Oral Health Disparities:How do Latino Children Fare?

Clemencia M. Vargas, DDS, PhD.University of Maryland Dental School

March 19, 2011

Disparities

Definition:

“Health differences which are unnecessary and avoidable but, in addition, are also considered unfair and unjust”.

Disparities

Social determinants of health:

Social conditions people are born, live, and work

Individual choices are important, but are influenced by social conditions.

(David Satcher PHR 2010)

Disparities

Health disparities put socially disadvantaged groups at further disadvantage regarding their health

Latinos in the US

Hispanics in the US by origin

Population in millions

Percentage

Hispanic 45.4 100.0

Mexican 29.3 64.5

Central American 3.6 7.9

South American 2.5 5.6

Puerto Rican 4.1 9.1

Dominican 1.2 2.8

Cuban 1.6 3.5

Other Hispanic 2.6 6

Source: American Community Survey collected Jan 2006-Dec 2008 from United States Life Tables by Hispanic Origin

Socioeconomic Status Indicators

Hispanic Non-H White

Non-H Black

Bachelor's Degreeor more(%)

12.6 30.4 17.2

Poverty (%) 18.9 6.1 17.2

Family Income (in US dollars) $43,240 $70,399 $41,567

Infant Mortality Rate(per 1000)

5.4 5.6 13.4

Source: “United States Life Tables by Hispanic Origin” from the CDC

Socioeconomic Status Indicators

Mexican Puerto Rican Cuban Central

Am.South Am.

Own home

55.0 44.7 68.4 44.5 56.2

BachelorDegree +

9.1 15.5 28.1 11.7 31.9

Children in poverty

29.8 34.1 14.0 24.0 13.7

Unempl. 7.9 9.7 5.5 7.1 6.9

Source: “The Hispanic Population in the United States: 2008 Detailed Tables” from the U.S. Census Bureau

Oral health

Oral health:Sources of Disparities

Structural issue– Dental care “system”– Financing dental care– Inadequate federal and state programs– Limited dental public health infrastructure

Source: Vargas & Arevalo, Dental Clinics of North America 2009

Oral health:Sources of disparities

Workforce– Shortage (5,000 pediatric dentists v. 47,000 pediatricians)

– Maldistribution– Limited scope of practice – Racial/ethnic homogeneity– Training deficiencies

Source: Vargas & Arevalo, Dental Clinics of North America 2009

Oral health:Sources of disparities

Population issues – » dentists, patients and community

– Social determinants– Oral health literacy !!!!!– Plain literacy– Cultural competency– Behavioral

Source: Vargas & Arevalo, Dental Clinics of North America 2009

Oral health literacy is …

Degree of capacity to

obtain,

process, and

understand

basic health information

services needed

to make decisions

Source: Healthy People 2010

Oral health literacy is …

Affected by:– Low English Proficiency (LEP)– Low educational attainment– Literacy and numeracy skills– Context

Still a new field … very limited information about Latinos with LEP

Oral Health Disparities

Monitoring Disparities: Data!

As long as there are disparities, data are necessary to:

– Plan, develop, and monitor programs– Track differences over time

Also to identify new disparities

Oral Health IndicatorsChildren Ages 2-11

GroupIndicators

NH white%

NH black%

Mexican American

%

Untreated 19.5 27.6 33.1

Caries free 61.4 56.6 44.6

Sealants (8 yr old) 37.6 22.6 19.4

Source: “Trends in Oral Health Status: United States, 1988-1994 and 1999-2004” by Dye BA, et al.

Oral Health IndicatorsChildren Ages 12-19

GroupIndicators

NH white%

NH black%

Mexican American

%

Untreated 16.2 25.7 28.6

Caries free 41.9 45.6 35.5

Sealants 43.9 25.7 27.2

Source: “Trends in Oral Health Status: United States, 1988-1994 and 1999-2004” by Dye BA, et al.

Oral Health Care

GroupDental visits

NH white%

NH black%

Mexican American

%Ages 2-11 Never 1 yr or less

22.867.3

21.964.7

28.256.5

Ages 12-19 Never 1 yr or less

1.078.7

3.365.3

10.654.8

Source: “Trends in Oral Health Status: United States, 1988-1994 and 1999-2004” by Dye BA, et al.

Conclusions

Compared to other groups, Latino children have:– Lower SES– More oral health problems– Less oral health care

Thank you!