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Are NHS dental practices socioeconomically distributed in Scotland, Wales and Northern Ireland?

Abstract

Aim To investigate the relationship between deprivation and distance to NHS dental providers in Scotland, Wales and Northern Ireland.

Methods A total of 1,795 NHS dental practices were located at the smallest geographic areas for Scotland, Wales and Northern Ireland. A geographic information system (GIS) was used to overlay the distribution of dental practices with areas graded by the Index of Multiple Deprivation (IMD) and population census from 2011.

Results In Scotland, Wales and Northern Ireland, 15%, 17.8% and 27.5% of the population lived outside 2.5 km of an NHS dental practice, respectively. NHS dental clinics were distributed mostly among people that lived in IMD 1 and 5 areas across the respective deprivation measures of all three nations. There were negligible differences in area-based deprivation measures and NHS dental clinic distribution.

Conclusion NHS dental practices in Scotland, Wales and Northern Ireland were not socioeconomically distributed, suggesting an equitable spatial availability of services based on need.

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References

  1. Kwan S, Petersen P E. Oral health: equity and social determinants. In Blas E, Kurup S (eds) Equity, social determinants and public health programmes. pp 159-176.Geneva: World Health Organisation, 2010.

  2. Drugan C S, Downer M C. Dental health in the United Kingdom and influencing variables. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54: 1027-1034.

  3. Guarnizo-Herreño C C, Watt R G, Fuller E et al. Socioeconomic position and subjective oral health: findings for the adult population in England, Wales and Northern Ireland. BMC Public Health 2014; 14: 827.

  4. Mejia G C, Elani H W, Harper S et al. Socioeconomic status, oral health and dental disease in Australia, Canada, New Zealand and the United States. BMC Oral Health 2018; 18: 176-179.

  5. Thomson W M, Poulton R, Milne B J, Caspi A, Broughton J R, Ayers K M S. Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort. Community Dent Oral 2004; 32: 345-353.

  6. Watt R, Anderson T, Fuller E, CDH consortium for the Health and Social Care Information Centre. Children's Dental Health Survey 2013. 2015. Available at https://files.digital.nhs.uk/publicationimport/pub17xxx/pub17137/cdhs2013report5contemporary-challenges.pdf (accessed November 2019).

  7. Rouxel P, Chandola T. Socioeconomic and ethnic inequalities in oral health among children and adolescents living in England, Wales and Northern Ireland. Community Dent Oral 2018; 46: 426-434.

  8. Watt R G. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community Dent Oral 2007; 35: 1-11.

  9. Freeman R. Barriers to accessing dental care: patient factors. Br Dent J 1999; 187: 141-144.

  10. El-Yousfi S, Jones K, White S, Marshman Z. A rapid review of barriers to oral healthcare for vulnerable people. Br Dent J 2019; 227: 143-151.

  11. Levesque J F, Harris M F, Russel G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12: 18.

  12. Whitehead M. The concepts and principles of equity and health. Health Promot Int 1991; 6: 217-228.

  13. McKinlay J B. Some approaches and problems in the study of the use of services - an overview. J Health Soc Behav 1972; 13: 115-152.

  14. Andersen R, Newman J F. Societal and individual determinants of medical care utilization in the United States. Milbank Q 2005; 83: 1-28.

  15. Anderson RM. Revisiting the behavioural model and access to medical care: does it matter? J Health Soc Behav 1995; 36: 1-10.

  16. Penchansky R, Thomas J W. The concept of access: definition and relationship to consumer satisfication. Med Care 1981; 19: 127-140.

  17. Guagliardo M F. Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr 2004; 3: 3.

  18. Pereira S, Ambrosano G, Cortellazzi K et al. Geographic information systems (GIS) in assessing dental health. Int J Environ Res Public Health 2010; 7: 2423-2436.

  19. Almado H, Kruger E, Tennant M. Application of spatial analysis technology to the planning of access to oral health care for at-risk populations. Aust J of Prim Health 2013; 21: 221-226.

  20. Md Bohari N F, Kruger E, John J, Tennant M. Analysis of dental services distribution in Malaysia: a geographic information systems-based approach. Int Dent J 2019; 69: 223-229.

