Dental service disparities in Canada: A Saskatoon, Saskatchewan case study

Oral health is an intrinsic component of overall health and wellbeing. However, in Canada oral health care (other than emergency, hospital-based services) is not covered by the Canada Health Act and is delivered primarily on a fee-for-service basis. This study explores the urban arrangement of dental services in comparison with other Primary Health Care services (in this case, family physicians) and further, determines the association between access to dental services and socio-economic variables. A GIS-based spatial accessibility method was used to calculate the neighbourhood access score for both dental and family physician services within Saskatoon, Saskatchewan. Spatial analysis and spatial statistical methods were applied to determine the relationship between dental access score and socioeconomic variables. A best-fit linear regression model was identified using a forward step-wise approach. Next, to reduce the spatial autocorrelation present in the linear model, a spatial lag regression model that includes a spatially lagged dependent variable, spatial weight matrix (queen contiguity, row-standardized) was estimated. Three explanatory variables (lone parent, home ownership, and dwellings needing major repairs) were found to be associated with the access to dental services. This study demonstrates the power of looking beyond the simple arrangement of health care services to highlight poorly served neighbourhoods in urban settings.