Original research| Volume 99, ISSUE 8, P1471-1478, August 2018

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What Are the Determinants of Dental Care Expenditures in Institutions for Adults With Disabilities? Findings From a National Survey

  • Author Footnotes
    ∗ Naouri and Bussiere contributed equally to this work.
    Diane Naouri
    Corresponding author Diane Naouri, MD, MSc, Saint-Antoine Hospital, Emergency Department, 184 Faubourg Saint-Antoine Street, 75012 Paris, France.
    ∗ Naouri and Bussiere contributed equally to this work.
    University of Paris Sorbonne, UPMC, Paris, France

    Emergency Department, Saint-Antoine Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
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  • Author Footnotes
    ∗ Naouri and Bussiere contributed equally to this work.
    Clémence Bussiere
    ∗ Naouri and Bussiere contributed equally to this work.
    University of Bourgogne, LEDi (EA7467), Dijon, France
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  • Nathalie Pelletier-Fleury
    Center for Research in Epidemiology and Population Health (CESP), INSERM (U1018), Villejuif, France
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  • Author Footnotes
    ∗ Naouri and Bussiere contributed equally to this work.
Published:January 17, 2018DOI:



      To analyze the determinants of dental care expenditures in institutions for adults with disabilities.


      Health and disability survey and insurance database.


      Institutional setting.


      Adults (N=2222) living in institutions for people with cognitive, sensory, and mobility disabilities.


      Not applicable.

      Main Outcome Measures

      We used a Heckman selection model to correct for potential sample selection bias due to the high percentage of non–dental care users. The Heckman selection model is a 2-step statistical approach based on the simultaneous estimation of 2 multiple regression models–a selection equation (step 1) and an outcome equation (step 2)–offering a means of correcting for nonrandomly selected samples. The selection equation modeled whether the individual had consulted a dentist at least once, whereas the outcome equation explained the dental care expenditures. Disability severity was assessed by scoring mobility and cognitive functional limitations. Regressions also included sociodemographic characteristics and other health-related variables.


      Individuals with the highest cognitive limitation scores, without family visits, without supplementary health insurance, and with poor oral health status were less likely to consult a dentist. After controlling for potential selection bias, the only variable that remained statistically significant in the outcome equation was the oral health status: when individuals with poor health status had consulted at least once, they had a higher level of dental care expenditure.


      Functional limitations were barriers to accessing dental care even in institutions for adult with disabilities. These barriers should be overcome because they may worsen their oral health status and well-being. Given the lack of literature on this specific topic, our results are important from a policy perspective. Health authorities should be alerted by these findings.


      List of abbreviations:

      HSI (Health and Disability Survey – Institutions Section), SNIIRAM (French National Health Insurance)
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