Dental service utilization in the very old: an insurance database analysis from northeast Germany

Abstract

Objectives: We assessed dental service utilization in very old Germans. Methods: A comprehensive sample of 404,610 very old (≥ 75 years), insured at a large statutory insurer (Allgemeine Ortskrankenkasse Nordost, active in the federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania), was followed over 6 years (2012–2017). Our outcome was the utilization of dental services, in total (any utilization) and in five subgroups: (1) examinations and associated assessment or advice, (2) restorations, (3) surgery, (4) prevention, (5) outreach care. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) German modified diagnosis-related groups (GM-DRGs) was explored. Results: The mean (SD) age of the sample was 81.9 (5.4) years. The utilization of any dental service was 73%; utilization was highest for examinations (68%), followed by prevention (44%), surgery (33%), restorations (32%), and outreach care (13%). Utilization decreased with age for nearly all services except outreach care. Service utilization was significantly higher in Berlin and most cities compared with rural municipalities, and in individuals with common, less severe, and short-term conditions compared with life-threatening and long-term conditions. In multi-variable analysis, social hardship status (OR: 1.14; 95% CI: 1.12-1.16), federal state (Brandenburg 0.85; 0.84–0.87; Mecklenburg-Western Pomerania: 0.80; 0.78–0.82), and age significantly affected utilization (0.95; 0.95–0.95/year), together with a range of co-morbidities according to ICD-10 and DRG. Conclusions: Social, demographic, regional, and general health aspects were associated with the utilization of dental services in very old Germans. Policies to maintain access to services up to high age are needed. Clinical significance: The utilization of dental services in the very old in northeast Germany showed significant disparities within populations. Policies to allow service utilization for sick, economically disadvantaged, rural and very old populations are required. These may include incentives for outreach servicing, treatment-fee increases for specific populations, or referral schemes between general medical practitioners and dentists.