Persistent but narrowing dental care inequalities in Canada from 2001 to 2016

Background
Similar to the United States, inequality in oral health care use is longstanding in Canada. It remains unclear whether this inequality is improving or worsening. In this study, the authors report on income-related inequality in dental visits in Canada and across its provinces over time and interprovincial inequality in dental visits among Canadian provinces.

Methods
The authors used 7 nationally representative health surveys of the Canadian population and collected data from 2001 through 2016. The magnitude of income-related inequality was measured using the slope index of inequality and relative index of inequality. Interprovincial inequality was examined using a number of indexes including the Theil index.

Results
Income-related inequality in dental visits was present in all survey years, with people in higher income groups reporting higher dental visit prevalence rates. However, results from the slope index of inequality and relative index of inequality showed a steady decline, meaning there was a decrease in the magnitude of inequality over time. Absolute and relative inequality decreased by 7.2% and 22.9% from 2000 through 2016, respectively. A similar decline was observed across most Canadian provinces. Interprovincial differences in dental visits also decreased over time.

Conclusions
There appears to be persistent but narrowing income-related inequality in dental visits in Canada and across its provinces over time. In addition, it appears that Canadian provinces are becoming more equal in terms of dental services use.

Practical Implications
Narrowing income-related inequality in dental visits in Canada is promising, suggesting a more equal distribution of dental visits. However, unequal use of dental services remains an issue affecting the Canadian population.