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25. Racial Variation in the Provision of VA Dental Care: The Case of Root Canal Therapy

NR Kressin, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC; U Boehmer, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC; D Berlowitz, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC; A Pitman, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC; CL Christiansen, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC; JA Jones, Center for Health Quality, Outcomes & Economic Research, Bedford VAMC

Objectives: Numerous studies have documented racial disparities in the provision of medical care, but sparse data exist regarding whether such disparities exist in dental care.

Methods: We examined whether there were racial differences in the provision of the preferred, tooth-sparing treatment of root canal therapy (vs. tooth extraction) among 42,846 users of VA dental care in 1998 with known race, controlling for severity of tooth and gum related disease, age, gender, medical comorbidities (Charlson index), psychiatric diagnoses which might affect dentists’ inclination to provide certain procedures (schizophrenia, alcoholism, and depressive disorder), and prior use of preventive services (an indicator of the patient’s value on oral health). We drew upon three data sources: the VA inpatient and outpatient clinic files (for data on sociodemographics, medical comorbidities, psychiatric diagnoses, and prior use of preventive dental services), and the VA Dental Activity System, which includes information about whether visits were for emergencies or regular care. Logistic regression analyses examined the association of race and receipt of root canal therapy, among both emergency and non-emergency visits, controlling for the above variables.

Results: In unadjusted analyses, African Americans (for regular visits: OR: 0.69, CI: 0.65-0.70; for emergency visits: OR:0.62, CI: 0.45-0.86) and Latinos (for regular visits: OR: 0.84, CI: 0.76-0.94; for emergency visits OR: 0.91 CI: 0.54-1.53) were less likely than Whites to receive root canal therapy, while Asians were more likely to receive this treatment (for regular visits OR: 1.67, CI: 1.31–2.14; for emergency visits OR: 5.27 CI: 1.55-17.87). Once the models were adjusted for the covariates, only African Americans remained significantly less likely to receive root canals than Whites (for regular visits OR: 0.78, CI: 0.72- 0.84; for emergency visits OR: 0.67, CI: 0.48 – 0.93); rates of root canal therapy among Latinos were not significantly different than Whites. However, Asians were more likely than Whites to receive root canal therapy (for regular visits OR: 1.78, CI: 1.31 – 2.43; for emergency visits OR: 3.75, CI: 1.01 – 14.01).

Conclusions: These results document that African American VA patients receive root canal therapy less frequently, even after controlling for tooth and gum severity, during both emergency and regular visits. Further, Asians received more root canal therapy in both settings than did Whites. Future research needs to identify the causal mechanisms of such disparities.

Impact: Differential access to dental care by racial/ethnic groups is of concern to VA, where the equitable provision of health care to all veterans is an important goal.