The association of social determinants of health with dental care use and expenditures among older adults in the United States

Background Oral health is a critical component of overall health, yet older adults in the United States continue to face persistent disparities in dental care access and utilization, largely shaped by social determinants of health (SDOH). Objective This study examined the influence of key SDOH factors on dental care utilization and expenditures among noninstitutionalized adults aged 65 years and older using cross-sectional data from the 2022 Medical Expenditure Panel Survey (MEPS). Methods Education, poverty level, marital status, dental insurance coverage, and geographic region were evaluated as primary SDOH variables. Dental care use and expenditures were modeled using a two-part approach in which multivariable logistic regression estimated the likelihood of any dental care utilization and a generalized linear model with log link and gamma distribution assessed total expenditures among users, with marginal effects calculated to estimate combined impacts. Results In 2022, 52.5% of older adults reported at least one dental visit, and the average expenditure among users was $1,016. Lower education (adjusted odds ratio [aOR] = 0.25; 95% CI: 0.18, 0.35) and poverty (aOR = 0.51; 95% CI: 0.38, 0.69) were associated with lower dental care use and reduced expenditures (−$161 and −$303, respectively), whereas private dental insurance was associated with higher utilization (aOR = 1.76; 95% CI: 1.42, 2.17) and greater expenditures (+$157). Conclusions These findings indicate that structural socioeconomic factors remain strongly associated with dental care access and financial burden among older adults and support the need for policies that integrate oral health into Medicare and broader national strategies to improve access and outcomes.