A colleague recently sent me an American poll on visits to the dentist, and we thought it'd be interesting to see how New Zealanders compared. Our poll covers a representative sample of n=1000 New Zealanders aged 18 years or older, and was conducted between April 29th and May 12th 2014, while the American survey is from the Gallup-Healthways Well-Being Index 2013 which covered 178,072 American adults.
The basic question was very simple: "have you visited a dentist in the past 12 months". The results, however, are perhaps surprising.
- 52% of New Zealanders say they have visited a dentist in the last 12 months.
- By comparison, 65% of Americans say they have done so.
Gallup's analysis (available here) focused on the fact that one third of Americans hadn't been to the dentist in the last year, clearly because the writer saw this as surprising and newsworthy. What would they have made of the fact that almost half the New Zealand population (47%) say they haven't visited?*
While the American survey showed women (67%) were more likely than men (62%) to have been to the dentist in the last year, we don't see that gender divide in New Zealand. 53% of men claim to have been to the dentist in the last year, compared with 52% of women (i.e. the difference isn't statistically significant). Where we do see big differences is in age:
- In New Zealand, 47% of under 30 year olds and 44% of 30-44 year olds say they have been to the dentist in the last twelve months.
- This compares with 59% of 45-59 year olds and 61% of over 60s.
That trend was present in the US data, but considerably less prominent.
Christchurch (59%) and Wellington (58%) residents are more likely than Aucklanders (50%) and people living in other parts of the North Island (50%) to have gone to the dentist in the last year, with South Islanders from outside Christchurch between those two extremes.
Dentistry is of course one of a number of areas in the New Zealand health system that is largely user pays, and likelihood of visiting a dentist is clearly related to income.
- 44% of those with personal incomes under $30,000 have been to the dentist in the last 12 months, compared with 57% of those with personal incomes over $50,000
- 42% of those with household incomes under $50,000 have been to the dentist in the last 12 months, compared with 57% of those with personal incomes over $50,000
This probably underestimates the actual differences between rich and poor, because the lower income categories include retired people who own their homes freehold, and older people are as noted more likely to visit the dentist. This point is illustrated by the fact that 66% of those who own their homes freehold have been to the dentist in the last twelve months. By comparison, 42% of those who are renting and not looking to buy (perhaps because they feel they cannot afford to) say they have been to the dentist in the last year.
Education is also a big factor, with 62% of those claiming postgraduate degrees having been to the dentist in the last year, compared with 48% of those with high school qualifications or less. Here again the age breakdown probably masks large demographic differences, as over 60s are less likely to have tertiary degrees.
It'll be no surprise to anyone who watches health and deprivation statistics to see that Maori are much less likely to have visited a dentist in the last year - 41% have done so. Unfortunately the sample sizes don't allow us to provide reliable breakdowns for other minority ethnic groups in New Zealand. As a reference, in the US 55% of Blacks and 55% of Hispanics said they had visited a dentist in the last year, compared with 70% of Asians and 68% of Whites.
In our New Zealand study we did something that wasn't in the Gallup poll - we asked those who hadn't been to a dentist in the last year how long it had been since they went.
- 9% of all New Zealanders say it's been more than 10 years since they went to the dentist, while another 8% say it's between 5 and 10 years. That's 17% of New Zealanders who haven't been to the dentist in the last 5 years.
- 11% of under 30s say it's been more than 10 years since they went to the dentist, which is remarkable given that most of them would have been at secondary school in that time (and therefore receiving free or subsidised dental care). A total of 20% of under 30s haven't been to the dentist in the last five years.
- 16% of people with personal incomes under $30,000 haven't been to the dentist in the last decade, compared with 7% of those with personal incomes over $50,000.
- 14% of people with household incomes under $50,000 haven't been to the dentist in the last decade, compared with 8% of those with household incomes over $50,000.
- 20% of all Maori say it's been more than ten years since they went to the dentist.
If you've seen our earlier research on inequality here, you may recall our attempt to define a 'rich' and 'poor' category. As I said there, it's a subjective exercise because we could define it in many ways but the idea is to identify a group who should (in theory at least) be relatively comfortable financially and a group who are relatively likely to be struggling. We've therefore focussed on people with relatively high incomes who don't have dependent children, and people on low incomes who aren't retired (as a reasonable proportion of retired people own their homes freehold and therefore have fewer expenses).
- 61% of those with household incomes over $100,000 with two or fewer adults in the household and no children have been to the dentist in the last year while 16% haven't been in the last five years.
- 46% of those with household incomes under $40,000 who aren't retired have been to the dentist in the last year, while 24% haven't been in the last five years.
The standard recommendation is that people should visit the dentist every six to twelve months, but clearly that's not happening for a lot of New Zealanders. I'm sure there's been more detailed research done on this by people in the health sector, but these numbers indicate to me that a lot of people are only going to the dentist when they think something is wrong. If, as the numbers seem to show, price is a major barrier, to what extent is our user-pays dentistry system causing problems which would have been easier and cheaper to solve if they'd been detected earlier?
Full results of this survey can be downloaded at the UMR Research website here.
*These don't add to exactly 100% because some respondents were unsure about whether they had been to the dentist in the last year.