Factors Associated with Dental Service Use of Older Korean Americans

Background and Purpose: Despite national efforts to close the health gap in the U.S. over the past few decades, oral health and dental care continue to demonstrate disparities. Since the Surgeon General’s landmark report in 2000 emphasized its importance for all Americans, oral health has become a national priority. However, many segments of the U.S. population experience disproportionate oral health problems and inequities in dental care, with older immigrants being at particular risk. Based on Andersen’s health care utilization model, the present study examined factors associated with dental service use in older Korean Americans. Older Korean Americans are an appropriate group to target for several reasons: (1) they are one of the rapidly expanding immigrant groups (i.e., Korean is the 5th largest Asian American subgroup), (2) they are limited in English proficiency (i.e., More than 80% of the Korean Americans speak a language other than English at home), (3) they manifest marked disparities in healthcare with a high rate of the uninsured and low rate of health service use, and (4) information on their oral health and dental care is limited.

Methods: Data were drawn from 2,176 older Korean Americans (M/SD=73.4/7.97) who were surveyed in five states (CA, NY, TX, HI, and FL) during 2017−2018. Poisson regression model examined predictors of dental visit in the past 12 months, focusing on predisposing variables (age, gender, marital status, education, and region), oral health needs (problems with teeth or gums and self-rated oral health), and enabling variables (dental health insurance, length of stay in the U.S., acculturation, and family network).

Results: More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the U.S., and larger family networks were associated with 1.01 to 1.35 times higher number of dental visits.

Conclusions and Implications: Supporting the proposed hypotheses, our analyses showed significant contributions of dental insurance coverage, length of stay in the U.S., and family network in predicting dental service use. The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants’ oral health and dental care from the perspectives of culture and family. Interventions to promote older ethnic immigrants’ dental service use should target those who are in an early stage of immigration and who lack dental health insurance, and should incorporate family components.