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Agency for Healthcare Research Quality

Child/Adolescent Health

Rural children with special health care needs are more likely than their urban counterparts to lack needed dental care

Children with special health care needs (CSHCN) generally need more medical care, mental health care, or educational services than do other children. They are also at greater risk of having dental problems, yet rural CSHCN are less likely than their urban counterparts to receive needed dental care. Researchers, supported in part by the Agency for Healthcare Research and Quality (HS13309), calculated that the probability of having an unmet need for dental care was 26.3 percent for urban CSHCN and 32.6 percent for rural CSHCN. The 6.3 percentage point difference translates into more than 100,000 additional rural CSHCN who are not receiving needed dental care.

According to the researchers, rural CSHCN have unmet needs for dental care for two main reasons: difficulty accessing care and because their parents do not recognize the need for it. Based on professional recommendations, CSHCN living in rural areas were 17 percent more likely to have an unmet need for dental care than urban CSHCN. However, based on parental perceptions of unmet need, there were no significant differences due to rural residence. Previous difficulty accessing dentists may lead to more conservative beliefs of what constitutes a "need." Also, when facing access barriers and limited resources, physicians and parents of CSHCN may place priority on the child's medical condition, especially at younger ages, explain the researchers. Once a child's need for dental care was recognized by a parent, rural residence itself was not a barrier to needed care. However, poverty, lack of insurance, and low levels of education created barriers to receiving care.

These findings were based on analysis of data from 2000 to 2002 on 37,461 CSHCN age 2 years and older from the State-stratified National Survey of CSHCN. Data on the children included types of health care, such as routine care, specialty care, and dental care, as well as demographic characteristics and insurance status.

See "The effect of rural residence on dental unmet need for children with special health care needs," by Asheley Cockrell Skinner, B.S., Rebecca T. Slifkin, Ph.D., and Michelle I. Mayer, Ph.D., M.P.H., R.N., in the Winter 2006 Journal of Rural Health 22(1), pp. 36-42.

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