Children’s Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007–2015)
Abstract
:1. Introduction
2. Methods
2.1. Data Source and Study Population
2.2. Measurement
2.3. Statistical Analyses
3. Results
3.1. Sample Characteristics
3.2. Association between Dental Insurance Coverage and Dental Sealant or Untreated Caries
3.3. Subgroup Analysis per Household Income
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Category | Pre-Policy (2007–2009) | First Period of Policy Implementation (2010–2012) | Second Period of Policy Implementation (2013–2015) | |||
---|---|---|---|---|---|---|
Unweighted Frequency (Weighted %) | Unweighted Frequency (Weighted %) | Unweighted Frequency (Weighted %) | ||||
Sex | ||||||
Girl | 1544 | (47.5) | 1339 | (48.0) | 995 | (49.0) |
Boy | 1701 | (52.5) | 1490 | (52.0) | 1092 | (51.0) |
Age (years) | ||||||
6–9 | 1466 | (40.5) | 1222 | (38.6) | 950 | (41.2) |
10–14 | 1779 | (59.5) | 1607 | (61.4) | 1137 | (58.8) |
Family structure | ||||||
Living without both parents | 483 | (15.7) | 461 | (19.1) | 560 | (26.4) |
Living with both parents | 2762 | (84.3) | 2368 | (80.9) | 1527 | (73.6) |
Region of residence | ||||||
Rural | 586 | (15.6) | 398 | (17.4) | 381 | (17.6) |
Urban | 2659 | (84.4) | 2431 | (82.6) | 1706 | (82.4) |
Type of health insurance | ||||||
Medical aid | 176 | (5.3) | 112 | (5.3) | 62 | (3.3) |
NHI | 3069 | (94.7) | 2717 | (94.7) | 2025 | (96.7) |
Household income | ||||||
Low | 801 | (24.9) | 674 | (29.1) | 482 | (23.1) |
Middle | 1603 | (49.1) | 1432 | (49.9) | 1066 | (51.9) |
High | 841 | (26.0) | 723 | (21.0) | 539 | (25.0) |
Self-rated dental health status | ||||||
Poor | 680 | (20.1) | 656 | (22.4) | 593 | (28.4) |
Fair | 1797 | (55.8) | 1670 | (57.3) | 1186 | (56.8) |
Excellent | 768 | (24.1) | 503 | (20.3) | 308 | (14.8) |
Dental checkup within a year | ||||||
No | 1247 | (38.1) | 1148 | (42.8) | 715 | (34.2) |
Yes | 1998 | (61.9) | 1681 | (57.2) | 1372 | (65.8) |
Frequency of teeth brushing per day | ||||||
0–1 | 444 | (13.9) | 270 | (10.7) | 163 | (7.8) |
Above 2 times | 2801 | (86.1) | 2559 | (89.3) | 1924 | (92.2) |
Number of dentists per 1000 residents (Mean/SD) | 0.392 | (0.004) | 0.416 | (0.004) | 0.432 | (0.005) |
Category | Prevalence of Dental Sealant Use | Prevalence of Untreated Caries | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
No | Yes | p-Value | No | Yes | p-Value | |||||
Unweighted Frequency (Weighted %) | Unweighted Frequency (Weighted %) | Unweighted Frequency (Weighted %) | Unweighted Frequency (Weighted %) | |||||||
NHI-insurance coverage: dental sealant | ||||||||||
Second Period (2013–2015) | 1218 | (27.39) | 869 | (33.88) | <0.001 | 1891 | (30.79) | 196 | (23.03) | <0.001 |
First Period (2010–2012) | 1673 | (35.75) | 1156 | (37.59) | 2527 | (36.41) | 302 | (36.59) | ||
Pre-policy (2007–2009) | 2229 | (36.86) | 1016 | (28.53) | 2771 | (32.80) | 474 | (40.38) | ||
