An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

Folayan M.O., Tantawi M.E., Virtanen J.I., Feldens C.A., Rashwan M., Kemoli A.M., Villena R., Al-Batayneh O.B., Amalia R., Gaffar B., Mohebbi S.Z., Arheiam A., Daryanavard H., Vukovic A., Schroth R.J., for the Early Childhood Caries Advocacy Group

Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria; Alexandria University, Alexandria, Egypt; Department of Clinical Dentistry, University of Bergen, Bergen, Norway; Department of Pediatric Dentistry, Univesidade Luterana Do Brasil, Canoas, Brazil; Centre for Oral Bioengineering, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, Mile End Road, London, E1 4NS, United Kingdom; Department of Conservative Dentistry, Faculty of Dentistry, Alexandria University, Alexandria, Egypt; Department of Paediatric Dentistry and Orthodontics, University of Nairobi, Nairobi, Kenya; Department of Pediatric Dentistry, San Martin de Porres University, Lima, Peru; Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan; Preventive and Community Dentistry Department, Faculty of Dentistry, Universitas Gadjah Mada Yogyakarta, Yogyakarta, Indonesia; Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran; Department of Community and Preventive Dentistry, University of Benghazi, Benghazi, Libyan Arab Jamahiriya; Dubai Health Authority, Dubai, United Arab Emirates; Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia; Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, and Departments of Pediatrics and Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada


Abstract

Background: Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. Methods: Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. Results: Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). Conclusions: Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC. © 2021, The Author(s).

Early childhood caries; Health expenditure; Universal health coverage


Journal

BMC Oral Health

Publisher: BioMed Central Ltd

Volume 21, Issue 1, Art No 126, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85102744724&doi=10.1186%2fs12903-021-01500-8&partnerID=40&md5=2823e3d258cf59afbf9eb1e77fe3d0aa

