Prior incarceration and out-of-pocket dental care expenditures among older adults in the United States

BACKGROUND: An accumulating body of research finds that a history of incarceration is associated with poorer oral health and lower dental care utilization. However, no previous research has investigated whether out-of-pocket (OOP) dental care expenditures differ among those with and without a history of incarceration. The purpose of the current study was to examine whether a history of incarceration is associated with OOP dental care expenditures among older adults in the United States. METHODS: We used pooled cross-sectional nationally representative data from the 2012 and 2014 waves of the Health and Retirement Study (HRS), including 11,438 respondents aged 55 and above. A two-part model was employed: a probit model estimated the likelihood of any OOP dental care expenditures among those with and without any lifetime history of incarceration (yes or no), and a generalized linear model (gamma distribution) estimated the relationship between prior incarceration and the amount of expenditure among those with positive costs. Models were adjusted for demographic, socioeconomic, health, and dental-related covariates. RESULTS: 6.8% of the sample reported a history of incarceration. Prior incarceration was not significantly associated with the likelihood of any OOP dental care expenditures or the amount of OOP dental care expenditures. Supplemental analyses found prior incarceration to be associated with a lower likelihood of any OOP dental care expenditures and a lower amount of dental care expenditures among respondents in the lowest quartile of household income. CONCLUSIONS: Despite known disparities in oral health and access, formerly incarcerated older adults do not differ significantly in OOP dental care expenditures compared to never-incarcerated peers on average. Lower OOP dental care expenditures were observed among formerly incarcerated persons at the lowest income quartile. Future research should explore the relationship between prior incarceration and dental care expenditures at other stages of the life course.