Geography matters: state-level variation in children's oral health care access and oral health status

Public Health. 2016 May;134:54-63. doi: 10.1016/j.puhe.2015.04.024. Epub 2016 Mar 16.


Objectives: To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences.

Study design: Observational study using cross-sectional surveys.

Methods: Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status. We assessed the unadjusted prevalences of these outcomes, then adjusted with child-, family-, and neighbourhood-level variables using logistic regression; these results are presented directly and graphically. Using multilevel analysis, we then calculated the degree to which child-, family-, and community-level variables explained state variation. Finally, we quantified the influence of state-level variables on state variation.

Results: Unadjusted rates of no preventive dental care ranged 9.0-26.8% (mean 17.5%), with little impact of adjusting (10.3-26.7%). Almost 9% of the population had fair/poor oral health; unadjusted range 4.1-14.5%. Adjusting analyses affected fair/poor oral health more than access (5.7-10.7%). Child, family and community factors explained ∼¼ of the state variation in no preventive visit and ∼½ of fair/poor oral health. State-level factors further contributed to explaining up to a third of residual state variation.

Conclusion: Geography matters: where a child lives has a large impact on his or her access to oral health care and oral health status, even after adjusting for child, family, community, and state variables. As state-level variation persists, other factors and richer data are needed to clarify the variation and drive changes for more egalitarian and overall improved oral health.

Keywords: Children's oral health; State variation.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Dental Care / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Health Status Disparities*
  • Health Surveys
  • Humans
  • Multilevel Analysis
  • Oral Health / statistics & numerical data*
  • Residence Characteristics / statistics & numerical data*
  • United States