BACKGROUND AND OBJECTIVE: Research that has repeatedly documented marked racial/ethnic disparities in US childrens receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white childrens receipt of dental care from 1964 to 2010. METHODS: We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: childs receipt of a dental visit in the previous 12 months and childs history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census. RESULTS: The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in childrens dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010. CONCLUSIONS: We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of childrens receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in childrens oral health status are eliminated.

Background and objective

Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010.

Methods

We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child's receipt of a dental visit in the previous 12 months and child's history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ(2) tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census.

Results

The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children's dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010.

Conclusions

We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children's receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children's oral health status are eliminated.

Objective

To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care.

Methods

Data were from the 2007 National Survey of Children's Health, for children 2-17 years (n=82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model-based survey-data-analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors.

Results

Unadjusted results show large racial/ethnic oral health disparities. Compared with non-Hispanic White people, Hispanic and non-Hispanic-Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0-4.6), 2.2 (2.0-2.4), respectively], lack preventive care [ORs 1.9 (1.8-2.0), 1.4 (1.3-1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3-1.7), 1.4 (1.3-1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5-1.8) and 1.2 (1.1-1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9-1.1), 1.1 (1.1-1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6-0.7)].

Conclusions

Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.

Objective

To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care.

Methods

Data were from the 2007 National Survey of Children's Health, for children 2-17 years (n=82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need. Model-based survey-data-analysis examined racial/ethnic disparities, controlling for child, family, and community/state (contextual) factors.

Results

Unadjusted results show large racial/ethnic oral health disparities. Compared with non-Hispanic White people, Hispanic and non-Hispanic-Black people were markedly more likely to be reported in only fair/poor oral health [odds ratios (ORs) (95% confidence intervals) 4.3 (4.0-4.6), 2.2 (2.0-2.4), respectively], lack preventive care [ORs 1.9 (1.8-2.0), 1.4 (1.3-1.5)], and experience delayed care/unmet need [ORs 1.5 (1.3-1.7), 1.4 (1.3-1.5)]. Adjusting for child, family, and community/state factors reduced racial/ethnic disparities. Adjusted ORs (AORs) for Hispanics and non-Hispanic Blacks attenuated for fair/poor oral health, to 1.6 (1.5-1.8) and 1.2 (1.1-1.4), respectively. Adjustment eliminated disparities for lacking preventive care [AORs 1.0 (0.9-1.1), 1.1 (1.1-1.2)] and in Hispanics for delayed care/unmet need (AOR 1.0). Among non-Hispanic Blacks, adjustment reversed the disparity for delayed care/unmet need [AOR 0.6 (0.6-0.7)].

Conclusions

Racial/ethnic disparities in children's oral health status and access were attributable largely to socioeconomic and health insurance factors. Efforts to decrease disparities may be more efficacious if targeted at social, economic, and other factors associated with minority racial/ethnic status and may have positive effects on all who share similar social, economic, and cultural characteristics.