Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy

Journal of Racial and Ethnic Health Disparities https://doi.org/10.1007/s40615-024-02001-4 Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy Hyewon Lee1 · Richa Deshpande2 · Emma K. T. Benn2 Received: 2 January 2024 / Revised: 30 March 2024 / Accepted: 7 April 2024 © The Author(s) 2024 Abstract Background Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy. Methods The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models. Results After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001. Conclusion The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers. Practical Implications The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs. Keywords Pregnancy · Oral health · Racial/ethnic disparities · Access to care Background The recent Surgeon General’s report on maternal health was published with clear concern about racial and ethnic health disparities among women [1]. Non-Hispanic Black and American Indian/Alaska Native (AI/AN) women showed significantly higher rates of pregnancy-related death and morbidity than women of other racial and ethnic groups [1]. * Hyewon Lee 1 Global Maternal and Child Oral Health Center, Seoul National University, Dental Research Institute & School of Dentistry, Seoul, South Korea 2 Center for Scientific Diversity, Center for Biostatistics, and Department of Population Health Science and Policy, Icahn School of Medicine, New York City, USA Similar findings and patterns across racial/ethnic groups of women have been observed in oral health status and dental care utilization. Historically, women of color showed poorer oral health and lower dental service utilization [2, 3]. The U.S. National Health and Nutrition Examination Survey from 1999 to 2004 showed the prevalence of untreated dental caries during pregnancy was higher among non-Hispanic Black women (45%) and Mexican American women (42%) than non-Hispanic White women (18%) [3], and a systematic review that examines a global perspective of racial-ethnic inequities in dental caries is under development [4]. In general, dental service utilization is low among pregnant women. A study based on Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) data reported that only about half of pregnant women had routine dental care during pregnancy [5], and the proportion of women who visited dentists during Vol.:(0123456789) Journal of Racial and Ethnic Health Disparities pregnancy was decreasing. Despite of the national guideline of oral health for pregnant women clearly indicating that dental care during pregnancy is safe and recommended, low dental service utilization among pregnant women persists due to lack of dental insurance, perceived ability to pay for care, difficulty finding dental providers who are willing to treat pregnant women due to liability concerns, and misconceptions about the safety of dental care during pregnancy. Racial/ethnic disparity in dental service utilization among women is alarming. A study based on CDC PRAMS data from 2012 to 2015 showed that the proportion of non-Hispanic White women who visited dentists for cleaning during pregnancy decreased from 56.7% in 2012 to 54.4% in 2015, whereas it decreased from 42.4 to 39.8% among non-Hispanic Black women during the same time period [5]. This Black-White disparity in utilizing routine dental care during pregnancy persisted when the analysis model was adjusted by mother’s age, marital status, dental insurance, education level, previous live birth, adequacy of prenatal care, and perception of benefits of oral health care [5], which confirmed the previous findings [6]. Therefore, there is a clear role of race/ethnicity in dental care utilization among women of childbearing age. While a previous study and its findings were significant in understanding the Black-White gap in accessing dental care during pregnancy, the study only included non-Hispanic Black and non-Hispanic White women aged 20 and older [5]. Also, a previous analysis on specific barriers to accessing dental care during pregnancy was limited as this PRAMS Phase 7 question was implemented in only five states. To fill this gap, we conducted a secondary analysis of the PRAMS Phase 8 dataset to (1) identify barriers to accessing dental care during pregnancy and (2) examine how the association between these barriers to accessing dental care is modified by race/ethnicity. Specific aim 1: to identify barriers to accessing dental care during pregnancy The study examined barriers to accessing dental care during pregnancy, including dental coverage, primary language, provider availability and willing to treat pregnant women, safety concerns of dental care, affordability of dental care, and perceived oral health benefits during pregnancy. We hypothesized that women who did not have dental coverage, whose primary language is not English, who reported difficulty in finding dentists, who had safety concerns about dental care, who reported difficulty in affording dental care, or who did not perceive the benefits of oral health were less likely to visit dentists for cleaning during pregnancy. Independent variables included each barrier to accessing dental care, and the dependent variable was dental visits for cleaning during pregnancy. Specific aim 2: to examine how the association between these barriers to accessing dental care and dental service utilization during pregnancy is (...truncated)