Oral health-related quality of life improvements and satisfaction in South Korea: results from the National Health Insurance Coverage Denture Project for the Elderly

Yu Hee Lee; Jin Ho Chun; Jung Hwa Lee

doi:10.11149/jkaoh.2015.39.1.37

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Lee, Chun, and Lee: Oral health-related quality of life improvements and satisfaction in South Korea: results from the National Health Insurance Coverage Denture Project for the Elderly

Original Article

J Korean Acad Oral Health 2015;39(1):37-42.

Published online: 12 March 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.1.37

Oral health-related quality of life improvements and satisfaction in South Korea: results from the National Health Insurance Coverage Denture Project for the Elderly

Yu Hee Lee¹, Jin Ho Chun², Jung Hwa Lee³

¹Graduate School of Public Health, Inje University, Busan, Korea

²Department of Preventive Medicine, Inje University School of Medicine, Busan, Korea

³Department of Dental Hygiene, College of Nursing and Healthcare Sciences, Dong-Eui University, Busan, Korea

Corresponding Author: Jung Hwa Lee Department of Dental Hygiene, College of Nursing and Healthcare Sciences, Dong-Eui University, 176 Eomgwangno, Busanjin-gu, Busan 614-714, Korea Tel: +82-51-890-4239 Fax: +82-505-182-687 E-mail: yamako93@deu.ac.kr

Received 27 October 2014 Revised 26 December 2014 Accepted 7 January 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

In this study, we assessed the effects of the National Health Insurance Coverage Denture Project for the Elderly on the improvement of oral health-related quality of life (QOL) and satisfaction.

Methods

Individuals aged ≥75 years (n=121) participated in the project at dental clinics or public health centers in Busan City, South Korea. Baseline and post-intervention follow-up surveys (personal interview) were conducted between October 2013 and April 2014.

Results

Significant improvements were demonstrated in all seven Oral Health Impact Profile-14 (OHIP-14) subscales at follow-up. Functional limitation showed the most improvement (2.81 points) followed by physical functionality, physical pain, psychological discomfort, social isolation, mental function, and social function. In addition, participants with no income who were required to pay for their expenses, reported higher satisfaction. The multiple logistic regression analysis showed that the rate of improvement on the OHIP-14 ten score increased in cases where participants who had to pay for their expenses (odds ratio [OR], 2.98; 95% confidence interval [CI]: 1.16, 7.66) but decreased for patients who received partial dentures (OR, 0.34; 95% CI: 0.13, 0.89), patients who expressed previous satisfaction with denture costs (OR, 0.37; 95% CI: 0.14, 0.97), and patients who had previous denture experience (OR, 0.43; 95% CI: 0.16, 1.12).

Conclusions

Despite the short period (2 years), the National Health Insurance Coverage Denture Project for the Elderly was able to demonstrate significant improvements in oral health-related QOL. Therefore, the establishment and integration of this project is recommended to maintain and improve the QOL for the rapidly aging population.

Keywords: Elderly, National Health Insurance Coverage Denture Project for the Elderly, OHIP-14

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Table 1.

Reliability of the each item in OHIP-14 questionnaire

Item	Cronbach’s alpha	Change when dropped
1. Worsening taste	0.9257	―0.0035
2. Inaccurate pronunciation	0.9278	―0.0014
3. Pain on oral cavity and inner cheek	0.9259	―0.0033
4. Discomfort to eat	0.9275	―0.0017
5. Discomfort to meet others	0.9220	―0.0072
6. Nervous due to oral problem	0.9257	―0.0035
7. Indigestion	0.9245	―0.0047
8. Insufficient food intake	0.9259	―0.0033
9. Feel difficulty or confused	0.9206	―0.0086
10. Difficult to rest comfortably	0.9237	―0.0055
11. Hard to do the ordinary job	0.9215	―0.0077
12. Irritable to others	0.9251	―0.0041
13. Hard to join with others	0.9221	―0.0071
14. Feel unsatisfactory usual life	0.9196	―0.0096

OHIP-14: oral health impact profile-14.

Table 2.

General characteristics of the study subjects (N=121)

Characteristics	Classification	No. (%)
Age (years)	Under 80	84 (69.4)
	Over 80	37 (30.6)
	Mean±S.D.(min.-max.)	78.8±3.9 (75-94)
Gender	Men	44 (36.4)
Gender	Women	77 (63.6)
Living with family	Yes	57 (47.1)
Living with family	No	64 (52.9)
Education	No, Elementary	78 (64.5)
	Middle, High	38 (31.4)
	Over college	5 (4.1)
Occupation	Yes	10 (8.3)
Occupation	No	111 (91.7)
Income	Yes	39 (32.2)
Income	No	82 (67.8)
Monthly cost of living (thousand KRW)	<100	11 (9.1)
	100-500	74 (61.2)
	≥500	36 (29.8)

Table 3.

