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J Am Dent Assoc, Vol 139, No 12, 1657-1666.
© 2008 American Dental Association
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TRENDS

Racial and ethnic disparities in nontraumatic dental-condition visits to emergency departments and physician offices

A study of the Wisconsin Medicaid program



Christopher Okunseri, BDS, MSc, FFDRCSI, Nicholas M. Pajewski, PhD, David C. Brousseau, MD, MS, Sandy Tomany-Korman, MS, Andrew Snyder, MPA and Glenn Flores, MD

Background. Nontraumatic dental condition (NTDC) visits occur in emergency departments (EDs) and physician offices (POs), but little is known about factors associated with NTDC visit rates to EDs and POs.

Methods. The authors analyzed all Medicaid dental claims in Wisconsin from 2001 through 2003 to examine factors associated with NTDC visits to EDs and POs. They performed bivariate and multivariable analyses. The independent variables they examined included race/ethnicity, age, sex, dental health professional shortage area (DHPSA) designation and urban influence code for county of residence.

Results. The authors evaluated 956,774 NTDC visits made during 1,718,006 person-years; 4.3 percent of visits occurred in EDs or POs. Native Americans, African-Americans and enrollees of unknown race/ethnicity had the highest unadjusted ED and PO visit rates for NTDCs. African-Americans, Native Americans, adults and residents in partial or entire DHPSAs had significantly higher adjusted rates of NTDC visits to EDs. The authors observed significantly higher adjusted NTDC visit rates to POs for Native Americans, adults and enrollees residing in entire DHPSAs, and a significantly lower adjusted rate among African-Americans.

Conclusions. Native Americans, those residing in entire DHPSAs and adults have significantly higher risks of NTDC visits to EDs and POs. African-Americans are at increased risk of making visits to EDs for NTDCs but at decreased risk of making visits to POs for NTDCs.

Clinical Implications. Reductions in Medicaid visits to EDs and POs and the associated costs might be achieved by improving dental care access and targeted educational strategies among minorities, DHPSA residents and adults.

Key Words: Medicaid; racial and ethnic disparities; nontraumatic dental conditions; emergency department; dental health professional shortage area

Abbreviations: DHPSA: Dental health professional shortage area. • ED: Emergency department. • ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification. • NTDC: Nontraumatic dental condition. • PO: Physician office. • UIC: Urban influence code.






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