Public Dental Expenditure and Dental Visits in Europe and Japan

BACKGROUND: Dental care is important for oral health, but access to dental services is subject to social inequalities and varies between countries. Despite this, few cross-national studies have examined how public dental expenditure relates to dental service use among older adults. This study aimed to investigate the associations between public dental expenditure and dental visits among older adults using an international comparative design. METHODS: Data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE, Wave 8, 2019), covering 25 European countries and Israel, and the Japanese Gerontological Evaluation Study (JAGES, 2019). The final sample included 48 497 adults aged 65 years or older. The outcome was any dental visit in the past year, while the explanatory variable was country-level annual per capita public dental expenditure on outpatient dental care in 2019 (USD), obtained from the OECD database and adjusted for purchasing power parity. A multilevel modified Poisson regression model was used to estimate prevalence ratios (PRs), accounting for between-country variability. Interaction terms between household income and public dental expenditure were included to examine effect modification. RESULTS: The overall dental visit rate was 59.5%, with higher rates among women, those with higher education, and those in higher income groups. Each $10 increase in per capita public dental expenditure at the country level was associated with higher dental visit rates (PR: 1.05, 95% CI: 1.03-1.07). The association was stronger among lower-income groups, suggesting that income-related inequalities in dental visits were smaller in countries with higher public dental expenditure. CONCLUSIONS: Public expenditure on dental care was associated with higher dental visit rates, particularly among low-income groups. These findings suggest that public financing of dental care may help reduce income-related inequalities in dental visits among older adults.