Access and social determinants of US oral health care across the lifespan

Yau-Hua Yu^*

• School of Dental Medicine, Tufts University, Boston, United States

Background: Disparities in healthcare access, driven by socioeconomic status and social determinants of health (SDOH), contribute to poor health outcomes. While prior studies established the relationship between SDOH and care access, fewer have explored their joint relationships with social satisfaction and health challenges across the lifespan. Rather than assessing direct associations between dental care utilization and physical or mental difficulties, this study examines broader interrelationships among SDOH, access to oral health care, and self-reported health challenges.A cross-sectional study using a lifespan approach-by examining participants within discrete age groups-was conducted on 127,886 individuals aged 18 years and older who participated in the All of Us research program and completed the 'Basics', 'Overall Health' and 'Health Care Access and Utilization' questionnaires. The distribution of participants' SDOH and self-reported health difficulties was presented and stratified by dental care utilization, income group and age across the lifespan. Multivariate logistic regression analyses were performed to assess the associations between SDOH and access to oral health care.Results: Across age groups, a consistent trend of disadvantaged social determinants associated with lacking oral health care utilization was noted. Young participants (18-35 years old) were the most likely to report not having received oral health care within the past 12 months (32.2%), worse mental health (29.6%, fair/poor), emotional problems (31.8%), and difficulties in concentrating or remembering (18%). Notably, young adults who did not visit a dentist within 12 months were also more likely to report not visiting a medical doctor (18.1%), being unable to afford copayment (69%), and more frequently using emergency or urgent care (20.2%). No insurance coverage (odds ratio [OR]=1.67, 95% confidence interval [CI]: 1.52-1.84), annual income less than $35,000 (OR=3.79, 95% CI: 3.58-4.01), and housing instability (OR=1.38, 95% CI: 1.32-1.44) were all significantly associated with lack of dental care.This study confirms that SDOH -particularly income and housing instability significantly impact individuals' ability to afford and access healthcare services, including dental care. These disparities were most pronounced among the youngest age group. Our findings support future policy interventions aimed at integrating dental care into overall healthcare, especially during early adulthood.