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日本における歯科医療利用の地域間格差．国民健康保険請求権データベースを用いた生態学的研究
Regional Inequality in Dental Care Utilization in Japan: An Ecological Study Using the National Database of Health Insurance Claims.
PMID: 34527966
抄録
背景:
本研究は，日本における歯科医療利用の地域間格差と社会経済的要因との関連について検討したものである．
BACKGROUND: This study examined regional inequalities in dental care utilization in Japan and the association of dental care utilization with socioeconomic factors.
方法:
第4回全国健康保険請求・特定健診データベース公開データを用いて，2017年4月から2018年3月までの集計データ2億1600万件を分析した生態学的研究である。歯科医療利用の指標として、外来受診、外来診療、虫歯充填、抜髄、歯石除去、歯周外科、抜歯、歯科ブリッジ、義歯の9つを使用した。これらの指標の標準化請求比率（SCR）は，日本の 47 都道府県を，人口あたりの歯科診療所数，1 人あたりの平均所得，大学進学率に基づいて 3 群に分け，算出した．また，歯科医療利用率と歯科医療供給量および地域の社会経済的要因との関連について検討した．
METHODS: Using the Fourth National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data, this ecological study analyzed 216 million pieces of aggregated data from April 2017 to March 2018. Nine indicators of dental care utilization were used: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan's 47 prefectures, which were divided into three groups based on the number of dental clinics per population, average income per capita, and the proportion of university enrollments. Associations of the dental care utilization with dental supply and regional socioeconomic factors were examined.
結果:
SCR の最大値と最小値の比率は，外来診療が 1-4，Outreach service が 19-3， 歯周外科手術が 17-6 であった．歯科材料供給量は，外来受診，アウトリーチ，歯石除去，歯周外科手術と正の相関があった．地域平均所得および教育水準は，歯石除去術と正の相関を示し，抜髄術，抜歯，ブリッジ，義歯と負の相関を示した．
FINDINGS: The ratios of maximum to minimum of SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Dental supply was positively associated with outpatient visits, outreach services, dental calculus removal, and periodontal surgeries. Regional average income and educational level were positively associated with dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures.
解釈:
日本では，歯科医療利用における地域格差は，歯周病治療とアウトリーチサービスでは存在するが，緊急歯科医療と実質的歯科医療では小さい．地域所得と教育水準が歯科医療利用に影響を及ぼしていると思われる．
INTERPRETATION: In Japan, regional inequalities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Regional income and educational levels appear to have influence on dental care utilization.
財源:
厚生労働省（H31-19FA1001）．
FUNDING: Ministry of Health, Labour and Welfare of Japan (H31-19FA1001).