Use of Preventive Dental Care Among Medicaid-Enrolled, School-Aged US Children in Immigrant and Nonimmigrant Families: Trends in Pennsylvania From 2005 Through 2010

摘要

Objectives. We describe trends in receipt of preventive dental care among Medicaid-enrolled children in Pennsylvania between 2005 and 2010, comparing the US children of immigrants with their co-ethnic peers in nonimmigrant families. Methods. We analyzed Pennsylvania Medicaid claims, birth records, and census data for children born in Pennsylvania and enrolled in Medicaid for 10 or more months during any of the calendar years assessed. Results. Receipt of preventive dental care was more likely among Latino children in immigrant families than among their peers in nonimmigrant families; also, it was more likely among White children in immigrant families than among their peers in nonimmigrant families. Rates of preventive dental care use among African American and Asian children in immigrant and nonimmigrant families were comparable. From 2005 to 2010, the percentage of Latino children in nonimmigrant families who received preventive dental care increased from 33% to 61%. Changes in other groups were significant but less dramatic. Conclusions. Receipt of preventive dental care has increased among Medicaid-enrolled children in Pennsylvania, with marked gains among Latino children. Within each racial/ethnic group, the children of immigrants were either more likely than or equally likely as children in nonimmigrant families to receive care. Dental caries is the most common chronic pediatric disease in the United States and overwhelmingly affects poor and minority children. 1–3 Data from the National Health and Nutrition Examination Survey show that, between 1999 and 2004, 67% of poor children aged 6 to 8 years had dental caries (teeth that had been damaged by decay). 4 Among children aged 2 to 11 years, 55% of Mexican American, 43% of African American, and 39% of non-Latino White children have been shown to be affected by caries. 5 Because childhood caries can be prevented with regular dental care, community water fluoridation, oral hygiene, and avoidance of cariogenic foods, improving children’s oral health is a public health priority. 1,5–8 The Healthy People 2020 initiative aims to decrease caries in children and adolescents by 10% and to increase the proportion of low-income children and adolescents who receive preventive dental care by 10%. 9 These goals are modest and achievable, particularly given that preventive dental care coverage is available for the majority (70%) of poor children in the United States through Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment benefit. 10 Despite this coverage level, there has not been wide-scale access to dental care among poor, insured children. 11 In 2010, only 44% of Medicaid-enrolled children aged 3 to 5 years and 49% of Medicaid-enrolled children aged 6 to 14 years received preventive dental care. 12 This represents a modest increase relative to previous years. In 2008, for example, 43% of children aged 3 to 6 years and 48% of children aged 7 to 11 years who had been enrolled in fee-for-service Medicaid for the entire year received preventive dental care. 13 In 2005, 33% of Medicaid-enrolled children aged 3 to 5 years and 39% of Medicaid-enrolled children aged 6 to 14 years received any preventive dental care. 14 Because states have variable procedures for collecting race and ethnicity data from enrollees, these analyses provide only limited insight into trends in receipt of oral health care among Medicaid-enrolled minority children. 15 Prior Medicaid analyses have also failed to take into account the status of children in immigrant families, including children who are themselves immigrants or have at least one parent born outside of the United States or its territories. 16 Children of immigrants are predominantly US citizens (89%) and account for 1 in 3 poor children, 78% of Asian children, and 58% of Latino children in the United States. 17 They are less likely than their peers with nonimmigrant parents to use many types of medical services. 18,19 For example, children in immigrant families are less likely to have a usual source of health care, 18,20,21 to receive primary care in a patient-centered medical home, 22 or to receive annual pediatric care. 22,23 Barriers to care that are concentrated among the children of immigrants include limited English proficiency (only 56% of children in immigrant families have at least 1 English-proficient parent, as compared with 99% of other children) and lack of familiarity with the US health system. 20,24,25 We sought to add to the literature by examining receipt of preventive dental care among Medicaid-enrolled children in Pennsylvania, with a specific focus on US-born children of immigrants. We used parent-identified race/ethnicity data derived from birth records to examine changes from 2005 to 2010 in dental care receipt and compare US-born children of immigrants with their co-ethnic peers in nonimmigrant families. We hypothesized that children of immigrants would be disadvantaged relative to other childr