A Retrospective Analysis of Dental Provider Distribution and Emergency Department Use for Dental Care in North Carolina

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  • September 20, 2019
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  • Zizzi, Alexandra
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • INTRODUCTION Emergency department (ED) use for dental care in North Carolina is higher than in neighboring states. The majority of conditions seen in the ED are infectious and preventable, signifying a lack of access to regular preventive care. Recent analysis shows uneven distribution of dentists around North Carolina; most are concentrated in highly populated urban areas, leaving rural areas heavily underserved. OBJECTIVES The purpose of this study is to establish the burden of ED use for dental care in North Carolina and to determine if the distribution of dentists is associated with ED use for dental conditions. METHODS This analysis uses linear regression. The outcome of interest is the rate of ED visits for dental care per 10,000 people in each county. The primary explanatory variable is the rate of dentists per 10,000 people in each county. Control variables are also at the county level: rural or urban county designation; percent aged 0-19, 20-39, 40-64, 65 and up; percent female; percent black, white, other race, Hispanic; percent estimated eligible for Medicaid. The analysis was also further stratified by urban or rural designation. Regression analysis could not be conducted for Medicaid population relative to significant Medicaid providers, but characteristics of patient population and ED use rates are included. RESULTS 108,625 cases across 100 counties were included, which accounted for approximately 2.5% of all ED visits in 2014. Rates of ED use ranged from 32 visits per 10,000 people to 436 visits per 10,000 people. Patients were disproportionately black, aged 20-39, and the great majority were self-pay or receiving Medicaid. Rural counties had higher rates than urban counties. There was no linear association found between rate of dentists and rate of ED use for dental care. In the overall model and in the rural model, Hispanic ethnicity was associated with a decrease in expected dental ED visits (C:-4.29, p=0.004 and C:-7.56, p=0.005, respectively). In addition, in the rural model, population aged 0-19 was associated with an expected increase in dental ED visits (C:13.18, p=0.015). Patients aged 20-39 made up the greatest portion of visits among those who receive Medicaid, followed by those aged 0-19. There were many more women than men (68% vs. 32). Regression analysis was not conducted for this population. DISCUSSION Analysis confirms results of patient characteristics are consistent with national estimates. Young adults and the uninsured are making up the greatest proportion of visits to the ED for dental care. No significant linear association was found between dental workforce and ED use, which means there are likely other access barriers at play. Rural areas are heavily underserved and will benefit from having more providers, but other barriers, such as cost and fear, must also be addressed.
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  • In Copyright
Advisor
  • Greene, Sandra
Degree
  • Master of Science in Public Health
Academic concentration
  • Health Policy Management
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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  • 70901ce5-7e00-4d43-a385-f1068105d604

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