背景:历史上,在美国,有色人种女性的口腔健康状况较差,牙科服务利用率较低。怀孕期间牙科护理的这些障碍包括牙科保险,主要语言,牙科提供商的可用性,安全问题,牙科护理的可负担性,和怀孕期间感知到的口腔健康益处。
方法:本研究的目的是检查种族/民族是否改变了怀孕期间获得牙科护理的障碍和牙科服务利用之间的关联。这项横断面研究样本包括来自21个州的62,189名年龄在20岁及以上,最近有出生史的女性,来自2016年至2019年的妊娠风险评估监测系统(PRAMS)数据。我们通过障碍相互作用项引入了种族/种族到我们的多元逻辑回归模型中。
结果:在调整了其他混杂因素后,怀孕期间的牙科保险和感知的口腔健康益处与4.0倍和5.6倍的几率相关,分别,怀孕期间牙科服务的利用情况。在包括在所有调整p值<0.001的相互作用分析中的所有障碍的牙科服务利用之间的关系的粗略和调整分析中,观察到种族/种族的统计学显著效应改变。
结论:交互分析发现,在报告这些牙齿障碍的女性中,怀孕期间就诊牙医的种族/族裔差异显著。相比之下,在没有报告这种障碍的妇女中,这种种族/族裔差异大大减弱。
结论:观察到的种族/民族差异可以通过这样的支持机制来减轻:牙科覆盖,提供者的可用性和愿意治疗孕妇,关于怀孕期间牙齿护理安全的口腔健康教育,和负担得起的牙科护理费用。
BACKGROUND: Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy.
METHODS: The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models.
RESULTS: After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001.
CONCLUSIONS: The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers.
CONCLUSIONS: The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs.