CENTER ON SOCIAL DISPARITIES IN HEALTH University of California, San Francisco
Medical provider promotion of oral health and women’s receipt of dental care during pregnancy Kristen Marchi MPH, Christine Rinki MPH, Monisha Shah MPH, Cheryl Terpak, RDH, MS, Melanie Dove, ScD 2014 CityMatCH Leadership And MCH Epidemiology Conference September 17, 2014
Center on Social Disparities in Health Department of Family and Community Medicine University of California, San Francisco
Maternal, Child and Adolescent Health Program California Department of Public Health
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Importance of oral health during pregnancy Higher rates of gingival inflammation/infection Periodontal disease associated with poor birth outcomes Intervention studies have not shown improvements in birth outcomes
Linked to future oral health status of her infant
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Importance of oral health care during pregnancy Oral health care during pregnancy is highly beneficial All pregnant women should receive at least one preventive oral health care visit Pregnancy is a teachable moment Prevent negative impact of dental disease and gingival infection
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
California women’s use of oral health care during pregnancy increased from 2002 to 2012 Percent of women with a dental visit
50% 40%
36% 37% 36% 35% 34% 32% 34%
39%
42% *
*
30% 20%
Dental visit
10% 0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Data source: Maternal and Infant Health Assessment (MIHA) 2002-2012. Percentages are weighted to represent all women with a live birth in California. *Data for dental visit were not available for 2010-2011.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Role of the provider Promotion of oral health from dental and other providers can increase use of care Many providers lack understanding about safety and impact of oral heath care during pregnancy Guidelines released in California and other states promote oral health care during pregnancy Little known about whether medical providers promote oral health during pregnancy
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Research questions Was there a change in medical provider promotion of oral health and receipt of oral health care during pregnancy between 2009 and 2012? What subgroups were more likely to experience changes in oral health promotion by their providers?
Are women whose medical providers promoted oral health during pregnancy more likely to seek care during pregnancy?
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Data source Maternal and Infant Health Assessment (MIHA) 2009 (n=3,105) and 2012 (n=6,810) Diverse, population-based survey of women with a live birth in California Participants pregnant during 2008/2009 and 2011/2012
Mail survey conducted in English/Spanish, with telephone follow-up to non-respondents Unweighted response rates of 70% Stratified sample weighted to represent delivery population
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Data source MIHA is a collaborative effort of: Maternal, Child and Adolescent Health and WIC Programs of the Center for Family Health, California Department of Public Health Center on Social Disparities in Health at the University of California, San Francisco
Website: www.cdph.ca.gov/MIHA
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
MIHA survey questions (2009, 2012) During your most recent pregnancy, did a medical doctor, nurse or other health care worker talk with you about the health of your teeth and gums? Y/N During your most recent pregnancy, did a medical doctor, nurse or other health care worker suggest that you go to see a dentist? Y/N During your most recent pregnancy, did you visit a dentist, dental clinic, or get dental care at any other health clinic? Y/N
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Maternal characteristics related to oral health care Income, WIC eligibility status, maternal education Race/ethnicity/nativity, language spoken at home Age, marital status, parity Pre-pregnancy and prenatal insurance, prenatal care initiation Smoking during pregnancy
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Analysis Prevalence of medical provider promotion of oral health and receipt of oral health visit in 2009 and 2012 Logistic regression: change in provider promotion of oral health/receipt of visit between 2009 and 2012 Unadjusted, adjusted for maternal characteristics Stratified by maternal characteristics
Logistic regression: association of provider oral health promotion with receipt of an oral health visit, adjusting for maternal characteristics and year
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in medical provider promotion of oral health from 2009 to 2012 Percent of women experiencing oral health promotion by medical provider
50%
aOR = 1.3 (1.2-1.5)
2009
42% 40%
36%
2012
aOR = 1.5 (1.3-1.7)
30%
26% 21%
20% 10% 0%
N=3,046
N=6,704
Talked about health of teeth and gums
N=3,047
N=6,699
Suggested woman see a dentist
Odds ratios adjusted for income, WIC status, race/ethnicity, education, language, age, marital status, parity, PNC insurance, insurance before pregnancy, PNC initiation and smoking.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Stratified Models: Change in medical provider promotion of oral health from 2009 to 2012 among subgroups of women Income
Marital status
WIC eligibility status
Parity
Maternal educationa
Pre-pregnancy insurance
Race/ethnicity/nativity
Prenatal insurancea,b
Language spoken at homeb
Prenatal care initiation
Ageb
