Examining the Effect of Income-Based Inequalities and Dental Service Provision on Dental Service Utilization among Older Australians: A Multiple Mediation Analysis

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dc.contributor.authorGhanbarzadegan, A.
dc.contributor.authorSohn, W.
dc.contributor.authorWallace, J.
dc.contributor.authorBrennan, D.S.
dc.contributor.authorJamieson, L.M.
dc.date.issued2024
dc.description.abstractIntroduction: Public service provision is one of the keys to reducing inequalities in the utilization of dental services. Given the increase in the aging population, there should be a focus on older adults’ oral health. However, this is often overlooked. Objectives: This study investigates the effectiveness of public services in reducing income-related inequalities in dental service utilization among older South Australians. Methods: A multiple counterfactual mediation analysis using the ratio of mediator probability weighting approach was used to explore the proposed mediation mechanism using a South Australian population of older adults (≥65 y). The exposure variable in the analysis was income, and the mediators were concession cards and the last dental sector (public or private). The outcome variable was the time of last dental visit. Results: Half of the older adults with high income (≥$40,000) owned a concession card, and 10% of those who attended public dental services belonged to this group. Interestingly, only 16.3% of the study participants had visited the public dental sector at their last dental appointment. Results showed a negligible indirect effect (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.85–1.05) and a significant direct effect (OR, 3.09; 95% CI, 2.24–4.87). By changing the potential outcome distributions to the counterfactual exposure distributions and taking the mediators’ distribution as a counterfactual exposure distribution, the odds of dental visits occurring before the past 12 mo approximately tripled for low-income compared to high-income individuals. Conclusion: Income inequalities were associated with relatively delayed dental visits in older South Australians, and provision of public services could not improve this pattern. This might happen due to inequitable access to concession cards and public services. A review of policies is required, including addressing income inequalities and implementing short-term approaches to improve service utilization patterns in older South Australians.
dc.description.statementofresponsibilityA. Ghanbarzadegan, W. Sohn, J. Wallace, D.S. Brennan, and L.M. Jamieson
dc.identifier.citationJDR Clinical and Translational Research, 2024; 9(3):248-255
dc.identifier.doi10.1177/23800844231199658
dc.identifier.issn2380-0844
dc.identifier.issn2380-0852
dc.identifier.orcidGhanbarzadegan, A. [0000-0002-4989-7272]
dc.identifier.orcidBrennan, D.S. [0000-0002-7888-0920]
dc.identifier.orcidJamieson, L.M. [0000-0001-9839-9280]
dc.identifier.urihttps://hdl.handle.net/2440/147899
dc.language.isoen
dc.publisherSAGE Publications
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1031310
dc.rights© The Author(s) 2023. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
dc.source.urihttps://doi.org/10.1177/23800844231199658
dc.subjectsocioeconomic factors; health care disparities; dental health services; public sector; private sector; Australia
dc.subject.meshHumans
dc.subject.meshDental Care
dc.subject.meshSocioeconomic Factors
dc.subject.meshAged
dc.subject.meshAged, 80 and over
dc.subject.meshOral Health
dc.subject.meshIncome
dc.subject.meshDental Health Services
dc.subject.meshHealth Services Accessibility
dc.subject.meshAustralia
dc.subject.meshSouth Australia
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshHealthcare Disparities
dc.subject.meshMediation Analysis
dc.subject.meshAustralasian People
dc.titleExamining the Effect of Income-Based Inequalities and Dental Service Provision on Dental Service Utilization among Older Australians: A Multiple Mediation Analysis
dc.typeJournal article
pubs.publication-statusPublished

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