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Oral health disparities: Racial, language and nativity effects.

ABSTRACT: This study examined racial oral health disparities among Non-Hispanic Whites, Non-Hispanic Blacks, and Hispanics. For Hispanics, this study also examined the role of language in oral health disparities between English-speaking Hispanics and Spanish-speaking Hispanics. This study included 12, 307 adults older than 20 from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Oral health is measured by self-rated oral health, the frequencies of dentist visits, and the number of missed teeth. Exposures of interest referred to social gradients, which include education, annual family income, foreign born, and citizenship. Covariates included age, gender, and marital status. Ordinal logistic regression models were used to estimates the effects of social gradients on self-rated oral health and dentist visits. Negative binomial regression model was applied to estimate the effects of social gradients on the number of missed teeth. Overall, Spanish-speaking Hispanics presented the most disadvantaged social gradients and the worst oral health results. Non-Hispanic Blacks and English-speaking Hispanics reported disadvantaged oral health status when compared to Non-Hispanic Whites. Foreign-born, higher education levels and annual family income play protective role on oral health outcomes, while respondents who do not have citizenship are at higher risk of self-rated fair/poor oral health and dentist visits.

SUBMITTER: Han C

PROVIDER: S-EPMC6658987 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundForeign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality.MethodsUsing SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System.ResultsAge-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White-Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from -2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality.ConclusionsAlthough all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation.

Project description:ObjectivesHospital emergency departments (EDs) are a place where many Americans seek treatment of dental conditions. Racial and ethnic minorities consistently have higher rates of ED utilization than whites for dental conditions. The reasons for these disparities and significant public health concerns are investigated less often. In this paper, we measure trends in racial disparities in ED discharges for dental conditions in Maryland from 2010 to 2013. To understand these disparities, we also describe differences between racial groups in age, gender, income, location, payer, comorbidities, and the availability of dental care.Methods2010-2013 State Emergency Department Data for Maryland were used in the analysis. Rates per 100,000 of the population are calculated using information from census population estimates. Cost-to-charge ratios are used to estimate the costs of ED discharges. Dental/oral health-related conditions (DOHRC) are defined as discharge diagnoses of ICD-9-CM codes 520.0 through 529.9. Descriptive statistics and fixed effects logistic regression models with a rare event correction are used to analyze the data.ResultsBlacks, especially females aged 25-34, have larger proportions of total ED discharges due to DOHRC, and higher population rates of DOHRC, than any other racial or ethnic group. In 2013, Blacks represented 30% of Maryland's population and accounted for 52% of ED costs for DOHRC. Hispanics and those of other races have much lower rates of DOHRC discharges. The regression results show that the high proportion of DOHRC discharges among Blacks may be explained by the concentration of Blacks in low-income central cities with less access to dental care.ConclusionThere are significant racial disparities in the ED utilization for DOHRC in Maryland. These disparities reflect the lack of access to dental care due to both cost and geographic limitations. This results in high healthcare costs and ineffective solutions for patients. Addressing oral health disparities will require policy solutions that are targeted to the populations most at need, and action plans that combine community and state level efforts.

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Oral health disparities: Racial, language and nativity effects.

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