Abstract
Background
Despite efforts to improve oral health, many New Zealanders require hospitalisation for treatment of preventable dental conditions, with the highest rates among Māori and Pacific peoples. Oral health care in New Zealand is publicly-funded from birth until age 18, the goal being that oral health benefits gained in childhood persist throughout life. From age 18, oral health services are predominantly paid for ‘out-of-pocket’ and publicly-funded services are limited.
Previous studies demonstrate that Māori and Pacific peoples experience the highest rates of hospital admission. Few data have been reported on this since 2009, and there has been no nationwide study to report on acute admission rates.
This thesis aimed to describe dental-related public hospital admission rates for the decade commencing 1 January 2010, by age group, ethnicity, deprivation and locality, and to build a profile of the nature of those admissions. Such information would contribute to discussions on the performance of the oral health care system, inform policy change and prompt health service improvement.
Methods
This retrospective study utilised routinely collected data from the National Minimum Dataset to describe the trends in nationwide public hospital admissions for the treatment of potentially preventable dental disease from 1 January 2010 to 31 December 2019. Data were requested for all admissions that included ICD-10 primary diagnostic codes K02-K09, K12, and K13. Population-based rates were analysed by year, region, age group, socioeconomic deprivation, and Total ethnicity. A Poisson regression model was built to adjust for major demographic confounders (age, sex, and socioeconomic deprivation) on ethnic inequities in rates. Ethnicity-specific rates were analysed by disease severity and the level of hospital care required.
Results
Data were available for 110,306 admissions, representing a population rate of 3.93 per 1,000 people. Of these, 17,157 were acute admissions, representing a rate of 4.36 per 10,000 people. Children aged 5 – 9 years had a substantially higher rate than other age groups, although among acute admissions, young adults aged 18 – 34 years had similarly high rates.
Rates were also pattered by socioeconomic deprivation, with those living in the most deprived areas being admitted at just over three times the rate of those living in the least.
Significant inequity was found between ethnic groups, with Māori and Pacific peoples admitted at twice the rate of European/Other. Significant discrepancies in rates persisted after adjusting for age, sex, and socioeconomic status. Disparities in rates between Māori, Pacific, and European/Other increased, as did disease severity and the level of care required. Māori and Pacific peoples were admitted with disease of the highest severity and required the highest level of care, at rates approximately three to three-and-a-half times that of European/Other.
Discussion / Conclusion
Potentially preventable admissions to New Zealand’s public hospitals for treatment of dental disease has remained high. Profound inequity in the oral health care system exists, with young adults, those of low socioeconomic status, and Māori and Pacific peoples over-represented among those admitted, and among those admitted with the highest severity of disease. These findings suggest an underperforming primary oral health care system. To reduce disparities, public health interventions focussed on those most impacted are urgently needed. This thesis makes several recommendations for interventions at service and policy levels that ultimately assist in realising the nation’s strategic vision for oral health “Good oral health for all, for life”.