Ethnic and socioeconomic inequalities in dental treatment at a school of dentistry.

Abstract

Background and objectives: Health services should be targeted toward those most in need of health care. Poor oral health disproportionately affects Māori, Pacific Island, and socioeconomically deprived New Zealanders of all ages, and oral health care services should be prioritised to such groups. In New Zealand, free oral health care is available for all children up to the age of 17. On the other hand, adult dental services are provided on a user-pays basis, except for a limited range of basic services for some adults, access to which varies regionally. This study investigated the extent of dental treatment inequalities among patients at New Zealand's only School of Dentistry.

Methods: Data were audited for all treatments provided at the University of Otago Faculty of Dentistry from 2006 to 2011 for patients born prior to 1990. Ethnic and socioeconomic inequalities in the provision of dental extractions, endodontic treatment, crowns, and preventive care were investigated. Differences were expressed as the odds of having received one or more treatments of that type during the six-year period 2006 to 2011.

Results: Data were analysed for 23,799 individuals, of whom 11,945 (50.2%) were female, 1,285 (5.4%) were Māori and 479 (2.0%) were Pacific, 4,040 (17.0%) were of low socioeconomic status (SES), and 2,681 (11.3%) were beneficiaries or unemployed. After controlling for SES, age, and sex, Māori had 1.8 times greater odds of having had a tooth extracted than NZ European patients, while Pacific Islanders had 2.1 times the odds. Furthermore, after controlling for ethnicity, age, and sex, low-SES patients had 2.4 times greater odds of having had a tooth extracted than high-SES patients, and beneficiaries had 2.9 times the odds. Conversely, these groups were less likely to have had a tooth treated with a crown or endodontics or receive preventive care.

Conclusions: Existing policies call for the reduction of inequalities. There is a need for a strategy to monitor changes in treatment inequality over time which includes improving equity in service care provision. The observed treatment inequalities are likely to be an underestimate of those occurring in private dental practice in New Zealand.