  21. Ranasinghe N, Kruger E, Tennant M. School dental service in Sri Lanka: geo-spatial analysis of access to oral health care. Int J Paediatr Dent 2018; 28: 490-496.

  22. Susi L, Mascarenhas A K. Using geographical information system to map the distribution of dentists in Ohio. J Am Dent Assoc 2002; 133: 636-642.

  23. Krause D, Frate D A, May W L. Demographics and distribution of dentists in Mississippi. J Am Dent Assoc 2005; 136: 668.

  24. Ravaghi V, Quinonez C, Allison P J. The magnitude of oral health inequalities in Canada: findings of the Canadian health measures survey. Community Dent Oral 2013; 41: 490-498.

  25. Hart J T. The inverse care law. Lancet 1971; 1: 405-412.

  26. Delamothe T. Universality, equity and quality of care. Br Med J 2008; 336: 1278-1281.

  27. Hawkes N. How different are NHS systems across the UK since devolution? Br Med J 2013; 346: 18-20.

  28. Greer S L. Devolution and health in the UK: policy and its lessons since 1998. Br Med Bull 2016; 118: 16-24.

  29. Sheiham A. Is there an inverse 'dental' care law? Br Dent J 2001; 190: 195.

  30. Jones C M. Capitation registration and social deprivation in England. An inverse 'dental' care law? Br Dent J 2001; 190: 203-209.

  31. Boulos M N K, Phillipps G P. Is NHS dentistry in crisis? 'Traffic light' maps of dentists distribution in England and Wales. Int J Health Geogr 2004; 3: 10.

  32. Landes, D P, Jardine C. Targeting dental resources to reduce inequalities in oral health in the North East of England - a health equity audit methodology to evaluate the effects of practice location, practice population and deprivation. Br Dent J 2010; DOI: 10.1038/sj.bdj.2010.676.

  33. O'Mullane D M, Robinson M E. The distribution of dentists and the uptake of dental treatment by schoolchildren in England. Community Dent Oral Epidemiol 1977; 5: 156-159.

  34. Scotland's Census. Output area 2011. 2019. Available online at https://www.scotlandscensus.gov.uk/ods-web/data-warehouse.html#bulkdatatab (accessed November 2019).

  35. Office for National Statistics. Table PP04 2011 Census: Usual resident population by five year age group, Output Areas (OA) in Wales. 2012. Available online at https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/2011censuspopulationandhouseholdestimatesforwardsandoutputareasinenglandandwales (accessed November 2019).

  36. Northern Ireland Statistics and Research Agency. Usual Resident Population KS101NI (statistical geographies). 2011. Available online at https://www.ninis2.nisra.gov.uk/public/AreaProfileReportViewer.aspx?tabchangeReportName=Small%20Area#345 (accessed November 2019).

  37. National Health Services. Who is entitled to free NHS dental treatment in England? 2017. Available at https://www.nhs.uk/common-health-questions/dental-health/who-is-entitled-to-free-nhs-dental-treatment-in-england/ (accessed November 2019).

  38. Department for Communities and Local Government. The English Index of Multiple Deprivation (IMD) 2015 - Guidance. 2015. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/464430/English_Index_of_Multiple_Deprivation_2015_-_Guidance.pdf (accessed November 2019).

  39. Scottish Government. The Scottish Index of Multiple Deprivation. 2019. Available online at https://www2.gov.scot/Topics/Statistics/SIMD (accessed November 2019).

  40. Northern Ireland Statistics and Research Agency. Northern Ireland Multiple Deprivation Measure 2017 (NIMDM2017). 2017. Available at https://www.nisra.gov.uk/statistics/deprivation/northernirelandmultipledeprivationmeasure2017nimdm2017 (accessed November 2019).

  41. Stats Wales. WIMD 2014. 2014. Available online at https://statswales.gov.wales/Catalogue/CommunitySafetyandSocialInclusion/WelshIndexofMultipleDeprivation/WIMD-2014 (accessed November 2019).

