Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers

Derek K. Smith; Barbara A. Murphy

doi:10.1016/j.pmedr.2019.100868

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Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers

Journal article

Open access

Peer reviewed

Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers

Derek K. Smith and Barbara A. Murphy

Preventive medicine reports, Vol.14, p.100868

06/01/2019

DOI: 10.1016/j.pmedr.2019.100868

PMCID: PMC6475717

PMID: 31024789

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Abstract

This study was an examination of dental care utilization among survivors of early life cancers (cancer diagnosis at 20 years of age or younger) and the extent to which socio-economic factors may present a barrier to care. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016 (n = 28,640). Survey-weighted regression models were used to evaluate associations between early life cancers and subsequent frequency of dental care as adults. A mediation analysis was conducted to test education and household income as potential mediators of this association using a non-parametric bootstrap approach. Early life cancers were associated with a significant decrease in dental care utilization as adults (OR:0.459, 95%CI:(0.226, 0.935)). This diminished utilization was particularly pronounced with survivors in their 20s and 30s. Over time dental care utilization began a slow recovery. The association between early cancer and level of education was estimated to be negative but did not reach statistical significance (OR:0.739, 95%CI:(0.503, 1.086), p = 0.123). Survivors of early life cancers were less likely to be in a higher income bracket (OR:0.663, 95%CI:(0.452, 0.973), p = 0.036)). Decreases in education and household income (p < 0.001) mediated the association between early cancers and lower dental utilization. This pathway accounted for 41.7% (95%CI:(14.1%, 50.6%)) of the association. Survivors of early life cancers did not utilize professional oral health care at a rate commensurate with their risk of dental disease. Providers involved in the long-term care should promote routine dental maintenance. Further study into non-economic barriers in this population is warranted.

Dental utilization

Mediation analysis

NHANES

Pediatric cancer

Social determinants of health care

Details

Title: Subtitle: Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers
Creators: Derek K. Smith - Vanderbilt University Medical Center
Barbara A. Murphy - Vanderbilt University Medical Center
Resource Type: Journal article
Publication Details: Preventive medicine reports, Vol.14, p.100868
DOI: 10.1016/j.pmedr.2019.100868
PMID: 31024789
PMCID: PMC6475717
NLM abbreviation: Prev Med Rep
ISSN: 2211-3355
eISSN: 2211-3355
Publisher: Elsevier Inc
Language: English
Date published: 06/01/2019
Academic Unit: Preventive and Community Dentistry; Dental Research
Record Identifier: 9984966851302771

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