Socioeconomic and Clinical Demography of Dental Missed Care Opportunities

Abstract

Introduction: Missed care opportunities (MCOs) contribute to poor health outcomes, and pediatric dental patients are particularly vulnerable; identifying associated patient characteristics will help inform development of targeted interventional programs. Objective: To assess socioeconomic and demographic disparities associated with MCOs among children in an urban pediatric hospital’s dental clinic. MCOs lead to a lack of continuous care and increased emergent needs, so understanding MCOs is required to achieve equitable pediatric dental health. Methods: A retrospective 2-y (2019–2020) cohort of MCOs in children 1 to 17 y old, with scheduled dental visits. MCOs were defined as appointments not attended or canceled and not rescheduled prior to initial scheduled visit. Multivariable mixed-effects logistic regression models with patient-level clustering assessed the associations of demographics, neighborhood-level socioeconomic factors (using social vulnerability index [SVI]), and clinic characteristics with MCOs. Results: Of 30,095 visits, 30.9% were MCOs. Multivariable logistic regression estimated increased likelihood of MCOs in Black/non-Hispanic (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09–1.32) and Hispanic (OR, 1.18; 95% CI, 1.06–1.31) patients, patients with public insurance (OR, 1.25; 95% CI, 1.15–1.36) or no insurance (OR, 1.46; 95% CI, 1.15–1.85), patients with complex chronic conditions (OR, 1.11; 95% CI, 1.03–1.19), visits scheduled during the COVID-19 pandemic (OR, 9.48; 95% CI, 8.89–10.11), appointments with wait days over 21 d (OR, 4.07; 95% CI, 3.49–4.74), and children from neighborhoods of high social vulnerability (75th percentile SVI) (OR, 1.08; 95% CI, 1.01–1.16). Conclusions: Children with highest dental MCOs were from neighborhoods with high SVI, had public insurance, and were from marginalized populations. MCOs contribute to inequities in overall health; hence, interventions that address barriers related to characteristics associated with pediatric dental MCOs are needed. Knowledge Transfer Statement: Missed care opportunities contribute to poor health outcomes; identifying associated patient characteristics will help inform development of targeted interventional programs. Providing these findings to stakeholders will better impart understanding access barriers and drive research and program development. Dissemination of this information in the form of altering appointment practices will better accommodate specific patient population needs.