Characteristics of the denture

Variables	Classification	No. (%)
Denture type	Full	52 (43.0)
Denture type	Partial	69 (57.0)
Reason why	Mastication	89 (73.6)
denture need	Beauty	10 (8.3)
	Pronunciation	1 (0.8)
	Discomfort	14 (11.6)
	Others	7 (5.8)
Information source	Media (TV, radio)	36 (29.8)
	Specialist (when dental care)	26 (21.5)
	Internet	1 (0.8)
	Neighborhood (family, friends)	31 (25.6)
	Facility (senior center, elderly school)	20 (16.5)
	Others	7 (5.8)
Previous denture	Yes	74 (61.2)
experience	No	47 (38.8)
Number of denture	1	44 (59.5)
experience times	2	17 (23.0)
(n=74)	≥3	13 (17.6)
Cognition to cost	Cheap	6 (8.1)
(n=74)	Reasonable	23 (31.1)
	Expensive	34 (45.9)
	Too expensive	11 (14.9)
Place of care (n=74)	Dental hospitalㆍclinic	45 (60.8)
	Public health center	2 (2.7)
	Unlicensed facility	27 (36.5)
Denture charge	Satisfaction	70 (57.9)
Denture charge	Dissatisfaction	51 (42.1)

Table 4.

The change of OHIP-14 level at pre and post experienced the insurance coverage denture project (Mean±S.D.)

	Pre	Post	Difference	P
OHIP-14	37.2±10.8	54.4±9.8	+17.2	<0.001
Functional limit	4.7±1.8	7.5±1.7	+2.81	<0.001
Physical pain	4.8±1.8	7.3±1.8	+2.51	<0.001
Emotional discomfort	5.4±2.1	7.8±1.6	+2.42	<0.001
Physical function	5.0±1.9	7.7±1.6	+2.66	<0.001
Mental function	5.6±1.9	7.9±1.5	+2.35	<0.001
Social function	5.9±1.9	8.0±1.4	+2.09	<0.001
Social separation	5.8±2.1	8.1±1.5	+2.37	<0.001

P by paired t-test, Total OHIP score is out of 70, the seven sub categories is out of 10.

Table 5.

The change of symptoms and discomforts at pre and post experienced the insurance coverage denture project No. (%)

Symptom and discomfort	Pre	Post	P
Often swelling, pain or bleeding	45 (37.2)	17 (14.0)	<0.001
Broken teeth &/or denture	53 (43.8)	6 (5.0)	<0.001
Pain &/or cold sensation when	40 (33.1)	15 (12.4)	<0.001
eating
Pain &/or cold sensation when	33 (27.3)	11 (9.1)	<0.001
brushing
Dull or tingling pain, usual time	54 (44.6)	19 (15.7)	<0.001
Dull or tingling pain, tongue &/	52 (43.0)	19 (15.7)	<0.001
or cheek
Halitosis (bad odor)	52 (43.0)	24 (19.8)	<0.001
No. of symptom and discomfort	2.72±2.07	0.96±1.28	<0.001
(out of 7)

P by chi-square test.

Table 6.

Satisfaction after experienced the insurance coverage denture project by the subject’s characteristics (Mean±S.D.)

Characteristics	Classification	Self rated satisfaction	Total satisfaction
Gender	Men (n=44)	3.8±1.0	74.2±17.5
	Women (n=77)	3.8±1.0	74.9±14.0
	P	0.852	0.821
Age (years)	<80 (n=84)	3.8±1.1	74.8±16.3
	≥80 (n=37)	3.8±0.9	74.3±12.7
	P	0.888	0.866
Education	No, Elementary (n=78)	3.9±0.9	76.0±12.7
	Middle, High (n=38)	3.7±1.1	72.1±19.1
	Over college (n=5)	3.6±1.1	72.6±20.3
	P	0.504	0.418
Income	Yes (n=39)	3.6±1.2	70.8±15.7
	No (n=82)	3.9±0.9	76.4±14.8
	P	0.128	0.059
Oral health status	Fair (n=15)	3.9±1.1	77.7±16.5
	Bad (n=106)	3.8±1.0	74.2±15.1
	P	0.843	0.407
Previous oral health education	Yes (n=31)	4.0±0.9	77.1±15.1
	No (n=90)	3.8±1.0	73.8±15.3
	P	0.246	0.292
Main medical cost coverage	Self (n=76)	4.0±1.0	76.9±15.9
	Relatives (n=45)	3.5±1.0	70.8±13.5
	P	0.005	0.033
Denture type	Full (n=52)	3.9±1.0	74.9±15.5
	Part (n=69)	3.8±1.0	74.4±15.2
	69 P	0.657	74 4±15 2 0.850
Previous denture experience	PYes (n=74)	0.657 3.8±1.0	0.850 74.4±16.1
	74 No (n=47)	3.9±1.0	74 4±16 1 75.1±14.1
	No (n=47) P	3.9±1.0 0.776	75.1±14.1 0.804
Experience leave alone missed teeth	Yes (n=74)	3.9±1.0	75.6±16.3
	No (n=47)	3.7±1.1	73.2±13.6
	P	0.315	0.408

P by t-test, P¶ by ANOVA. Self rated satisfaction based on the one item with score out of 5, Total satisfaction based on the seven items with score out of 100.

Table 7.

Factors influencing OHIP-14 improvement with over ten score change (multiple logistic regression analysis) (N=121)

	OR (95% CI)	P
Denture type	0.34 (0.13-0.89)	0.029
Previous denture experience	0.43 (0.16-1.12)	0.084
Previous satisfaction to denture cost	0.37 (0.14-0.97)	0.044
Subjective oral health status	0.54 (0.14-2.06)	0.370
Experience leave alone missed teeth	0.86 (0.34-2.18)	0.748
Previous ora health education	1.02 (0.34-3.05)	0.967
Main medical cost coverage	2.98 (1.16-7.66)	0.023

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