doi: 10.1186/s12903-021-01500-8

Issn: 14726831

Type: All Open Access, Gold, Green


References

. Guidelines on Prevention of Early Childhood Caries: An EAPD Policy Document (2008) . EAPD Board, , https://www.eapd.eu/uploads/1722F50D_file.pdf; American Academy of Pediatrics (2008) Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Pediatr Dent., 30, pp. 40-43; Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies (2016) Pediatr Dent, 38 (6), pp. 52-54; Meyer, F., Enax, J., Early childhood caries: epidemiology, aetiology, and prevention (2018) Int J Dent, 2018, p. 1415873; Folayan, M.O., Arije, O., El Tantawi, M., Association between early childhood caries and malnutrition in a sub-urban population in Nigeria (2019) BMC Pediatr, 19 (1), p. 433; Sheiham, A., Dental caries affects body weight, growth and quality of life in pre-school children (2006) Br Dent J, 201 (10), pp. 625-626; Gaur, S., Nayak, R., Underweight in low socioeconomic status preschool children with severe early childhood caries (2011) J Indian Soc Pedodontics Prevent Dent, 29 (4), p. 305; Casamassimo, P.S., Thikkurissy, S., Edelstein, B.L., Maiorini, E., Beyond the DMFT: the human and economic cost of early childhood caries (2009) J Am Dent Assoc, 140 (6), pp. 650-657; Harris, R., Nicholl, A., Adair, P.M., Pine, C.M., Risk factors for dental caries in young children: a systematic review (2004) Community Dent Health, 21, pp. 71-85x. , PID: 15072476; Fisher-Owens, S.A., Gansky, S.A., Platt, L.J., Weintraub, J.A., Soobader, M.J., Bramlett, M.D., Newacheck, P.W., Influences on children’s oral health: a conceptual model (2007) Paediatrics, 120, pp. 510-520; Tinanoff, N., Baez, R.J., Diaz Guillory, C., Donly, K.J., Feldens, C.A., McGrath, C., Phantumvanit, P., Songpaisan, Y., Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective (2019) Int J Pediatr Dent, 29 (3), pp. 238-248; Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016 (2017) Lancet, 390, pp. 1211-1259; Folayan, M.O., El Tantawi, M., Aly, N.M., Al-Batayneh, O.B., Schroth, R.J., Castillo, J.L., Association between early childhood caries and poverty in low and middle income countries (2020) BMC Oral Health, 20 (1), p. 8; Folayan, M.O., El Tantawi, M., Vukovic, A., Schroth, R.J., Alade, M., Mohebbi, S.Z., Global Early Childhood Caries Research Group. Governance, maternal well-being and early childhood caries in 3–5-year-old children (2020) BMC Oral Health, 20 (1), p. 166; Folayan, M.O., Tantawi, M.E., Gaffar, B., Schroth, R.J., Catillo, J.L., Al-Batayneh, O.B., An ecological study of the association between environmental indicators and early childhood caries (2020) BMC Res Notes, 13 (1), p. 474; El Tantawi, M., Folayan, M.O., Mehaina, M., Vukovic, A., Castillo, J.L., Gaffar, B.O., Arheiam, A., Lee, G.H.M., Prevalence and data availability of early childhood caries in 193 United Nations Countries, 2007–2017 (2018) Am J Public Health, 108 (8), pp. 1066-1072; Karim, D.O., Health expenditure and economic growth nexus: an ARDL-type analysis for Nigeria (2016) Imp J Interdisc Res, 2 (2), pp. 516-529; Universal Health Coverage (2018) World Health Organization, , http://www.who.int/universal_health_coverage/en/; Listl, S., Galloway, J., Mossey, P.A., Marcenes, W., Global economic impact of dental diseases (2015) J Dent Res, 94, pp. 1355-1361; Wang, T.T., Mathur, M.R., Schmidt, H., Universal health coverage, oral health, equity and personal responsibility . Bulletin of the World Health Organization, , https://www.who.int/bulletin/volumes/98/10/19-247288/en/; Wang, T.T., Mathurb, M.R., Schmidt, H., Universal health coverage, oral health, equity and personal responsibility (2020) Bull World Health Organ, 98, pp. 719-721; Edelstein, B., Policy issues in early childhood caries (1998) Commun Dent Oral Epidemiol, 26 (S1), pp. 96-103; Claire Stevens, C.B.E., Eliminating early childhood caries (2019) Br Dent J, 226, p. 548; UHC Service Coverage Index, , https://data.worldbank.org/indicator/SH.UHC.SRVS.CV.XD, Available at,. Accessed: 11 October 2020; Current Health Expenditure (% of GDP, , https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS, Available from,. Accessed: 11 October 2020; Ranabhat, C.L., Jakovljevic, M., Dhimal, M., Kim, C.B., Structural factors responsible for universal health coverage in low- and middle-income countries: results from 118 countries (2020) Front Public Health, 7, p. 414; Zaman, S.B., Hossain, N., Mehta, V., Sharmin, S., Mahmood, S., An association of total health expenditure with GDP and life expectancy (2017) J Med Res Innov, 1 (2), pp. Au7-AU12; (2018) Global Health Observatory Data Repository: Exclusive Breastfeeding under 6 Months Data by Country, , http://apps.who.int/gho/dat.a/node.main.1100?lang=en, Available at,. Accessed 16 February 2019; Saunders, C., Abel, G., Ecological studies: use with caution (2014) Br J Gen Pract, 64 (619), pp. 65-66; Mathur, M.R., Williams, D.M., Reddy, K.S., Universal health coverage a unique policy opportunity for oral health (2015) J Dent Res, 94, pp. 3S-5S; Fisher, J., Selikowitz, H.S., Mathur, M., Varenne, B., Strengthening oral health for universal health coverage (2018) Lancet, 392 (10151), pp. 899-901; Dewanto, I., Koontongkaew, S., Widyanti, N., Characteristics of dental services in rural, suburban, and urban areas upon the implementation of indonesia national health insurance (2020) Front Public Health, 8, p. 138; Chu, C.H., Ho, P.L., Lo, E.C., Oral health status and behaviours of preschool children in Hong Kong (2012) BMC Public Health, 12, p. 767; (2008) WHO Commission on Social Determinants of Health—Final Report: Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health, , https://www.who.int/social_determinants/thecommission/finalreport/en/, Geneva: World Health Organization, Accessed: 11 October 2020; Ismail, A.I., Sohn, W., The impact of universal access to dental care on disparities in caries experience in children (2001) J Am Dent Assoc, 132 (3), pp. 295-303; Evans, D.J., Rugg-Gunn, A.J., Tabari, E.D., Butler, T., The effect of fluoridation and social class on caries experience in 5-year-old Newcastle children in 1994 compared with results over the previous 18 years (1996) Community Dent Health, 13, pp. 5-10. , PID: 8634899; Pucca, G.A., Jr., Gabriel, M., Araujo, M.E., Almeida, F.C., Ten years of a national oral health policy in Brazil: innovation, boldness, and numerous challenges (2015) J Dent Res, 94 (10), pp. 1333-1337; Azañedo, D., Hernández-Vásquez, A., Casas-Bendezú, M., Gutiérrez, C., Agudelo-Suárez, A.A., Cortés, S., Factors determining access to oral health services among children aged less than 12 years in Peru (2017) F1000Res, 6, p. 1680; Bailit, H.L., Newhouse, J., Brook, R., Dental insurance and the oral health of preschool children (1986) JADA, 113, pp. 773-776. , PID: 3465793; Virtanen, J.I., Berntsson, L.T., Lahelma, E., Köhler, L., Murtomaa, H., Children’s use of dental services in the five Nordic countries (2007) J Epidemiol Community Health, 61 (12), pp. 1080-1085; Feldens, C.A., Fortuna, M.J., Kramer, P.F., Ardenghi, T.M., Vítolo, M.R., Chaffee, B.W., Family health strategy associated with increased dental visitation among preschool children in Brazil (2018) Int J Paediatr Dent, 28 (6), pp. 624-632; Malik, N.A., Rosalien, R., Khalissya, N., Iwany, A.B., Maharani, D.A., Perceived need and utilization of dental health care services in Indonesia: a secondary analysis using the national socioeconomic data (2020) Makara J Health Res, 24 (2), pp. 121-127; Vargas, C.M., Ronzio, C.R., Disparities in early childhood caries (2006) BMC Oral Health, 6, p. S3; Guideline on infant oral health care (2014) Pediatr Dent, 36, pp. 1141-1145; (2019) Universal Health Coverage (UHC)., , https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc); Markovic, D., Soldatovic, I., Vukovic, R., Peric, T., Campus, G.G., Vukovic, A., How much country economy influences ECC Profile in Serbian children—a macro-level factor analysis (2019) Front Public Health, 7, p. 285; (2013) HRH Commitments, , www.who.int/workforcealliance/forum/2013/hrh_commitments/en/index.html, . Accessed 15 Jun 2017; The Abuja Declaration: Ten Years On, , https://www.who.int/healthsystems/publications/abuja_declaration/en/, Available at,. Accessed: 12 October 2020; Mbuya-Brownsapuwa, R.H., (2015) Health Budget Advocacy: A Guide for Civil Society in Malawi, , https://www.healthpolicyproject.com/pubs/747_MalawiBudgetAdvocacybooklet.pdf, Washington, DC: Futures Group, Health Policy Project. Available at:, Accessed 13 October 2020

Indexed by Scopus

Leave a Comment