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. 2025 Apr 7;25(1):501.
doi: 10.1186/s12903-025-05821-w.

The association between predisposing, enabling and need factors and oral health care utilization among U.S. working age adults

McKing I Amedari  1 , Adejare Jay Atanda  2 , Ifeoma K Amedari  3 , Mauda Monger  4 , Benjamin H Walker  4
Affiliations

The association between predisposing, enabling and need factors and oral health care utilization among U.S. working age adults

McKing I Amedari et al. BMC Oral Health. .

Abstract

Background: Irregular dental visits due to cost-related delays contribute to poor oral health outcomes, dental needs, and emergency service utilization across the life course. The study investigated how predisposing, enabling, and needs factors are associated with cost-related delays in oral health care and postponed dental visits.

Methods: Using secondary data from the 2022 National Health Interview Survey for United States (U.S.) adults aged 18-64 years, the study conducted descriptive, bivariate, and multivariate data analyses. Separate multivariable logistic regressions were used to model cost-related delayed oral health care and postponed dental visits (no dental visit in the past 12 months) as a function of predisposing, enabling, and need factors (n = 17,513). Predictor variables included race, education, smoking status, age, gender and employment status (Predisposing factors), family income as a percentage of the Federal Poverty Level (FPL) and Health Service Deficit (HSD) variables (no health insurance, no usual medical primary care provider, > 12 months of last medical exam and delayed medical care due to cost) (Enabling factors), difficulty engaging in social activities and the presence of > 1 comorbidity (Need factors).

Results: The prevalence of cost-related delayed oral health care was 20.2%, and that of postponed dental visits was 36.4%. Strong predictors for cost-related delayed oral health care emerged from predisposing factors (smoking OR = 1.47, 95% CI, 1.33, 1.62), enabling factors (no health insurance OR = 2.96, 95% CI, 2.56, 3.42), and need factors (difficulty engaging in social activity OR = 1.59, 95% CI, 1.34, 1.88) at p < 0.001. Enabling factors were the strongest predictors of postponed dental visits. The odds decreased with higher family income [> 400% FPL vs. < 100% FPL (OR, 0.50; 95% CI, 0.43, 0.58)], whereas the odds increased by 68%, 64%, 130%, and 57% for persons with no health insurance, no usual primary care provider, > 12 months of last medical exam, and delayed medical care due to cost, respectively.

Conclusions: Individual factors, including smoking, lack of health insurance, and difficulty engaging in social activity, were independently associated with cost-related delayed oral health care, and the strong links between postponed dental visits and HSDs provide a clear opportunity for advocating for medical and dental integration for patient-centered care.

Keywords: Cost-related delayed oral health care; Health service deficits; Postponed dental visits.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework adapted from the Andersen Framework for health service utilization
See this image and copyright information in PMC

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