Role of distance in the utilization of emergency departments for non-traumatic dental conditions in Maryland, USA, 2017-2021.

backgroundDisparities in access to oral health are evident in Emergency Departments' (EDs) utilization for non-traumatic dental conditions (NTDCs) in the United States (US). While studies have examined the associations of socio-economic factors with ED utilization, there is little evidence of the role of distance on EDs use for NTDCs. To fill the gap, the main objectives of our study were to: (i) assess how geographic proximity to the nearest ED influences utilization of NTDCs (ii) examine how utilization varies with distance to nearest private dental clinics, community health centers or federally qualified health centers and urgent care clinics.

methodsWe used the State Emergency Department Database and The American Dental Association provider data files for 2017-2021 for Maryland. Following the Dental Quality Alliance (DQA) guidelines, we extracted NTDC visits using ICD-10 diagnoses codes. On using negative binomial regression models, we estimated the ED utilization rate for the overall population as well as for sub-groups defined by age, race/ethnicity and payer as a function of nearest distances between the patient zip code and an ED facility; as well as to dental providers, while controlling for confounders.

resultsThe average NTDC utilization rate declined (β= -0.299; 95% CI: [-0.411, -0.188) as distance to the nearest ED increased, while utilization was positively associated with distance to a nearest provider (β = 0.313; 95% CI: 0.200, 0.425). Distance decay effect amongst NH Blacks was the highest and different from that of NH Whites: there was a decline of 40.4% and 16.9% in ED visits with doubling of distance, respectively. Significant differences were reported between children (β = 0.236, 95% CI: 0.086, 0.386) and young adults aged 19-34 years (β = 0.395, 95% CI: 0.265, 0.526) in utilization as distance to a nearest provider increased. Lastly, a doubling of distance to Medicaid-accepting dentists or those affiliated with FQHCs was linked to an approximately 23% increase in ED use for NTDCs.

conclusionsOur findings show evidence of a distance decay effect with respect to ED utilization for NTDC visits, while also demonstrating a decline in ED visits when a dental provider was nearby suggesting an interplay of perceived need, cost, and access to dental care in the community.