Longitudinal assessment of dental utilization in pediatric refugees resettled in Washington state

Abstract

Purpose: Existing literature surrounding pediatric refugee oral health is limited. Further understanding of dental utilization in this population is necessary for driving policy and resources to support pediatric refugee oral health. This study compares dental utilization between pediatric refugees resettled in Washington (WA) State and Medicaid eligible pediatric non-refugee residents.Methods: This retrospective longitudinal study utilized a dataset generated from a collaborative effort between the Washington State Health Care Authority, the Department of Health, and the Department of Social and Health Services. The 1,125 pediatric refugees were matched based on sex, age, and Medicaid enrollment date in an approximate ratio of 1:3 with 3,462 pediatric non-refugees. Both groups were followed over 36 months from 2015-2018. Medicaid data including demographics, disability status, dental claims dates and codes were analyzed using descriptive statistics and ANOVA. Results: Of the 1,125 pediatric refugees settled in WA State in 2015 most refugee children were non-disabled, reported White race, and were between 0-6 years of age. From 2015-2018, 90% of pediatric refugees utilized dental services compared to 81% of pediatric non-refugees. Over the 36 months, refugee children had 1.4 times more overall mean claims, 1.3 times more diagnostic mean claims, 1.9 times more surgery mean claims and 2.4 times more restorative mean claims than non-refugee children. In Year One, pediatric refugees showed higher overall mean claims and mean claims by individual categories than pediatric non-refugees except for orthodontics and miscellaneous. There was a year over year decrease for pediatric refugees in overall mean claims and mean claims in all individual categories except for orthodontics which showed an increase. Conclusion: From 2015-2018 newly resettled pediatric refugees utilized dental care at a higher rate than non-refugees and consumed more dental services. Pediatric refugees initially had greater acute dental needs than pediatric non-refugees and consumed more restorative and surgical services. This trended lower year by year and was ultimately comparable to levels observed in pediatric non-refugees by Year Three.