  42. ESRI. What is GIS? Available at https://www.esri.com/en-us/whatisgis/overview (accessed November 2019).

  43. Murad A A. Creating a geographical information systems-based spatial profile for exploring health services supply and demand. Am J of Appl Sci 2011; 8: 644.

  44. Apparicio P, Abdelmajid M, Riva M, Shearmur R. Comparing alternative approaches to measuring the geographical accessibility of urban health services: Distance types and aggregation-error issues. Int J Health Geogr 2008; 7: 7.

  45. Shaw M, Dorling D. Who cares in England and Wales? The positive care law: cross-sectional study. Br J Gen Pract 2004: 54: 899-903.

  46. Moles D R, Frost C, Grundy C. Inequalities in availability of national health services general dental practitioners in England and Wales. Br Dent J 2001; 190: 548-553.

  47. Doran T, Drever F, Whitehead M. Is there a north-south divide in social class inequalities in health in Great Britain? Cross sectional study using data from 2001 census. Br Med J 2004; 328: 1043-1045.

  48. Jones C M, Clouting D, McCartney G. Socio-economic status of patients registered with NHS dental services in Scotland: an inverse 'dental' care law? Br Dent J 2013; DOI: 10.1038/sj.bdj.2013.223.

  49. Ulhaq A, McMahon A D, Buchanan S, Goold S, Conway D I. Socioeconomic deprivation and NHS orthodontic treatment delivery in Scotland. Br Dent J 2012; DOI: 10.1038/sj.bdj.2012.724.

  50. Mercer S W, Watt G C M. The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Ann Fam Med 2007; 5: 503-510.

  51. Kruger E, Whyman R, Tennant M. High-acuity GIS mapping of private practice dental services in New Zealand: does service match need? Int Dent J 2012; 62: 95-99.

  52. Tennant M, Kruger E, Shiyha J. Dentisttopopulation and practicetopopulation ratios: in a shortage environment with gross mal-distribution what should rural and remote communities focus their attention on? Rural Remote Health 2013; 13: 2518.

  53. Kurcz R, Kruger E, Tennant M. Using GIS to analyse dental practice distribution in Indiana USA. Community Dent Health 2013; 30: 155.

  54. Tennant M, Kruger E. Turning Australia into a 'flat-land': What are the implications for workforce supply of addressing the disparity in rural-city dentist distribution? Int Dent J 2014; 64: 29-33.

  55. Hine J, Kamruzzaman M D. Journeys to health services in Great Britain: An analysis of changing travel patterns in 1985-2006. Health Place 2012; 18: 274-285.

  56. Landes D P, Holmes R D. Dental practice populations: the effect of distance on the most socially deprived communities accessing dental care in the North East of England. Public Health 2012; 126: 424-426.

  57. News. NHS dentistry is falling behind in an overall growing dental market. Br Dent J 2019; 226: 243.

  58. Wenzle M, McCuskee S, Mossialos E. Commissioning for equity in the NHS: rhetoric and practice. Br Med Bull 2015; 115: 5-17.

  59. Borreani E, Wright D, Scambler S, Gallagher J E. Minimising barriers to dental care in older people. BMC Oral Health 2008; 8: 7.

  60. Newton J T, Williams A C, Bower E J. Inequalities in the provision of NHS primary care dental services in Scotland in 2004. Prim Dent J 2007; 14: 89-96.

  61. Lucarotti P S K, Burke F J T. Factors influencing patients' continuing attendance at a given dentist. Br Dent J 2015; DOI: 10.1038/sj.bdj.2015.230.

  62. Shin H, Eunsuk A. Does the regional deprivation impact the spatial accessibility to dental care services? PLoS One 2018; DOI: 10.1371/journal.pone.0203640.

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Acknowledgements

This research was supported by an Australian Government Research Training Program (RTP) Scholarship.

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Correspondence to Olivia Jo.

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Jo, O., Kruger, E. & Tennant, M. Are NHS dental practices socioeconomically distributed in Scotland, Wales and Northern Ireland?. Br Dent J 229, 40–46 (2020). https://doi.org/10.1038/s41415-020-1748-7

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