BackgroundThe current public health research agenda was to identify the means to reduce oral health inequalities internationally. The objectives of this study were to provide evidence of inequality in unmet dental needs and to find influencing factors attributable to those among South Korean adults.MethodsPooled cross-sectional data from the fourth Korean National Health and Nutrition Examination Survey (2007–2009) on 17,141 Korean adults were used. Demographic factors (sex, age, and marital status), socioeconomic factors (education level, employment status, and income level), need factors (normative dental needs and self-perceived oral health status), and oral health-related factors (the number of decayed teeth, the presence of periodontitis, and the number of missing teeth) were included. Multiple logistic regression analysis was performed.ResultsOf South Korean adults, 43.9% had perceived unmet dental needs, with the most common reason being financial difficulties. The disparities in unmet dental care needs were strongly associated with income level, normative treatment needs, and self-perceived oral health status. The low-income group, people with normative dental treatment needs, and those with perceived poor oral health status were more likely to have unmet dental needs. There was considerable inequality in unmet dental care needs due to economic reasons according to such socioeconomic factors as income and education level.ConclusionsPublic health policies with the expansion of dental insurance coverage are needed to reduce inequalities in unmet dental care needs and improve the accessibility of dental care services to vulnerable groups who are experiencing unmet dental care needs due to socioeconomic factors despite having normative and self-perceived needs for dental treatment.

BackgroundTo better understand income-related inequalities in health care use, it is imperative to identify sources of inequalities and assess the extent to which health care use is still related to income after differences in need across the income distribution are accounted for. Little is known regarding rural-urban differences in income-related inequalities and subgroup variation in horizontal inequities in health care use. This study decomposes income-related inequalities in ambulatory care use into contributions of need and non-need factors and compares horizontal inequities of subgroups in rural and non-rural areas.MethodsThis analysis used non-elderly adult samples from the 1998 to 2001 U.S. National Health Interview Survey data. The area of residence was categorized as rural for non-Metropolitan Statistical Area (MSA) and non-rural for MSA. Concentration indices of ambulatory care use were used to gauge income-related inequalities and decomposed into contributing factors. Horizontal inequities were measured using two methods and the results were compared.ResultsAmbulatory care use was disproportionately concentrated in the poor before need adjustment. However, the results of decomposition and horizontal inequity analyses indicate that the pro-poor concentration of health care use was due to greater health care need in low-income groups. Adjusting for need, ambulatory care use was distributed favoring the better-off, to a larger degree in non-rural areas. Health-related variables were the major contributors to income-related inequalities. Non-need factors, including socioeconomic factors, health insurance, and usual source of care, also contributed to income-related inequalities. There were variation in determinants' contributions to income-related inequalities between rural and non-rural populations and subgroup differences in horizontal inequities. Horizontal inequities were greater within non-whites, high school graduates, individuals with private health insurance, and those without a usual source of care with some geographic variation.ConclusionsOur analysis shows that seemingly pro-poor income-related inequalities in ambulatory care use were largely due to greater health care need among low-income groups. The results demonstrate different contributions of determinants to income-related inequalities and variation in horizontal inequities by subgroup and locale. The findings of this study should help identify targets for policy intervention for each rural and non-rural area.

This study describes the pattern and predictors of ambulatory care utilization among Korean Americans (KAs) living in Los Angeles. Data were gathered via a mail survey. Analysis employed a two-part model: logit model for factors affecting any health care use and truncated negative binomial model for frequency of use given one visit. Use of ambulatory care among KAs was low (2.80 visits during prior 12 months), compared to their counterparts in South Korea and the U.S. population. Variables associated with higher utilization included old age, health needs, and health insurance. Income had a positive effect on health care utilization decisions among the uninsured. Acculturation appeared to be neither a strong nor consistent predictor of ambulatory care utilization among KAs. Of particular concern is the finding that KAs suffer from inadequate access to care due to lack of employment-based health insurance.

The findings suggest a need for further research addressing barriers to cancer screening in Korean Americans.

The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.