COVID-19 and access to subsidized dental care according to household income. A register-based population study from Norway
DOI:
https://doi.org/10.2340/aos.v84.44938Keywords:
Inequality, COVID-19, lockdown, dental care, household incomeAbstract
Objective: The objective of this study was to examine inequalities in access to subsidized dental care according to household income before, during and after the COVID-19 lockdown in Norway.
Material and methods: Our data encompassed all individuals aged 20 years and above (n = 3,977,747). The data were analyzed using a linear probability model. The outcome variable was whether an individual had received subsidized dental care, and the main independent variable was net household income. Analyses were carried out with and without the following control variables: gender, age (fixed effects), level of education, immigrant background and place of residence (fixed effects for county). Inequalities were measured using concentration indices.
Results: The proportion of adults who received subsidized dental care was 3.10% before lockdown, 0.47% during lockdown and 2.15% after lockdown. The concentration indices were small. The unstandardized concentration indices (without control variables included) were: 0.04 before, 0.002 during and 0.04 after lockdown. The standardized concentration indices (with control variables included) were: 0.02 before, −0.007 during and 0.02 after lockdown. We carried out several supplementary analyses. They all supported our main findings.
Conclusion: The lockdown did not lead to inequalities in access to subsidized dental care in Norway according to income.
Downloads
References
World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19. 11 March 2020 [cited 2025 Aug 14]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
World Health Organization. Coronavirus disease (COVID-19): weekly epidemiological update. 31 August 2020 [cited 2025 Aug 14]. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update---31-august-2020
Raknes G, Strøm MS. Figures for covid-19 associated deaths in the cause of death register in 2020. Oslo: The Institute of Public Health; 2021 [cited 2025 Aug 14]. Available from: https://www.fhi.no/op/dodsarsaksregisteret/tall-for-covid-19-assosierte-dodsfall- i-dodsarsaksregisteret-i-2020/
Ministry of Health and Care Services. Omfattende tiltak for å bekjempe koronaviruset. (Comprehensive measures to combat the coronavirus). [cited 2025 Aug 14]. Available from: https://www.regjeringen.no/no/dokumentarkiv/regjeringen-solberg/aktuelt-regjeringen-solberg/smk/pressemeldinger/2020/nye-tiltak/id2693327/
Norwegian Government. Timeline: news from Norwegian Ministries about the Coronavirus disease Covid-19. [cited 2025 Aug 14]. Available from: https://www.regjeringen.no/en/topics/koronavirus- covid-19/timeline-for-news-from-norwegian-ministries-about-the- coronavirus-disease-covid-19/id2692402/
Ursin G, Skjesol I, Tritter J. The COVID-19 pandemic in Norway: the dominance of social implications in framing the policy response. Health Policy Technol. 2020;9:663–72. https://doi.org/10.1016/j.hlpt.2020.08.004 DOI: https://doi.org/10.1016/j.hlpt.2020.08.004
Grytten J, Skau I. Do patients with more education receive more subsidized dental care? Evidence from a natural experiment using the introduction of a school reform in Norway as an instrumental variable. Med Care 2018;56:877–82. https://doi.org/10.1097/MLR.0000000000000976 DOI: https://doi.org/10.1097/MLR.0000000000000976
