Racial differences in predictors of incident dental care use by adults

Background: Racial disparities in oral health are now widely recognized. These disparities might be partly attributable to racial differences in dental care use. Our previous work (Gilbert et al., Soc Sci Med, 1998) identified predictors of use, but did not stratify analysis by race. Objectives: To quantify racial differences in predictors of incident dental care use. Methods: Data were taken from an observational study that included at baseline 873 non-Hispanic African-Americans (AA) and non-Hispanic Whites (NHW) with at least 1 tooth, & who were at least 45 years old. Subjects participated for an interview & clinical exam at baseline & 24-mo., with 6-mo. telephone interviews in between. A person-interval constituted one person participating for a given 6-mo. interview. Results: In GEE regressions of 6-monthly incident dental care done separately by race/ethnicity, conclusions about predictors of use did differ between the AA and NHW models. These variables were associated with increased use in the AA model only: having dental insurance, no frustration with past dental care, having a tendency not to use a homemade remedy, and incident loose tooth. These variables were significant in the NHW model only: incident broken tooth, incident broken filling, incident 'cavities', incident oral disadvantage due to disease, satisfaction with dental appearance, and perceived need due to a specfic dental problem. These variables predicted use in both models: typical approach to care as reported at baseline, greater ability to pay an unexpected $500 dental bill, gender, and incident toothache/abscess. Model fit was better for the AA model than it was for the NHW model. Conclusions: Predictors of dental care use differed between AA and NHW in this sample of dentate adults. These differences may contribute to racial disparities in oral health.