Perceived racial discrimination partially mediates racial-ethnic disparities in dental utilization and oral health

Objectives Perceived racial discrimination has been associated with poor health outcomes, yet its impact on oral health disparities is not understood. We examine the role of perceived racial discrimination in healthcare settings in explaining racial-ethnic disparities in dental visits and tooth loss. Methods We used behavioral risk factor surveillance system (BRFSS) data for 2014 from four diverse states (AZ, MN, MS and NM) that included "reactions to race" module. Using Poisson regression to estimate risk ratios, we employed inverse odds ratio(IOR)-weighted estimation for mediation analyses to estimate the role of perceived discrimination, after equalizing other confounders and risk factors. Results We found that among those with similar risk factors, those who experienced racial discrimination were 15% less likely to visit a dentist, and 12% more likely to have tooth loss than those who were treated same as other races. Both Hispanics and non-Hispanic Blacks were 26% less likely to visit a dentist (for Hispanics, RR = 0.74, 95%CI: 0.69-0.78; for non-Hispanic Blacks, RR = 0.74, 95%CI: 0.70-0.79), and non-Hispanic Blacks were 36% more likely to have tooth loss relative to non-Hispanic Whites with similar risk factors (RR = 1.36, 95%CI: 1.28-1.45). Perceived discrimination appears to contribute to racial-ethnic disparities in dental utilization among Hispanics, and disparities in tooth loss among non-Hispanic Blacks, relative to non-Hispanic Whites. Conclusions Perceived racial discrimination partially explains the racial-ethnic disparities in dental utilization and tooth loss among those who otherwise share the same risk factors for these outcomes. Addressing discrimination and systemic racism can reduce the racial-ethnic disparities in oral health.