Ministry of Health and Care Services. Forskrift om stønad til dekning av utgifter til undersøkelse og behandling hos tannlege og tannpleier for sykdom. (Regulation on benefits to cover expenses for examination and treatment by dentists and dental hygienists for illness). [cited 2025 Aug 14]. Available from: https://lovdata.no/dokument/SF/forskrift/2014-12-16-1702
Statistics Norway. Health accounts. [cited 2025 Aug 14]. Available from: https://www.ssb.no/en/statbank/list/helsesat
Grytten J, Skau I. Educational inequalities in access to fixed prosthodontic treatment in Norway. Causal effects using the introduction of a school reform as an instrumental variable. Soc Sci Med. 2020;260:113105. https://doi.org/10.1016/j.socscimed.2020.113105 DOI: https://doi.org/10.1016/j.socscimed.2020.113105
Ministry of Health and Care Services. NOU 2003:1. Behovsbasert finansiering av spesialisthelsetjenesten (Need-based financing of the specialist health service). [cited 2025 Aug 14]. Available from: https://www.regjeringen.no/contentassets/9662c674072f4240bf97e47e336b00a0/no/pdfs/nou200320030001000dddpdfs.pdf
Ministry of Health and Care Services. St.meld. nr. 35 (2006–2007). Tilgjengelighet, kompetanse og sosial utjevning – framtidas tannhelsetjenester. (Availability, competence and social equalization – dental health services of the future). [cited 2025 Aug 14]. Available from: https://www.regjeringen.no/no/dokumenter/Stmeld-nr-35-2006-2007-/id475114/
Checchi V, Bellini P, Bencivenni D, Consolo U. COVID-19 dentistry- related aspects: a literature overview. Int Dent J. 2021;71:21–6. https://doi.org/10.1111/idj.12601 DOI: https://doi.org/10.1111/idj.12601
Deana NF, Seiffert A, Aravena-Rivas Y, Alonso-Coello P, Muñoz-Millán P, Espinoza-Espinoza G, et al. Recommendations for safe dental care: a systematic review of clinical practice guidelines in the first year of the COVID-19 pandemic. Int J Environ Res Public Health 2021;18:10059. https://doi.org/10.3390/ijerph181910059 DOI: https://doi.org/10.3390/ijerph181910059
Fini MB. What dentists need to know about COVID-19. Oral Oncol. 2020;105:104741. https://doi.org/10.1016/j.oraloncology.2020.104741 DOI: https://doi.org/10.1016/j.oraloncology.2020.104741
Shamsoddin E, DeTora LM, Tovani-Palone MR, Bierer BE. Dental care in times of the COVID-19 pandemic: a review. Med Sci. 2021:9:13. https://doi.org/10.3390/medsci9010013 DOI: https://doi.org/10.3390/medsci9010013
Aminu AQ, McMahon AD, Clark C, Sherrif A, Buchanan C, Watling C, et al. Inequalities in access to NHS primary care dental services in Scotland during the COVID-19 pandemic. Br Dent J. 2023. https://doi.org/10.1038/s41415-023-5856-z DOI: https://doi.org/10.1038/s41415-023-5856-z
Aquilanti L, Gallegati S, Temperini V, Ferrante L, Skrami E, Procaccini M, et al. Italian response to coronavirus pandemic in dental care access: the DeCADE study. Int J Environ Res Public Health 2020;17:6977. https://doi.org/10.3390/ijerph17196977 DOI: https://doi.org/10.3390/ijerph17196977
Burgette JM, Weyant RJ, Ettinger AK, Miller E, Ray KN. What is the association between income loss during the COVID-19 pandemic and children’s dental care? J Am Dent Assoc. 2021;152:369–76. https://doi.org/10.1016/j.adaj.2021.02.001 DOI: https://doi.org/10.1016/j.adaj.2021.02.001
Chan ACY, Sneed RS. Factors associated with health care delays among adults over 50 during the COVID-19 pandemic. J Gerontol A Biol Sci Med Sci. 2023; 78:630–6. https://doi.org/10.1093/gerona/glac174 DOI: https://doi.org/10.1093/gerona/glac174
Choi SE, Simon L, Basu S, Barrow JR. Changes in dental care use patterns due to COVID-19 among insured patients in the United States. J Am Dent Assoc. 2021;152:1033–43.e3. https://doi.org/10.1016/j.adaj.2021.07.002 DOI: https://doi.org/10.1016/j.adaj.2021.07.002
