Impact of Dental Insurance on Dental Utilization Among Subgroups of Latino/a/e Children

Background and Purpose: The Latino/a/e community experiences multiple barriers to accessing and utilizing oral health care and disproportionately poor oral health outcomes. Poor oral health has adverse effects on the healthy development of children and is a primary marker of social inequality. Oral health insurance improves access to necessary care, and all children covered by public insurance are insured, but there is tremendous variation across Latino/a/e subgroups with respect to their trust and familiarity with the US medical system and their attitudes toward oral health. Despite this, no previous study has investigated whether the benefits of insurance coverage for children’s oral health vary across subgroups and many public health surveillance data sources tend to aggregate Latino/a/e subgroup, which may effectively mask sub-group specific health needs. Accordingly, this study aimed to explore differences in insurance coverage rates among children from various Latin countries of origin and further whether these differences were associated with various oral health utilization outcomes of these children.

Methods: Using nationally representative data from the 2009–2019 waves of the National Health Interview Study, we conducted logistic regression analyses to examine the relationship between insurance coverage (none, public, private/other) and dental utilization outcomes (needed but couldn’t afford care, when last seen dentist) among Latino/a/e children in the sample (N= 28,218). Our sample focused specifically on children under 18 years old from Mexican, Puerto Rican, Cuban, Dominican, Central/South American, and Other Latino/a/e ethnicities. We first generated uncontrolled and controlled predicted probabilities of child dental insurance coverage among subgroups of Latino/a/e children. In subsequent regressions, we estimated the associations between oral health insurance coverage and dental care utilization, investigating differences in this association across subgroups after including adjustments for race, age, gender, income, citizenship status, and household characteristics.

Results: In both unadjusted and adjusted predicted probability models, for all subgroups, there is a higher rate of public dental insurance coverage compared to having no insurance or private/other insurance coverage. In fully adjusted regression models, having either private or public insurance was associated with favorable oral health utilization outcomes compared to not having insurance. Despite subgroup differences in rates of coverage, there were no statistical differences in the predicted benefit of insurance coverage across subgroups.

Conclusions and Implications: To our knowledge, there are no studies that explore disaggregated dental insurance rates among Latino/a/e children and their potentially varied impacts on oral health utilization. It is necessary to explore this relationship because the Latin population is the largest ethnic population in the US and is continuing to grow. Researchers must acknowledge and examine the sources of heterogeneity among the Latino/a/e population and how these may yield uneven access to and utilization of dental services, generating health disparities. Future studies should continue to take advantage of disaggregated data on Latino/a/e ethnicity to investigate subgroup differences and thereby influence policy and social work practice.