Comparing oral health care utilization estimates in the United States across three nationally representative surveys

OBJECTIVE: To compare estimates of dental visits among adults using three national surveys. DATA SOURCES/STUDY DESIGN: Cross-sectional data from the National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Health Expenditure surveys (NMCES, NMES, MEPS). STUDY DESIGN: This secondary data analysis assessed whether overall estimates and stratum-specific trends are different across surveys. DATA COLLECTION: Dental visit data are age standardized via the direct method to the 1990 population of the United States. Point estimates, standard errors, and test statistics are generated using SUDAAN. PRINCIPAL FINDINGS: Sociodemographic, stratum-specific trends are generally consistent across surveys; however, overall estimates differ (NHANES III 364-day estimate] versus 1993 NHIS: -17.5 percent difference, Z = 7.27, p value < 0.001; NHANES III 365-day estimate] vs. 1993 NHIS: 5.4 percent difference, Z = -2.50, p value = 0.006; MEPS vs. 1993 NHIS: -29.8 percent difference, Z = 16.71, p value < 0.001). MEPS is the least susceptible to intrusion, telescoping, and social desirability. CONCLUSIONS: Possible explanations for discrepancies include different reference periods, lead-in statements, question format, and social desirability of responses. Choice of survey should depend on the hypothesis. If trends are necessary, choice of survey should not matter however, if health status or expenditure associations are necessary, then surveys that contain these variables should be used, and if accurate overall estimates are necessary, then MEPS should be used. A validation study should be conducted to establish "true" utilization estimates.