Choi S, Simon L, Riedy C, Barrow J. Modeling the impact of COVID-19 on dental insurance coverage and utilization. J Dent Res. 2021;100:50–7. https://doi.org/10.1177/0022034520954126 DOI: https://doi.org/10.1177/0022034520954126
Choi S, Mo E, Sima C, Wu H, Thakker-Samtani M, Tranby AK, et al. Impact of COVID-19 on dental care utilization and oral health conditions in the United States. JDR Clin Trans Res. 2024;9:256–64. https://doi.org/10.1177/23800844231165016 DOI: https://doi.org/10.1177/23800844231165016
Hajek A, De Bock F, Huebl L, Kretzler B, König H-H. Postponed dental visits during the COVID-19 pandemic and their correlates. Evidence from the nationally representative COVID-19 snapshot monitoring in Germany (COSMO). Healthcare. 2021;9:50. https://doi.org/10.3390/healthcare9010050 DOI: https://doi.org/10.3390/healthcare9010050
Hopcraft M, Farmer G. Impact of COVID‐19 on the provision of paediatric dental care: analysis of the Australian child dental benefits schedule. Community Dent Oral Epidemiol. 2021;49:369–76. https://doi.org/10.1111/cdoe.12611 DOI: https://doi.org/10.1111/cdoe.12611
Karande S, Chong GTF, Megally H, Parmar D, Taylor GW, Obadan-Udoh EM, et al. Changes in dental and medical visits before and during the COVID‐19 pandemic among US children aged 1–17 years. Community Dent Oral Epidemiol. 2023;51:483–93. https://doi.org/10.1111/cdoe.12806 DOI: https://doi.org/10.1111/cdoe.12806
Kranz AM, Chen A, Gahlon G, Stein BD. 2020 trends in dental office visits during the COVID-19 pandemic. J Am Dent Assoc. 2021;152:535–41.e1. https://doi.org/10.1016/j.adaj.2021.02.016 DOI: https://doi.org/10.1016/j.adaj.2021.02.016
Kranz A, Gahlon G, Dick A, Stein B. Characteristics of US adults delaying dental care due to the COVID-19 pandemic. JDR Clin Trans Res. 2021;6:8–14. https://doi.org/10.1177/2380084420962778 DOI: https://doi.org/10.1177/2380084420962778
Lyu W, Wehby GL. Effects of the COVID-19 pandemic on children’s oral health and oral health care use. J Am Dent Assoc. 2022;153: 787–96.e2. https://doi.org/10.1016/j.adaj.2022.02.008 DOI: https://doi.org/10.1016/j.adaj.2022.02.008
O’Donnell R, Vernazza C, Landes D, Freeman Z. Dental public health in action: the covid-19 restrictions on dentistry in England and their impact on access to dental care for high-risk patient groups in the North-East and North Cumbria. Community Dent Health 2022:39:4–7. https://doi.org/10.1922/CDH_00150ODonnell04
Semprini J. 2023. Estimating the within-person change in dental service access measures during the COVID-19 pandemic. Int J Dent. 2023:5601447. https://doi.org/10.1155/2023/5601447 DOI: https://doi.org/10.1155/2023/5601447
Stennett M, Tsakos G. 2022. The impact of the COVID-19 pandemic on oral health inequalities and access to oral healthcare in England. Br Dent J. 2022;232:109–14. https://doi.org/10.1038/s41415-021-3718-0 DOI: https://doi.org/10.1038/s41415-021-3718-0
Takeda A, Tomio J, Fukuda H, Ando Y, Yokoyama T. Trends in dental visits during the state of emergency for COVID-19 in Japan: a retrospective observational study. BMJ Open 2022;12:e064666. https://doi.org/10.1136/bmjopen-2022-064666 DOI: https://doi.org/10.1136/bmjopen-2022-064666
Jiang N, Kinge JM, Skau I, Grytten J. Does subsidized orthodontic treatment reduce inequalities in access? Evidence from Norway based on population register data. Community Dent Oral Epidemiol. 2024;52:232–8 https://doi.org/10.1111/cdoe.12918 DOI: https://doi.org/10.1111/cdoe.12918
OECD. Divided we stand: why inequality keeps rising. Paris: OECD Publishing; 2011.