Sex | ||||||||||
Girl | 2427 | (48.25) | 1451 | (47.95) | 0.824 | 3404 | (48.00) | 474 | (49.07) | 0.587 |
Boy | 2693 | (51.75) | 1590 | (52.05) | 3785 | (52.00) | 498 | (50.93) | ||
Age (years) | ||||||||||
6–9 | 2453 | (42.99) | 1185 | (35.02) | <0.001 | 3439 | (43.37) | 199 | (16.79) | <0.001 |
10–14 | 2667 | (57.01) | 1856 | (64.98) | 3750 | (56.63) | 773 | (83.21) | ||
Family structure | ||||||||||
Living without both parents | 1019 | (21.78) | 485 | (17.34) | <0.001 | 1248 | (18.85) | 256 | (28.95) | <0.001 |
Living with both parents | 4101 | (78.22) | 2556 | (82.66) | 5941 | (81.15) | 716 | (71.05) | ||
Region of residence | ||||||||||
Rural | 893 | (17.40) | 472 | (16.00) | 0.304 | 1175 | (16.73) | 190 | (17.93) | 0.457 |
Urban | 4227 | (82.60) | 2569 | (84.00) | 6014 | (83.27) | 782 | (82.07) | ||
Type of health insurance | ||||||||||
Medical aid | 247 | (5.10) | 103 | (4.06) | <0.001 | 273 | (4.27) | 77 | (7.75) | <0.001 |
NHI | 4873 | (94.90) | 2938 | (95.94) | 6916 | (95.73) | 895 | (92.25) | ||
Household income | ||||||||||
Low | 1388 | (27.61) | 619 | (22.95) | <0.001 | 1618 | (24.44) | 339 | (35.74) | <0.001 |
Middle | 2,570 | (50.30) | 1531 | (50.11) | 3679 | (51.42) | 422 | (42.04) | ||
High | 1212 | (22.09) | 891 | (26.94) | 1892 | (24.14) | 211 | (22.22) | ||
Self-rated dental health status | ||||||||||
Poor | 1167 | (22.06) | 762 | (25.24) | <0.001 | 1809 | (24.99) | 120 | (11.14) | <0.001 |
Fair | 2863 | (55.67) | 1790 | (58.48) | 4177 | (57.89) | 479 | (48.62) | ||
Excellent | 1090 | (22.27) | 489 | (16.28) | 1203 | (17.12) | 376 | (40.24) | ||
Dental checkup within a year | ||||||||||
No | 2104 | (41.74) | 1006 | (33.48) | <0.001 | 2640 | (37.25) | 470 | (48.41) | <0.001 |
Yes | 3016 | (58.26) | 2035 | (66.52) | 4549 | (62.75) | 502 | (51.59) | ||
Frequency of teeth brushing per day | ||||||||||
0–1 | 605 | (12.24) | 272 | (8.68) | <0.001 | 735 | (10.47) | 142 | (13.95) | 0.005 |
Above 2 times | 4515 | (87.76) | 2769 | (91.32) | 6454 | (89.53) | 830 | (86.05) | ||
Number of dentists per 1000 residents (Mean/SD) | 0.409 | (0.003) | 0.413 | 0.004 | <0.001 | 0.411 | (0.003) | 0.408 | (0.005) | <0.001 |
Category | Prevalence of Dental Sealant Use | Prevalence of Untreated Caries | ||||||
---|---|---|---|---|---|---|---|---|
Model I | Model II | Model I | Model II | |||||
OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | |
NHI-insurance coverage: dental sealant | ||||||||
Second Period (2013–2015) | 1.60 | 1.35, 1.89 | 1.58 | 1.33, 1.87 | 0.61 | 0.49, 0.76 | 0.65 | 0.51, 0.83 |
First Period (2010–2012) | 1.36 | 1.16, 1.59 | 1.39 | 1.18, 1.63 | 0.82 | 0.67, 0.99 | 0.79 | 0.64, 0.98 |
Pre-policy (2007–2009) | 1.00 | 1.00 | 1.00 | 1.00 | ||||
Sex | ||||||||
Girl | 0.98 | 0.87, 1.09 | 1.07 | 0.91, 1.26 | ||||
Boy | 1.00 | 1.00 | ||||||
Age (years) | ||||||||
