Density of dental practitioners and access to dental care for the elderly: a multilevel analysis with a view on socio-economic inequality.

ABSTRACT

OBJECTIVES: To examine the relations between density of dental practitioners (DDP) and socio-economic and demographic factors shown to affect access to dental care for the elderly. METHODS: Data are taken from a cross-sectional survey - 2008 Disability Healthcare - Household section Survey (HSM). HSM is a representative random sample of French people living in their own domiciles. Our study focuses on the 9233 individuals aged 60 years and above. Multilevel models are employed to disentangle the relations between the determinants of dental care utilisation and DDP. Statistical analyses are conducted using SAS 9.2 and HLM 6. RESULTS: Low-income and lack of complementary health insurance are associated with higher odds of not having visited a dentist, revealing a high unequal access to dental care. By using multilevel modelling, DDP appears to be a significant factor to access to dental services. When considering the intricate relations between income gradient and DDP, the latter lessens the income-related inequality to access dental services. CONCLUSION: DDP seems favouring a more equitable access to dental care, mitigating under-caring of the poorest. This point is to be added in the debate about density of healthcare suppliers.