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Mapping Dental Deserts: Oral Health Equity in Los Angeles County
Aya Obara, MPHEpidemiologistLos Angeles County Department of Public HealthOral Health Program
Background
• Areas with1:
–No or insufficient dental services;
–High population density;
– Low median
household income.
1. Cabezas, M. Identifying Dental Deserts in the Los Angeles County Safety Net using GIS Maps. 2016. http://www.nationaloralhealthconference.com/docs/presentations/2016/04-19/Maritza%20Cabezas-Dental%20Deserts%20of%20the%20Los%20Angeles%20County%20Safety-Net%20Dental%20Clinics%20Using%20GIS%20Maps.pdf
What is a Dental Desert?
Los Angeles County Oral Health At A Glance
1. 2016. Prepared by California Department of Public Health – Oral Health Program. All measures are for full-scope beneficiaries with no share of cost (SOC) with at least 3 months of continuous eligibility in the same plan. Annual Dental Visit: Percentage of beneficiaries who had at least one (1) dental visit during the measurement period. [Numerator: Number of beneficiaries with at least 90 days continuous enrollment in the same plan within the measurement year who received any dental procedure (D0100-D9999) or dental encounter at a Safety Net Clinic (SNC) (e.g., Federally Qualified Health Centers (FQHCs); Rural Health Clinics (RHCs); and Indian Health Services/Memorandum of Agreement Clinics (co mmunity health centers)) during the period. Denominator: Number of beneficiaries with at least 90 days continuous enrollment in the same plan within the measurement year.] Preventive Dental Visit: Percentage of beneficiaries who received any preventive dental service during the measurement period. [Numerator: Number of beneficiaries with at least 90 days continuous enrollment in the same plan within the measurement year who received any preventive dental service (D1000-D1999 or ICD 10: K023 K0251 K0261 K036 K0500 K0501 K051 K0510 K0511 Z012 Z0120 Z0121 Z293 Z299 Z98810) in the measurement period. Denominator: Number of beneficiaries with at least 90 days continuous enrollment in the same plan within the measurement year.]
2. 2016. Health Resources & Services Administration, 18 May 2018. [Online]. Available: https://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2016&state=CA#glist.3. 2018. Med-Cal Health and Dental benefits, 9 October 2018 [Online]. Available: https://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-Cal_EHB_Benefits.aspx. 4. 2006. Center for Oral Health. The California Smile Survey: An Oral Health Assessment of California’s Kindergarten and 3rd Grade Children. Raw data provided.
Over 40% of people in LA County are enrolled in Medi-Cal.3
Approximately 14% of federally funded health centers offer
dental services.2
Dental utilization from Medi-Cal
population is least prevalent among White, Black, and NH/PI adults ages
21-44.1
Over 66% of 3rd graders
have a history of
tooth decay.4
Los Angeles County Facts
1. U.S. Census Bureau Quickfacts: Los Angeles County, California. https://www.census.gov/quickfacts/fact/table/losangelescountycalifornia,ca/PST045217. Accessed 25 September 2018.2. Los Angeles County Department of Public Health. ArcCatalog. Accessed 25 September 2018.3. County of Los Angeles. Accessed 15 October 2018. http://www.lacounty.gov/government/about-la-county/unincorporated-areas/
Los Angeles County Population Density
Legend
Census Block Groups in Los Angeles County
2016 Total Population / AreaSqMil
0 - 1,000
1,001 - 5,000
5,001 - 10,000
10,010 - 50,000
50,010 - 100,000
100,100 - 198,200
Mapping Objectives
• Provide accurate information to city council members and other decision-makers
Update Dental Desert map
• Raise community support for additional dental sites
• Aid existing clinics planning for workforce expansion
Spatially analyze service capacity of
publicly funded clinics offering dental
services
Methodology
• Areas with1:
–No or insufficient dental services;
–High population density;
– Low median
household income.
1. Cabezas, M. Identifying Dental Deserts in the Los Angeles County Safety Net using GIS Maps. 2016. http://www.nationaloralhealthconference.com/docs/presentations/2016/04-19/Maritza%20Cabezas-Dental%20Deserts%20of%20the%20Los%20Angeles%20County%20Safety-Net%20Dental%20Clinics%20Using%20GIS%20Maps.pdf
What is a Dental Desert?
Types of Clinics Included in Map
• Federally-funded health centers that provide health services
• Dental Clinics
– My Health LA (MHLA)
– Community clinics funded by Department of Health Services
– Community clinics not funded by Department of Health Services
– Comprehensive Health Centers (County funded)
– Dental schools
Areas with High Population Density & Low Income
Buffer Analysis and Fishnet Grid
Dental Desert Approximation
Dental Desert Approximation
Alternative Methodology: Weighted Overlay
Created by The Office of Health Assessment and Epidemiology. GIS Unit. 10/18/18.
Created by The Office of Health Assessment and Epidemiology. GIS Unit. 10/18/18.
Weighted Overlay
Results
Initial Findings (In Progress)
• Quantitative:
–Approximately 36 noncontinuous square miles of Dental Desert identified.
–32 publicly funded medical clinics identified for potential dental services expansion.
• Qualitative:
– Spatial trend between fishnet grid and weighted overlay methodology show that dental desert continues to be concentrated in the South Central region of Los Angeles County.
Discussion
Considerations
• Difference in Dental Desert over past 4 years:
–Additional clinics included in updated map
–Median Household Income trends in Los Angeles County1
• Future of Dental Desert:
–Partial restoration of Medi-Cal dental benefits to full restoration in 2018
1. 2017. LAEDC, 15 October 2018. [Online]. Available: https://laedc.org/2017/09/14/income-growth-los-angeles-county/
Next Steps
Validate data discrepancies
Further analysis on dentist FTEs
Overlay with other oral health equity indicator
data
Acknowledgements
• Dr. Maritza Cabezas, DDS, MPH – Dental Director, LACDPH, Oral Health Program
• Dr. Abrey Daniel, DDS – Dentist, LACDPH, Oral Health Program
• Douglas Morales, MPH – Principal GIS Analyst, LACDPH, Office of Health Assessment and Epidemiology
• Nicole Richardson, MPH – Epidemiology Analyst, LACDPH, Office of Health Assessment and Epidemiology