6–9 | 0.67 | 0.60, 0.74 | 0.28 | 0.23, 0.34 | ||||
10–14 | 1.00 | 1.00 | ||||||
Family structure | ||||||||
Living without both parents | 0.76 | 0.65, 0.89 | 1.53 | 1.22, 1.90 | ||||
Living with both parents | 1.00 | 1.00 | ||||||
Region of residence | ||||||||
Rural | 0.92 | 0.75, 1.12 | 1.06 | 0.83, 1.35 | ||||
Urban | 1.00 | 1.00 | ||||||
Type of health insurance | ||||||||
Medical aid | 1.03 | 0.75, 1.41 | 1.05 | 0.70, 1.56 | ||||
NHI | 1.00 | 1.00 | ||||||
Household income | ||||||||
Low | 0.78 | 0.65, 0.94 | 1.23 | 0.95, 1.59 | ||||
Middle | 0.82 | 0.71, 0.94 | 0.84 | 0.67, 1.05 | ||||
High | 1.00 | 1.00 | ||||||
Self-rated dental health status | ||||||||
Poor | 1.48 | 1.23, 1.77 | 0.23 | 0.18, 0.30 | ||||
Fair | 1.35 | 1.16, 1.57 | 0.37 | 0.31, 0.44 | ||||
Excellent | 1.00 | 1.00 | ||||||
Dental checkup within a year | ||||||||
No | 0.70 | 0.62, 0.79 | 1.35 | 1.14, 1.60 | ||||
Yes | 1.00 | 1.00 | ||||||
Frequency of teeth brushing per day | ||||||||
0–1 | 0.77 | 0.64, 0.92 | 1.02 | 0.79, 1.31 | ||||
Above 2 times | 1.00 | 1.00 | ||||||
Number of dentists per 1000 residents (Mean/SD) | 0.97 | 0.76, 1.23 | 1.03 | 0.74, 1.45 |
(a) | ||||||
Category | Prevalence of Dental Sealant Use | |||||
High | Middle | Low | ||||
OR | 95% CI | OR | 95% CI | OR | 95% CI | |
NHI-insurance coverage: dental sealant | ||||||
Second Period (2013–2015) | 1.27 | 0.94, 1.73 | 1.58 | 1.26, 1.99 | 2.05 | 1.50, 2.81 |
First Period (2010–2012) | 1.26 | 0.94, 1.67 | 1.29 | 1.04, 1.60 | 1.83 | 1.35, 2.47 |
Pre-policy (2007–2009) | 1.00 | 1.00 | 1.00 | |||
(b) | ||||||
Category | Prevalence of Untreated Caries | |||||
High | Middle | Low | ||||
OR | 95% CI | OR | 95% CI | OR | 95% CI | |
NHI-insurance coverage: dental sealant | ||||||
Second Period (2013–2015) | 0.78 | 0.48, 1.28 | 0.62 | 0.44, 0.86 | 0.58 | 0.38, 0.86 |
First Period (2010–2012) | 0.76 | 0.49, 1.19 | 0.67 | 0.49, 0.90 | 0.94 | 0.66, 1.35 |
Pre-policy (2007–2009) | 1.00 | 1.00 | 1.00 |
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Sohn, M.; Park, S.; Lim, S.; Park, H.-J. Children’s Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007–2015). Int. J. Environ. Res. Public Health 2019, 16, 2773. https://doi.org/10.3390/ijerph16152773
Sohn M, Park S, Lim S, Park H-J. Children’s Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007–2015). International Journal of Environmental Research and Public Health. 2019; 16(15):2773. https://doi.org/10.3390/ijerph16152773
Chicago/Turabian StyleSohn, Minsung, Sujin Park, Sungwon Lim, and Hee-Jung Park. 2019. "Children’s Dental Sealant Use and Caries Prevalence Affected by National Health Insurance Policy Change: Evidence from the Korean National Health and Nutrition Examination Survey (2007–2015)" International Journal of Environmental Research and Public Health 16, no. 15: 2773. https://doi.org/10.3390/ijerph16152773