eating certain foods at least sometimes in the previous 12 months because of problems with their teeth, mouth or dentures as those in the favourable group (22.9% compared with 12.3%). Financial barriers to accessing dental care The relationship between dental attendance patterns and the frequency in which cost is reported as a barrier to accessing dental care is provided in Fig. 1. Adults with an unfavourable pattern of dental attendance were more than three times as likely as those in the favourable attendance group to have avoided or delayed making a dental visit in the previous 12 months due to the cost (51% compared with 16%). Figure 1Open in figure viewerPowerPoint Financial barriers to accessing dental care by pattern of dental attendance (estimate and 95% CI). For adults with a favourable dental attendance pattern, only 4% reported they would have ‘a lot of difficulty’ paying a $100 dental bill out of their own pocket, significantly lower than the proportion of adults in the unfavourable attendance group (23%). When the dental bill was increased to $150 the proportion of adults reporting ‘a lot of difficulty’ increased in each of the dental attendance groups. However, adults with an unfavourable dental attendance pattern were three times as likely to report ‘a lot of difficulty’ paying a $150 dental bill as those in the favourable group (33% compared with 11%). Treatment received in the previous 12 months In the telephone survey 4038 dentate adults made a dental visit in the previous 12 months and were asked about the dental treatment they had received during this period. Of the 4038 adults, 2669 were classified as having a favourable dental attendance pattern, 1001 were classified to the intermediate category and 348 were classified as having an unfavourable dental attendance pattern. A dental attendance category could not be derived for 20 adults due to missing data in one or more of the data items used to derive this composite classification. The type of dental treatment received was strongly associated with usual dental visiting behaviour (Fig. 2). Adults with an unfavourable pattern of dental attendance were only half as likely to have received a scale and clean treatment as adults with a favourable attendance pattern (42% compared with 87%). Conversely, those with an unfavourable attendance pattern were 2.7 times as likely to have had a tooth extracted in the previous 12 months as those in the favourable group (24% compared with 9%), and 1.3 times more likely to have received a filling (45% compared with 34%). Figure 2Open in figure viewerPowerPoint Dental treatment received in the previous 12 months by pattern of dental attendance (estimate and 95% CI). Discussion The concept of categorizing Australian adults into three contrasting groups which reflect their usual dental visiting behaviour was first explored using data from the 2004–06 NSAOH.1, 2 These groups were formed through the concept of a ‘favourable’ to ‘unfavourable’ pattern of dental attendance where these descriptors reflected how closely the pattern of dental attendance aligned with that recommended by the dental profession. This report highlights some positive findings since the 2004–06 survey but also highlights some areas of concern. Over the last five years there has been a statistically significant increase in the proportion of adults with a favourable pattern of dental attendance. In 2004–06, 40.1% of adults had a favourable pattern of dental attendance compared to 45.9% in 2010 (to enable comparisons data from both surveys was standardized to the 2011 Census age–gender distribution). Another welcome finding from this research is the statistically significant decline in the proportion of Australian dentate adults with an unfavourable pattern of dental attendance. In 2004–06, 28.3% of adults had an unfavourable pattern of dental attendance declining to 22% in 2010. Of some concern is that the sociodemographic and socioeconomic characteristics associated with an unfavourable dental attendance pattern in 2004–06 are the same characteristics highlighted in this research. In both surveys an unfavourable pattern of dental attendance was more frequent among adults who were male, uninsured for dental expenses, living in households earning less than $50 000 per year, the unemployed, those with no post-secondary education and those living in rental accommodation. There is also strong evidence to suggest that dental attendance patterns are significantly associated with oral health outcomes. In both the 2004–06 and 2010 surveys the proportion of adults who rated their dental health as either fair or poor was 23 percentage points higher for adults with an unfavourable attendance pattern compared to those in the favourable attendance group. Similarly, adults with an unfavourable attendance pattern were significantly more likely to report being uncomfortable about the appearance of their teeth, mouth or dentures. Furthermore, the type of dental treatment received was significantly associated with dental visiting behaviour. Adults with an unfavourable attendance pattern were significantly more likely to have received an extraction and/or filling in the previous 12 months as those in the favourable group. This research also highlights that cost still remains a significant deterrent to accessing regular dental care. In both the 2004–06 and 2010 surveys approximately one in two adults with an unfavourable dental attendance pattern reported they had avoided or delayed making a dental visit in the previous 12 months due to the cost. This study is limited by self-report of both oral health status and dental visiting patterns and may be subject to recall bias. Its strengths lie in the population based survey on which it is based. Analysis of the 2010 survey supports the findings from the 2004–06 NSAOH. While there has been some improvement in dental attendance patterns in the last five years there still remain a sizeable proportion of Australian adults who are infrequent problem-oriented visitors. The challenge for Australia's dental health system is to make dental care more affordable and find more effective ways of promoting the benefits of regular preventive dental care. Acknowledgements This article was prepared by Anne Ellershaw. The National Dental Telephone Interview Survey is supported by the Australian Government Department of Health and Ageing (AGDoHA) and the Australian Institute of Health and Welfare (AIHW). References 1Ellershaw AC, Spencer AJ. Dental attendance patterns and oral health status. Dental Statistics and Research Series No. 57. Cat. No. DEN 208. Canberra: AIHW, 2011. Google Scholar 2Slade GD, Spencer AJ, Roberts-Thomson KF, eds. Australia's dental generations: the National Survey of Adult Oral Health 2004–06. Cat no. DEN 165. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 34), 2007. Google Scholar 3 Australian Bureau of Statistics. Super CUBE data set population estimates by age and sex, Australia, by geographic classification (ASGC 2009) at 30 June 2009 (Cat. No. 3235.0). Available at: ‘http://www.abs.gov.au/ausstats/abs@.nsf/mf/3235.0’. Google Scholar 4 Australian Bureau of Statistics. 2011 Census of Population and Housing Basic Community Profile (Cat. No. 2001.0). Available at: ‘http://www.censusdata.abs.gov.au/census_services/getproduct/census/2011/communityprofile/0’. Google Scholar Citing Literature Volume59, Issue1March 2014Pages 129-134 FiguresReferencesRelatedInformation