Individual- and Area-level Factors of Access to Oral Healthcare Among Middle-Aged and Older adults in Ontario

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Nair_AnushaP_MSc_2025_Thesis.pdf (1.71 MB)

Date

2025-11-10

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Abstract

Canada’s aging population faces growing oral health challenges, with access to oral healthcare remaining uneven across individuals and regions. This thesis examines how both individual- and area-level oral healthcare care access factors shape oral health outcomes among middle-aged and older adults in Ontario. First, a geospatial analysis assessed dentist distribution across Forward Sortation Areas using spatial mapping and inequality measures, exploring inequalities by area-level income and geographic remoteness. Then, a cross-sectional multilevel analysis using data from the Canadian Longitudinal Study on Aging (2018-2021) evaluated the association between access to oral healthcare and three oral health outcomes: self-reported oral health, functional dentition, and frequency of dental visits. The geospatial analysis revealed the presence of inequalities in dentist distribution in Ontario, especially when stratified by area-level income and remoteness. The multilevel analysis showed the strong and consistent association of individual-level access to oral healthcare factors across all oral health outcomes in aging Ontarians. Further research should focus on incorporating other area-level access measures in both geospatial and multilevel studies.

Summary for Lay Audience

Oral health, encompassing healthy teeth and gums, is a vital component of overall well-being, particularly as people age. In Canada, older adults face growing oral health challenges, yet access to oral healthcare remains uneven. Poor oral health can lead to tooth loss, pain, and difficulties with eating and speaking, and is also linked to broader health issues such as poor nutrition, social isolation, and chronic diseases like diabetes and heart disease. This thesis explores how both individual-level factors of access to oral healthcare such as income, dental insurance, and education and area-level factors such as dentist availability, neighborhood income, and remoteness contribute to oral health outcomes among middle-aged and older Ontarians. To begin, I conducted a geospatial analysis to examine the distribution of dentists across Ontario’s Forward Sortation Areas (FSAs). The maps provided a broad overview, showing that Dentist-to-Population Ratios (DPRs) were generally higher in wealthier and urban FSAs. However, to better understand inequality within these groups, I applied the Lorenz Curve and Gini Coefficient. These measures revealed that dentist distribution was more unequal within lower-income quintiles and urban areas, indicating their influence on dentist distribution. In the second part of the study, I used cross-sectional data from a national cohort to examine how individual and area-level factors relate to three oral health outcomes: self-reported oral health, functional dentition (having at least 20 natural teeth), and last dental visit. Individual-level factors such as lower income and lack of dental insurance were consistently linked to poorer outcomes, showing a clear social gradient. Having private dental insurance was especially protective, highlighting its role in enabling oral healthcare. Additionally, women generally had better oral health outcomes than men, and while older adults were more likely to have lost teeth, they tended to report better self-rated oral health, possibly reflecting adaptation over time. Additionally, there was no significant association observed between area-level access factors such as DPR, FSA-level income and geographic remoteness and oral health outcomes. These findings emphasize the strong influence of personal resources and social factors on oral health among aging Canadians.

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Access to oral healthcare, dentist-to-population ratio, inequalities, aging, socioeconomic factors, oral health, CLSA

URI

https://hdl.handle.net/20.500.14721/39184

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