Avoidance dental visit, the impact of predictor factors: A cross-sectional study in Kerman, Iran

Document Type: Original Article(s)


1 Associate Professor, Department of Health Management, Policy and Economics, School of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran

2 PhD Student, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Professor, Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran

4 Assistant Professor, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

5 Assistant Professor, Department of Health Management, Policy and Economics, School of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND AND AIM: In spite of different reforms and programs, the evidence indicates that Iran dental health sector has not been able to improve the dental situation and decrease the unmet needs. This study assessed the factors which affect the avoiding dental visit during one year ago because of its costs.METHODS: This cross-sectional study was performed on 1158 household heads which were selected through multi-stage sampling in Kerman, Iran, and questioned house by house using trained interviewers. The association of dichotomous outcome variables of “have you avoided or postponed dental visit during 1 years ago in spite of need because of its costs?” with 3 types of predictor variables of household heads including sex as binary predictor, age as continuous predictor, and income and education as categorical variables studied using regression logistics.RESULTS: The odds ratio (OR) of avoiding dental visit because of its costs in men was 1.4 times more than women (P = 0.035). The OR decreased by 0.01 with each year increase in age (P = 0.017). Furthermore, the OR is people with incomes 267-803, 803-1339 and > 1339 USD in comparison with the heads incomes under 267 USD was 0.31, 0.02, 0.01, respectively (P = 0.001), and in people with educational level < diploma, diploma, Bachelor of Science (BSc), Master of Science (MSc) and Doctor of Medicine (MD)/Doctor of Philosophy (PhD) in comparison with illiterate/elementary decreased by 0.51, 0.13, 0.04, 0.01 and 0.02, respectively (P < 0.001).CONCLUSION: The factors of older ages, being a woman, increasing education and income level decrease the rate of avoiding a dental visit. In the absence of strong dental health insurance, these factors determine the utilization of the services which lead to horizontal inequality.


  1. Science and Technology Subcommittee on Population Health of the Standing Senate Committee on Social Affairs. A healthy, productive Canada: A determinant of health approach. Ottawa, Canada: Senate Committee Reports; 2009.
  2. Wamala S, Merlo J, Bostrom G. Inequity in access to dental care services explains current socioeconomic disparities in oral health: The Swedish National Surveys of Public Health 2004-2005. J Epidemiol Community Health 2006; 60(12): 1027-33.
  3. Hessari H, Vehkalahti MM, Eghbal MJ, Samadzadeh H, Murtomaa HT. Oral health and treatment needs among 18-year-old Iranians. Med Princ Pract 2008; 17(4): 302-7.
  4. Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.
  5. Jadidfard MP, Yazdani S, Khoshnevisan MH. Social insurance for dental care in Iran: A developing scheme for a developing country. Oral Health Dent Manag 2012; 11(4): 189-98.
  6. World Health Organization. The world health report 2000 - Health systems: Improving performance. Geneva, Switzerland: WHO; 2000.
  7. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health sector evolution plan in iran; equity and sustainability concerns. Int J Health Policy Manag 2015; 4(10): 637-40.
  8. Barouni M, Amiresmaieli MR, Shahravan A, Amini S. The efficiency assessment of dental units using data envelopment analysis approach: The case of Iran. Iran J Public Health 2017; 46(4): 552-9.
  9. Oral Health Bureau, Deputy for Public Health, Ministry of Health and Medical Education. Oral health status in Iran 2012. Tehran, Iran: Ministry of Health and Medical Education; 2012. [In Persian].
  10. Pakshir HR. Oral health in Iran. Int Dent J 2004; 54(6 Suppl 1): 367-72.
  11. Statistical Center of Iran. Population and housing census, 2011 [Online]. Available from: https://www.amar.org.ir/english/Population-and-Housing-Censuses
  12. Peltzer K, Pengpid S. Dental health status and oral health behavior among university students from five ASEAN countries. Nagoya J Med Sci 2017; 79(2): 123-33.
  13. Nishide A, Fujita M, Sato Y, Nagashima K, Takahashi S, Hata A. Income-related inequalities in access to dental care services in Japan. Int J Environ Res Public Health 2017; 14(5).
  14. Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: Results from a nationally representative survey. J Rural Health 2014; 30(1): 79-88.
  15. Moore PJ, Sickel AE, Malat J, Williams D, Jackson J, Adler NE. Psychosocial factors in medical and psychological treatment avoidance: the role of the doctor-patient relationship. J Health Psychol 2004; 9(3): 421-33.
  16. Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. BMC Fam Pract 2016; 17: 38.
  17. Locker D, Maggirias J, Quinonez C. Income, dental insurance coverage, and financial barriers to dental care among Canadian adults. J Public Health Dent 2011; 71(4): 327-34.
  18. Mercer SW, Guthrie B, Furler J, Watt GC, Hart JT. Multimorbidity and the inverse care law in primary care. BMJ 2012; 344: e4152.
  19. Locker D, Leake JL. Inequities in health: dental insurance coverage and use of dental services among older Ontario adults. Can J Public Health 1993; 84(2): 139-40.
  20. Millar WJ, Locker D. Dental insurance and use of dental services. Health Rep 1999; 11(1): 55-67.
  21. Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CLG. Use of and access to health services in Brazil, 2013 National Health Survey. Rev Saude Publica 2017; 51(suppl 1): 3s.
  22. Zhang Y. Racial/ethnic disparity in utilization of general dental care services among US adults: Medical Expenditure Panel Survey 2012. J Racial Ethn Health Disparities 2016; 3(4): 565-72.
  23. Vikum E, Bjorngaard JH, Westin S, Krokstad S. Socio-economic inequalities in Norwegian health care utilization over 3 decades: the HUNT Study. Eur J Public Health 2013; 23(6): 1003-10.
  24. Kannan VD, Veazie PJ. Predictors of avoiding medical care and reasons for avoidance behavior. Med Care 2014; 52(4): 336-45.
  25. Sabbah W, Tsakos G, Sheiham A, Watt RG. The role of health-related behaviors in the socioeconomic disparities in oral health. Soc Sci Med 2009; 68(2): 298-303.
  26. World Health Organization Regional Office for Europe. European health for all database (HFA-DB) WHO/Europe [Online]. [cited 2016 Jul]; Available from: URL: http://data.euro.who.int/hfadb/
  27. National Education Measurement Organization. Manuals for selection of academic fields in the university entrance exam [Online]. [cited 2015]; Available from: URL: http://sanjesh.org/group.aspx?gid=1
  28. Hessari H. Oral health among young adults and the middle-aged in Iran [Doctoral Thesis]. Helsinki, Finland: Department of Oral Public Health, Institute of Dentistry Faculty of Medicine, University of Helsinki; 2009.
  29. Chen M, Andersen RM, Barmes David E, Leclerq MH, Lyttle CS. Comparing oral health care systems : A second international collaborative study. Geneva, Switzerland: 1997.