Dr Claire Telford, Michael Donaldson and Professor Ciaran O’Neill*

1. Variations in use of publicly funded general dental practitioner services in Northern Ireland by children and adolescents Dr Claire Telford, Michael Donaldson and Professor Ciaran O’Neill*

2. Background A social gradient in health and healthcare use has been commented on in various areas These issues have been evidenced in the area of oral health and oral healthcare NILS provides a mechanism by which a fuller characterisation of the user is possible and through which insights into behaviour can be obtained

3. Percentage of 15 year old children with obvious tooth decay experience by country % children Source: Children’s dental health in the UK, 2003

4. Mean number of teeth with obvious decay experience by country in 15 year old children DMFT Source: Children’s dental health in the UK, 2003

5. Aims To identify whether differences in registration and use related to socio-demographic characteristics exist in respect of publicly funded general dental practitioner services in Northern Ireland and if so to identify the nature of these differences To compare differences across age groups to gain a fuller understanding of behaviour patterns

6. Methods NHS reimbursement data were linked to census and vital statistics data within the Northern Ireland Longitudinal Study Children aged 4 – 10 Adolescents aged 11 -16 Data available for 2001/02 – 2007/08 (later for older age group)

7. Methods 13,564 adolescents included in this study (approx 28% of population), Approx. 12,000 children Dependent variables: registration, length of registration and intensity of use (monetary) Independent variables: household reference person occupation and highest educational qualification, gender, family size and structure, community background

8. With respect to children Significant differences in registration rates by social class that while converging remain evident over time – roughly 30% spread converging to 20% point spread No significant differences between genders Significant differences by family type – lone parents and co-habiting couples with lower registration rates - 20% point spread converging overtime to 14% point Significant differences by community background that while converging remain evident over time – roughly an 8% spread converging to a 4% spread

9. Results - registration With respect to adolescents * Denotes statistical significance, P <0.001

10. Results – registration * Denotes statistical significance, P <0.001

11. Adolescents – total expenditures

12. Results – intensity of use (HRP occupation) Concentration indices for all treatments (adjusting for all other Factors)

13. Conclusions Dental registration is lower amongst lower SES Intensity of dental services usage is lower amongst those at the bottom of the social scale Higher social classes have higher average expenditure on orthodontics but lower average expenditure on extractions and conservative treatment

14. Conclusions NILS can afford valuable insights into the role of economic variables in patterns of registration and use Significant differences in patterns of registration and use are evident that can be interpreted within standard economic models The manner of healthcare funding may contribute to patterns of utilization and warrant examination

15. Acknowledgements The help provided by the staff of the Northern Ireland Longitudinal Study (NILS) and the NILS Research Support Unit is acknowledged. The NILS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the ESRC and the Northern Ireland Government. The authors alone are responsible for the interpretation of the data.