Prevalence and Patterns of Dental Care Utilization among US-Born and Non–US Born Hispanics in the Hispanic Community Health Study/Study of Latinos

Abstract

Objectives: Access to routine dental services is important to maintaining good oral health. The aims of this study were to describe the dental care utilization patterns of a diverse group of Hispanic/Latino men and women and assess differences in dental care utilization by perceived need for dental care and proxy measures of acculturation. Methods: Data from 13,792 participants of the Hispanic Community Health Study were analyzed with SAS 9.4. Time since last dental visit was dichotomized into <1 and ≥1 y. Acculturation measures included the language and social subscales of the Short Acculturation Scale for Hispanics, the Multiethnic Study of Atherosclerosis nativity subscore, and immigrant generation. Survey logistic regression adjusted for demographic (age and sex) and health-related variables, estimated associations among perceived need for dental care, acculturation measures, and dental care utilization. Results: About a quarter (23%) of the participants were born in the 50 US states, excluding territories, while 77% were non–US born. Overall, 74% perceived a need for dental care. Upon covariate adjustment, perceiving a need for dental care was associated with reduced odds of reporting a past-year dental visit (odds ratio, 0.32; 95% CI, 0.28 to 0.37), while there appeared to be no meaningful association between proxy measures of acculturation and past-year dental visit. Having health insurance was significantly associated with a past-year dental visit (odds ratio, 2.23; 95% CI, 1.99 to 2.49) for all groups combined and among the different Hispanic/Latino background groups. Conclusions: Acculturation affects general health and contributes to general health disparities; however, its role in dental care utilization remains questionable. Given that acculturation is a process that occurs over several years, longitudinal studies that evaluate oral health trajectories along the acculturation continuum are needed. Knowledge Transfer Statement: The results of this study are valuable for dental public health program planning and implementation for minority groups, as it describes the varying patterns of dental care utilization among US-born and non–US born Hispanics/Latinos and identifies factors that may partly explain dental care utilization patterns, such as acculturation.

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

“…This study finds that AAAU < 18 s' oral health outcomes are more favorable than USBs' across nearly every measure. This set of findings contrasts with existing evidence that immigrants have comparatively poorer oral health outcomes than their US-born counterparts [24][25][26][27][28][29], and merits special consideration. Differences observed may be attributable to a variety of factors.…”

“…Thus, U.S.-born health care safety net patients in Richmond Virginia may be disproportionately more exposed throughout their lives to a variety of factors that harm oral health such as racially biased exclusions from dental care or sub-optimal treatment decisions [34,35], political determinants of health such as redlining and inadequate access to healthful foods [36], or commercial determinants such as excess exposure to commercial tobacco outlets [37]. In other words, in contrast to the historically advantaged index groups (e.g., white, middle class) to whom minoritized groups are compared in population-level oral health studies (e.g., [24,26,28,29]), many or most participants enrolled in our study may have experienced deleterious conditions that negatively affect their oral health above and beyond income constraints, including but not limited to geographic and schedule barriers to care, structural ethno-racism and xenophobia, and dental benefits absence from Virginia's adult Medicaid benefit prior to 2020. We will explore these topics when analyzing qualitative data collected for this study.…”

“…For example, non-US-born residents are approximately half as likely to have had a past year dental visit as their U.S.-born counterparts, and these visits were more likely to be for tooth extraction and less likely for comprehensive dental care or a full examination [26,27]. Latinx/Hispanic adults who report need of a dental appointment-a validated measure of clinical diagnoses-were less likely to have had a past year appointment one regardless of country of birth [28,29]. Relationships between immigration and oral health have seldom been considered using a lifecourse approach.…”

Disparities in Dental Service Use among Adult Populations in the United States

“…From a research perspective, to date, many fundamental aspects of AIANs' health, including oral health, have not been systematically addressed. One study, for instance, revealed that having health insurance was significantly related to a past-year dental visit for Hispanics, regardless of their immigration and acculturation status (Akinkugbe et al 2020). In addition to insurance status, another overlooked factor to reduce disparities is to improve the workforce racial/ethnic diversity of dental providers.…”

Social support associated with restorative treatment, professionally applied fluoride and flossing: A cross‐sectional analysis including recent immigrants from Central America and Mexico in the Midwest USA

“…Socioeconomic status (SES) is often cited as a fundamental cause of disease, 13 yet oral health disparities are also shaped by other social factors including acculturation, health literacy and social connectivity, including social support. 14 For example, stronger social support is generally considered to be a positive influence on oral health outcomes, such as dental visits 15,16 or periodontal conditions, 17 as well as on seeking treatment for health issues more broadly. However, the relative contributions of these factors may differ across populations and groups.…”