Smoking during pregnancy
a: Model for provider discussed teeth and gums, p-value for interaction of year*subgroup < 0.05 b: Model for provider suggested seeing a dentist, p-value for interaction of year*subgroup < 0.05
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in provider discussion of oral health from 2009 to 2012, by maternal education
Percent of women whose provider discussed oral health
aOR= 1.6 (1.1-2.1)
49%
50% 40%
aOR= 1.3 (1.0-1.7)
38%
aOR= 1.7 (1.3-2.1)
45%
aOR= 1.0 (0.8-1.3)
41%
39%
37% 36% 31%
30%
2009 20%
2012
10% 0% < High school
High school/GED
Some college
College graduate
Odds ratios adjusted for income, WIC status, race/ethnicity, language, age, marital status, parity, insurance before pregnancy, prenatal insurance, PNC initiation and smoking. P-value for interaction of year*maternal education = 0.02.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in provider discussion of oral health from 2009 to 2012, by PNC insurance type aOR= 1.1 (0.9-1.3)
aOR= 1.6 (1.3-1.9)
Percent of women whose provider discussed oral health
50% 40%
47%
35%
36%
37%
30% 2009 2012
20% 10% 0% Private
Medi-Cal
Odds ratios adjusted for income, WIC status, race/ethnicity, education, language, age, marital status, parity, insurance before pregnancy, PNC initiation and smoking. P-value for interaction of year*PNC insurance = 0.03.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in provider suggestion of dental visit from 2009 to 2012, by PNC insurance type
Percent of women whose provider suggested they see a dentist
50% aOR = 1.1 (0.8-1.4)
aOR = 1.8 (1.5-2.2)
40%
35%
30% 20%
25% 16%
2009 2012
16%
10% 0% Private
Medi-Cal
Odds ratios adjusted for income, WIC status, race/ethnicity, education, language, age, marital status, parity, insurance before pregnancy, PNC initiation and smoking. P-value for interaction of year*PNC insurance = 0.01.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in provider suggestion of dental visit from 2009 to 2012, by language
Percent of women whose provider suggested they see a dentist
50%
aOR = 1.2 (1.0-1.5)
aOR = 1.6 (1.2-2.1)
40%
40%
aOR = 1.5 (0.8-2.7)
40% 2009
31%
30% 20%
aOR = 2.8 (1.8-4.6)
17%
2012 21%
20%
20%
15%
10% 0% English
Spanish
English/Spanish equally
Asian/other language
Odds ratios adjusted for income, WIC status, race/ethnicity, education, age, marital status, parity, PNC insurance, insurance before pregnancy, PNC initiation and smoking. P-value for interaction of year*language = 0.009.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in provider suggestion of dental visit from 2009 to 2012, by WIC status Percent of women whose provider suggested they see a dentist
50% aOR = 1.8 (1.4-2.2) 40% 30%
aOR = 0.9 (0.6-1.5)
aOR = 1.2 (0.9-1.5)
25% 21% 25%
20%
2009
34% 15%
17%
2012
10% 0% Enrolled in WIC
Eligible not enrolled
Ineligible for WIC
Odds ratios adjusted for income, language, race/ethnicity, education, age, marital status, parity, PNC insurance, insurance before pregnancy, PNC initiation, and smoking. P-value for interaction of year*WIC status = 0.003.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Change in women’s receipt of oral health care during pregnancy from 2009 to 2012 Percent of women with a dental visit during pregnancy
50%
(ref)
aOR = 1.3 (1.1-1.4) 42%
40%
38%
30% 20% 10% N=3,069
N=6,763
2009
2012
0% Odds ratios adjusted for income, WIC status, race/ethnicity, education, language, age, marital status, parity, PNC insurance, insurance before pregnancy, PNC initiation, and smoking.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Percent of women with a dental visit during pregnancy
Use of oral health care by medical provider promotion practices, MIHA 2009 and 2012 combined 70% 60%
aOR = 4.6 (3.9-5.3)
aOR = 6.1 (5.1-7.2) 63%
58%
50% 40% 30% 20% 10%
29%
33%
Yes No
(ref)
(ref)
0% Provider discussed health of teeth and gums
Provider suggested woman see a dentist
Odds ratios adjusted for income, WIC use, race/ethnicity, education, language, age, marital status, parity, PNC insurance, insurance before pregnancy, PNC initiation and smoking.
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Limitations Cannot determine cause of changes in provider oral health promotion or women’s receipt of an oral health visit Multiple statistical tests were undertaken, increasing the chances of significant findings No information available on dental problems, nor on what the providers actually discussed Type of provider unknown Recall bias
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Conclusion Medical provider promotion of oral health and women’s receipt of care improved significantly between 2009 and 2012 Pregnant women whose providers promoted oral health were more likely to visit dentist Suggests outreach to women through medical providers can help increase dental visits during pregnancy
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Conclusion, continued Despite improvements, medical provider promotion of oral health and women’s use of care remain low Discussion of oral health only 42% Referral to dentist only 26% Had dental visit only 42%
CENTER ON SOCIAL DISPARITIES IN HEALTH University of Calif ornia, San Francisco
Implications Strengthen efforts to ensure all medical providers promote recommended oral health messages: Dissemination of CA Perinatal Oral Health Guidelines, National Consensus Statement on Oral Health Care during Pregnancy Medical provider training and continuing education Identify barriers among providers to discussing oral health
Identify reasons women do not seek care and develop additional strategies for resolving barriers
