Factors Associated with Receiving Treatment for Dental Decay for Medicaid- Enrolled Children Under 12 公开

Zilversmit, Leah (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/g445cd431?locale=zh
Published

Abstract




Objectives:
Researchers have found that Medicaid-enrolled children face barriers to
dental care. Several Medicaid-enrolled children are screened for tooth decay through the
IDPH I-Smile program. We identified children younger than twelve with decay and
determined the characteristics of children seeking treatment for decay. The purpose of
this study is (1) to determine how many Medicaid-enrolled children younger than 12
years who screened positive for decay obtained treatment for dental caries within six
months and (2) to identify the factors associated with children not receiving dental
treatment.

Methods:
We linked program data for screened children to Medicaid claims for dental
treatment (N=16,109) and we performed multivariate logistic regression to assess the
association of sociodemographic characteristics to receipt of treatment for children who
screened positive or negative for decay.

Results:
Eleven percent of children had decay and nearly 24% of children with decay had
a Medicaid claim for treatment. Being of school age (OR: 1.484, p-value=0.001) and not
having a dental home (OR: 1.904, p-value<0.0001) were positively associated with not
seeking dental treatment. Of the 14,293 children screening negative for decay, 3.5% had
a Medicaid claim for caries treatment and they were more likely to be school-aged (OR:
0.656, p-value <0.0001).

Conclusions:
Children older than five and without a dental home are more likely to go
untreated for caries. It will be critical that programs such as I-Smile™ link at-risk
children to dental homes.

Table of Contents

TABLE OF CONTENTS

Chapter 1: Introduction.....................................................................................................1
Chapter 2: Review of Literature........................................................................................5
Chapter 3: Manuscript.....................................................................................................20
Title Page .................................................................................................................................. 20
Statement of Contribution....................................................................................................... 21
Abstract ..................................................................................................................................... 22
Introduction .............................................................................................................................. 24
Methods ..................................................................................................................................... 26
Results ....................................................................................................................................... 30
Discussion.................................................................................................................................. 33
Acknowledgments .................................................................................................................... 37
References ................................................................................................................................. 38
Figures and Tables ................................................................................................................... 41

Figure 1: Children younger than 12 screened for decay from January to April 2010,
outcomes for first screening ................................................................................................... 41
Table 1: Descriptive analysis of children screening positive and negative for decay in first
screening ................................................................................................................................ 42
Table 2: Bivariate analysis of treatment for children screening positive for decay in first
screening and receiving treatment ......................................................................................... 43
Table 3: Bivariate analysis of treatment for children screening negative for decay in first
screening for receiving treatment........................................................................................... 44
Table 4: Regression model describing odds of not receiving treatment for children screened
positive and negative for decay ............................................................................................ 45
Figure2: Median income and location of dental providers in Iowa, 2011 ............................. 46
Chapter 4: Discussion/Recommendations ......................................................................47

References .........................................................................................................................54
Appendices ........................................................................................................................58

Appendix A: Letter of Withdraw from IRB Committee ...................................................... 58
Appendix B: Child and Adolescent Risk Reporting System (CAReS) Form ..................... 59
Appendix C: Figures not included in Manuscript ................................................................ 61

Figure 3: Map of Public Health Regions ............................................................................... 61
Figure 4: I-Smile™ coordinators map ................................................................................... 62
Figure 5: Median income and location of dentists in 5 most populated cities,
Iowa 2011 ............................................................................................................................. 63
Figure 6: Licensed dentists within median family income census tract per family
population .............................................................................................................................. 64
Figure 7: Iowa dentists and dental specialists ...................................................................... 65
Figure 8: Percent distribution of time interval for children treated within first six months
after screening, by positive or negative for decay, Iowa 2010 .............................................. 66

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