The Effect of Community-Level Unemployment on Preventive Oral Health Care Utilization

• Published in: Health services research 2009-02, Vol.44 (1), p.162-181
• Main Authors: Quinn, Brian C., Catalano, Ralph A., Felber, Eugene
• Format: Article
• Language: English
• Subjects: Analysis; Confounding (Statistics); Dental care; Dental Care - utilization; Dental insurance; Dental treatment; Dentists; Economic indicators; Employment security; Environmental Context and Access; Health Status Disparities; Helpseeking; Humans; Hypotheses; Insurance claims; Insurance, Dental - statistics & numerical data; Medical care; Medical care utilization; Models, Statistical; Oral health; Oral health care; Population; Preventive health care; Studies; time series analysis; Unemployment; Unemployment - statistics & numerical data; Unemployment insurance; Utilization; Variables; Washington
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/j.1475-6773.2008.00901.x

Objective. To test the hypothesis that high community‐level unemployment is associated with reduced use of preventive dental care services by a dentally insured population. Data. The study uses monthly data on population dental visits and unemployment in the Seattle and Spokane areas from 1995 to 2004. Utilization data come from Washington Dental Services. Unemployment data were obtained from the Bureau of Labor Statistics and Washington's Employment Security Department. Study Design. The study uses a Box–Jenkins Autoregressive Integrated Moving Average (ARIMA) method to measure the association between the variables over time. The approach controls for the effects of autocorrelation, seasonality, and confounding variables. Findings. In the Seattle area, an unexpected 10,000 unit increase in the number of unemployed individuals is associated with a 1.24 percent decrease in preventive visits during the month ( p=.0043). In the Spokane area, a similar increase in unemployment is associated with a 5.95 percent decrease in preventive visits ( p=.0326). The findings persist when the independent variable is the number of initial unemployment insurance claims. Conclusions. The analysis suggests that utilization of preventive dental care declines during periods of high community‐level unemployment. Community‐level unemployment may impede or distract populations from utilizing preventive dental services. The study's findings have implications for insurers, dentists, policy makers, and researchers.