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Investigating the “inverse care law” in dental care: A comparative analysis of Canadian jurisdictions

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Abstract

OBJECTIVES: To compare physician and dentist visits nationally and at the provincial/territorial level and to assess the extent of the “inverse care law” in dental care among different age groups in the same way.

METHODS: Publicly available data from the 2007 to 2008 Canadian Community Health Survey were utilized to investigate physician and dentist visits in the past 12 months in relation to self-perceived general and oral health by performing descriptive statistics and binary logistic regression, controlling for age, sex, education, income, and physician/dentist population ratios. Analysis was conducted for all participants and stratified by age groups - children (12–17 years), adults (18–64 years) and seniors (65 years and over).

RESULTS: Nationally and provincially/territorially, it appears that the “inverse care law” persists for dental care but is not present for physician care. Specifically, when comparing to those with excellent general/oral health, individuals with poor general health were 2.71 (95% confidence interval [CI]: 2.70–2.72) times more likely to visit physicians, and individuals with poor oral health were 2.16 (95% CI: 2.16–2.17) times less likely to visit dentists. Stratified analyses by age showed more variability in the extent of the ‘inverse care law” in children and seniors compared to adults.

CONCLUSIONS: The “inverse care law” in dental care exists both nationally and provincially/territorially among different age groups. Given this, it is important to assess the government’s role in improving access to, and utilization of, dental care in Canada.

Résumé

OBJECTIFS: Comparer les visites chez le médecin et chez le dentiste à l’échelle nationale et à l’échelle provinciale/territoriale et évaluer de la même façon l’ampleur de la „loi inverse des soins” dans les soins dentaires selon différents groupes d’âge.

MÉTHODE: Nous avons utilisé les données publiquement disponibles de l’Enquête sur la santé dans les collectivités canadiennes de 2007 à 2008 pour étudier les visites chez le médecin et chez le dentiste au cours des 12 mois antérieurs par rapport à la santé générale et à la santé buccodentaire autoperçues, à l’aide de statistiques descriptives et d’une analyse de régression logistique binaire, après avoir apporté des ajustements pour tenir compte des effets de l’âge, du sexe, de l’instruction, du revenu et du nombre de médecins ou dentistes par habitant. Cette analyse a été effectuée pour tous les participants et stratifiée par groupe d’âge: enfants (12–17 ans), adultes (18–64 ans) et aînés (65 ans et plus).

RÉSULTATS: À l’échelle nationale et à l’échelle provinciale/territoriale, il semble que la „loi inverse des soins” joue encore dans les soins dentaires, mais pas dans les soins médicaux. Plus précisément, comparativement aux personnes dont la santé générale ou la santé buccodentaire est excellente, les personnes en mauvaise santé générale étaient 2,71 fois (intervalle de confiance de 95 % [IC]: 2,70–2,72) plus susceptibles d’aller chez le médecin, et les personnes en mauvaise santé buccodentaire étaient 2,16 fois (IC de 95 %: 2,16–2,17) moins susceptibles d’aller chez le dentiste. Les analyses stratifiées selon l’âge indiquent une plus grande variabilité dans l’ampleur de la „loi inverse des soins” chez les enfants et les aînés que chez les adultes.

CONCLUSIONS: La „loi inverse des soins” dans les soins dentaires existe à la fois à l’échelle nationale et à l’échelle provinciale/territoriale dans différents groupes d’âge. Il est donc important d’évaluer le rôle du gouvernement pour améliorer l’accès et le recours aux soins dentaires au Canada.

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Authors and Affiliations

  1. Dental Public Health, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, ON, M5G 1G6, Canada

    Armita Dehmoobadsharifabadi BSc, MSc, Sonica Singhal BDS, MPH, MSc, PhD, FRCD(C) & Carlos Quiñonez DMD, MSc, PhD, FRCD(C)

  2. Health Promotion Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada

    Sonica Singhal BDS, MPH, MSc, PhD, FRCD(C)

Authors
  1. Armita Dehmoobadsharifabadi BSc, MSc
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  2. Sonica Singhal BDS, MPH, MSc, PhD, FRCD(C)
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  3. Carlos Quiñonez DMD, MSc, PhD, FRCD(C)
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Correspondence to Armita Dehmoobadsharifabadi BSc, MSc.

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Conflict of Interest: None to declare.

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Dehmoobadsharifabadi, A., Singhal, S. & Quiñonez, C. Investigating the “inverse care law” in dental care: A comparative analysis of Canadian jurisdictions. Can J Public Health 107, e538–e544 (2016). https://doi.org/10.17269/CJPH.107.5454

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  • DOI: https://doi.org/10.17269/CJPH.107.5454

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