Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004-2012: a repeated cross-sectional study.

BACKGROUND: The aim of this study was to assess trends and inequalities in dental care utilization in Estonia and Lithuania in relation to large-scale macroeconomic changes in 2004-2012. METHODS: Data on 22,784 individuals in the 20-64 age group were retrieved from nationally representative cross-sectional surveys in 2004, 2006, 2008, 2010 and 2012. Age- and sex-standardized prevalence estimates of past 12-month dental visits were calculated for each study year, stratified by gender, age group, ethnicity, educational level and economic activity. Multivariable logistic regression analysis was used to assess the independent effect of study year and socioeconomic status on dental visits. RESULTS: The age- and sex-standardized prevalence of dental visits in the past 12 months was 46-52% in Estonia and 61-67% in Lithuania. In 2004-2008, the prevalence of dental visits increased by 5.9 percentage points in both countries and fell in 2008-2010 by 3.8 percentage points in Estonia and 4.6 percentage points in Lithuania. In both countries the prevalence of dental care utilization had increased slightly by 2012, although the increase was statistically insignificant. Results from a logistic regression analysis showed that these differences between study years were not explained by differences in socioeconomic status or oral health conditions. Women, the main ethnic group (only in Estonia), and higher educated and employed persons had significantly higher odds of dental visits in both countries, but the odds were lower for 50-64 year olds in Lithuania. CONCLUSIONS: In European Union countries with lower national wealth, the use of dental services is sensitive to macroeconomic changes regardless of the extent of public coverage, at the same time, higher public coverage may not relate to lower inequalities in dental care use.

Alcohol consumption, smoking and overweight as a burden for health care services utilization: a cross-sectional study in Estonia.

BACKGROUND: Alcohol consumption, smoking and weight problems are common risk factors for different health problems. We examine how these risk factors are associated with the use of health care services. METHODS: Data for 6500 individuals in the 25-64 age group came from three cross-sectional postal surveys conducted in 2004, 2006, and 2008 in Estonia. The effect of alcohol consumption, smoking and weight problems on the use of primary and specialist care services, hospitalizations and ambulance calls was analysed separately for men and women by using binary logistic regression. RESULTS: Overweight and/or obesity were strongly related to the use of primary care and out-patient specialist services for both genders, and to hospitalizations and ambulance calls for women. Current smoking was related to ambulance calls for both genders, whereas smoking in the past was related to the use of primary care and specialist services among men and to hospitalizations among women. Beer drinking was negatively associated with all types of health care services and similar association was found between wine drinking and hospitalizations. Wine drinking was positively related to specialist visits. The frequent drinking of strong alcohol led to an increased risk for ambulance calls. Drinking light alcoholic drinks was positively associated with all types of health care services (except ambulance calls) among men and with the use of specialist services among women. CONCLUSIONS: Overweight and smoking had the largest impact on health care utilization in Estonia. Considering the high prevalence of these behavioural risk factors, health policies should prioritize preventive programs that promote healthy lifestyles in order to decrease the disease burden and to reduce health care costs.