Date of Award

8-12-2014

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Ike Okosun, MS, MPH, PhD, FTOS, FACE

Second Advisor

Charles Moore, MD

Third Advisor

John Steward, MPH

Abstract

INTRODUCTION: Oral health is a worldwide concern that affects people of every age, socioeconomic status, and ethnicity. Having good oral health is vital to overall health and well-being. Dental caries and periodontal diseases are preventable, but disparities exist in access to preventive care. Proper oral hygiene includes brushing with fluoride toothpaste, flossing, and regular dental visits. Adults without dental insurance may have financial obstacles to proper oral hygiene. Due to lack of dental care, adults without dental insurance may seek acute dental treatment in inappropriate settings, such as an emergency department.

AIM: The purpose of this study was to examine if insurance status is associated with being dental and trauma patients presenting to Grady Memorial Hospital’s emergency department for care.

METHODS: Data were obtained from Grady Memorial Hospital, Atlanta, GA for the years 2010-2013. Emergency department data for trauma and dental patients aged 20-64 years (n = 27,247) were extracted using ICD-9 codes and the age variable. Chi-square analyses were used to assess differences in insurance status between dental and trauma patients. Odds ratios from bivariate and multivariate analyses were used to determine associations between being a dental or trauma patient and selected independent variables. The model of best fit was determined using the stepwise logistic regression technique.

RESULTS: Insurance status was significantly different between trauma and dental patients (p < .001). Approximately 78% of dental patients were uninsured, while about 57% of trauma patients were uninsured. Controlling for cofounders, being uninsured was statistically significant. Being uninsured was significantly associated with an increased likelihood of being a dental patient (OR: 2.58, 95% CI: [2.17,3.07], p < .001).

DISCUSSION: The results from this study demonstrate that insurance status is a main reason why dental patients seek care in an emergency department. Dental patients are significantly more likely to be uninsured than trauma patients. This issue of lack of insurance coverage for dental patients must be addressed in order to decrease the current disparities in care. Further research is needed to determine if there are additional driving factors which contribute to the decision to visit an emergency department for dental care. Due to the disparities that exist in access to dental care, and the repercussions that occur from a lack of dental insurance, dental insurance coverage is a public health concern that needs to be given more attention.

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