Eurostat. Statistics explained. Glossary: equivalised income. [cited 2025 Aug 14]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:Equivalised_income
O’Donnell O, van Doorslaer E, Wagstaff A, Lindlow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, DC: The World Bank; 2007. DOI: https://doi.org/10.1596/978-0-8213-6933-3
Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33:545–57. https://doi.org/10.1016/0277-9536(91)90212-U DOI: https://doi.org/10.1016/0277-9536(91)90212-U
Jiang N, Grytten J, Kinge JM. Inequality in access to dental services in a market-based dental care system: a population study from Norway 1975–2018. Community Dent Oral Epidemiol. 2022;50:548–58. https://doi.org/10.1111/cdoe.12709 DOI: https://doi.org/10.1111/cdoe.12709
Erreygers G. 2009. Correcting the concentration index. J Health Econ. 2009;28:504–15. https://doi.org/10.1016/j.jhealeco.2008.02.003 DOI: https://doi.org/10.1016/j.jhealeco.2008.02.003
Statistics Norway. Statbank. Population. [cited 2025 Aug 14]. Available from: https://www.ssb.no/en/statbank/table/07459/
Eurostat. Healthcare personnel statistics–dentists, pharmacists and physiotherapists. [cited 2025 Aug 14]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_personnel_statistics_-_dentists,_pharmacists_and_physiotherapists&stable=0#Healthcare_personnel
Statistics Norway. Statbank. Dental health care. [cited 2025 Aug 14]. Available from: https://www.ssb.no/en/statbank/list/tannhelse
Widstrom E, Eaton KA, Luciak-Donsberger C. Changes in dentist and dental hygienist numbers in the European Union and economic area. Int Dent J. 2010;60:311–6. https://doi.org/10.1922/IDJ_2530Widstrom06 DOI: https://doi.org/10.1016/S0020-6539(20)34193-9
Grytten J, Skau I, Holst D. Is the distribution of dentists in Norway uneven? Norw Dent J. 2002;112:172–7. https://doi.org/10.56373/2002-3-3 DOI: https://doi.org/10.56373/2002-3-3
Grytten J. Effect of time costs on demand for dental services among adults in Norway in 1975 and 1985. Community Dent Oral Epidemiol. 1991;19:190–4. https://doi.org/10.1111/j.1600-0528.1991.tb00144.x DOI: https://doi.org/10.1111/j.1600-0528.1991.tb00144.x
Holmgren T, Rongen G, Grytten J. Private general dentists – do they have enough to do? Norw Dent J. 2017;127:948–52. https://doi.org/10.56373/2017-11-3 DOI: https://doi.org/10.56373/2017-11-3
Collins B. Big data and health economics: strengths, weaknesses, opportunities and threats. Pharmacoeconomics 2016;34:101–6. https://doi.org/10.1007/s40273-015-0306-7 DOI: https://doi.org/10.1007/s40273-015-0306-7
Thygesen LC, Ersbøll AK. When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol. 2014;29:551–8. https://doi.org/10.1007/s10654-013-9873-0 DOI: https://doi.org/10.1007/s10654-013-9873-0
Wang X, Cheng Z. Cross-sectional studies: strengths, weaknesses, and recommendations. Chest 2020;158:S65–71. https://doi.org/10.1016/j.chest.2020.03.012 DOI: https://doi.org/10.1016/j.chest.2020.03.012
Additional Files
Published
Issue
Section
License
Copyright (c) 2025 Nan Jiang, Jonas Minet Kinge, Irene Skau, Jostein Grytten
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes high quality original research papers as well as critical reviews relevant on diseases of the oral cavity, their treatment, epidemiology and associated biomaterials and their development.
