Abstract：
OBJECTIVE: This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults.
METHODS: Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals.
RESULTS: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway.
CONCLUSIONS: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.
METHODS: Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals.
RESULTS: The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway.
CONCLUSIONS: Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.
摘要：
目的：本研究旨在评估在存在社会人口统计学混杂因素的情况下，支付牙科账单困难与牙科服务使用的负担能力之间的关联，并评估牙科焦虑的作用和对牙科专业人员作为中介的满意度。第二个目的是调查牙科焦虑和对牙科专业人员的满意度如何改变澳大利亚成年人的负担能力与牙科服务使用之间的关系。
方法：使用澳大利亚成人口腔健康国家研究（2004-06和2017-18）的纵向数据。进行了泊松回归和路径分析，以确定可负担性与牙科服务使用频率之间的关联。通过对牙科焦虑和对牙科专业人员的满意度进行分层，进行效果测量修改（EMM）分析。
结果：该研究包括1698名澳大利亚成年人，发现对于那些难以支付牙科账单的人来说，低频率的牙科就诊率增加了20％。患有牙科焦虑症的成年人（患病率[PR]=1.14）和对牙科专业人员不满意的成年人（PR=1.17）在支付牙科账单困难的情况下，牙科就诊频率低的患病率更高。这表明牙科焦虑和对牙科专业人员的不满是该途径的影响因素。
结论：经历牙科焦虑和对牙科专业人员不满意的成年人在面临支付牙科账单困难时更有可能避免牙科就诊。然而,重要的是要注意，这些关联不一定意味着因果关系。
方法：使用澳大利亚成人口腔健康国家研究（2004-06和2017-18）的纵向数据。进行了泊松回归和路径分析，以确定可负担性与牙科服务使用频率之间的关联。通过对牙科焦虑和对牙科专业人员的满意度进行分层，进行效果测量修改（EMM）分析。
结果：该研究包括1698名澳大利亚成年人，发现对于那些难以支付牙科账单的人来说，低频率的牙科就诊率增加了20％。患有牙科焦虑症的成年人（患病率[PR]=1.14）和对牙科专业人员不满意的成年人（PR=1.17）在支付牙科账单困难的情况下，牙科就诊频率低的患病率更高。这表明牙科焦虑和对牙科专业人员的不满是该途径的影响因素。
结论：经历牙科焦虑和对牙科专业人员不满意的成年人在面临支付牙科账单困难时更有可能避免牙科就诊。然而,重要的是要注意，这些关联不一定意味着因果关系。
