Published online February 1, 2007
PEDIATRICS Vol. 119 Supplement February 2007, pp. S12-S21 (doi:10.1542/peds.2006-2089D)
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SUPPLEMENT ARTICLE


Disparities in Dental Insurance Coverage and Dental Care Among US Children: The National Survey of Children's Health

Jihong Liu, ScDa, Janice C. Probst, PhDa,b, Amy B. Martin, PhDa,b, Jong-Yi Wang, PhDb and Carlos F. Salinas, DMDc

a Arnold School of Public Health
b South Carolina Rural Health Research Center, University of South Carolina, Columbia, South Carolina
c College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina

OBJECTIVES. We sought to understand disparities in dental insurance coverage and dental care among US children by race/ethnicity, urban/rural residence, and socioeconomic status.

METHODS. Linked data from the National Survey of Children's Health and Area Resource File were analyzed (N = 89 071). Multiple logistic regression analysis was used to adjust for confounders.

RESULTS. A total of 22.1% of US children lacked parentally reported dental insurance coverage in the preceding year, 26.9% did not have a routine preventive dental visit, and 5.1% had parentally perceived unmet need for preventive dental care. US-born minority children were less likely to lack dental insurance than US-born white children; however, foreign-born Hispanic children were more likely to be uninsured. Rural children were more likely to be uninsured than urban children. Children with health insurance were more likely to have dental coverage. Children who lacked dental insurance were less likely to have received preventive care and more likely to have unmet need for care. Compared with US-born white children, all minority children were less likely to receive preventive care. These disparities were exacerbated among foreign-born children. Fewer race-based disparities were found for unmet need for dental care. Only black children, both US- and foreign-born, had higher odds of unmet need for preventive services than US-born white children. Poor dental health was strongly associated with unmet need. Disparities in dental insurance coverage and dental care are also evident by family socioeconomic status.

CONCLUSIONS. Poor and minority children were less likely to receive preventive dental care, even when insurance status was considered. Rural children were less likely to have dental insurance than urban children. Foreign birth affected insurance status for Hispanic children and use of preventive services for all minority children.

Key Words: oral health • CSHCN • foreign-born • minorities • rural health

Abbreviations: NSCH—National Survey of Children's Health • ARF—Area Resource File • SES—socioeconomic status • CSHCN—children with special health care needs • OR—odds ratio • aOR—adjusted odds ratio • CL—confidence limit

Accepted Sep 15, 2006.