{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:20:41Z","timestamp":1787757641406,"version":"build-2784847793"},"posted":{"date-parts":[[2026,8,23]]},"group-title":"Public and Global Health","reference-count":10,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"award":["P30AG066619"],"award-info":[{"award-number":["P30AG066619"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,8,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To describe age-group differences in inability to afford dental treatment and cost related dental delay, among the US community-dwelling population.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Study design<\/jats:title>\n                  <jats:p>Descriptive analysis of nationally representative survey data.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    Using nationally representative Medical Expenditure Panel Survey data (2018-2021), we examined trends in inability to afford dental treatment and cost-related dental treatment delays across four age groups (2-17, 18-39, 40-64, \u226565 years). Weighted analyses accounted for the complex survey design; statistical significance was set at\n                    <jats:italic>p<\/jats:italic>\n                    &lt;0.001.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Cost-related delays declined modestly from 2018 to 2021 but remained most prevalent among adults aged 40-64 (4.8% for ages 40-64, 3.4% for ages 18-64, 2.2% for ages\u226565 in 2021; p&lt;0.001).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Middle-aged adults seem to experience delays due to cost, underscoring the need for dental coverage to expand dental coverage for this group and to reduce their out-of-pocket costs.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.08.22.26361060","type":"posted-content","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T05:30:13Z","timestamp":1787549413000},"source":"Crossref","is-referenced-by-count":0,"title":["Trends in Why Americans Delayed Dental Care From Pre-Pandemic to the COVID-19 Era: Implications for Aging and Oral Public Health"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1521-9809","authenticated-orcid":false,"given":"Preeti Pushpalata","family":"Zanwar","sequence":"first","affiliation":[{"name":"Center for Healthy Aging Behaviors and Longitudinal Investigations (CHABLIS), The University of Chicago, 5801 S Ellis Ave, Chicago, IL 60637, United States"},{"name":"Hopkins Economics of Alzheimer\u2019s Disease & Related Dementias, John Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 2120, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay Sureshbhai","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration and Policy, Barnett College of Public Health, Temple University, 1210 W. Berks St., Philadelphia, PA 19122, United States"},{"name":"Kornberg School of Dentistry, Temple University, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026082607450525000_2026.08.22.26361060v1.1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13189"},{"key":"2026082607450525000_2026.08.22.26361060v1.2","doi-asserted-by":"publisher","DOI":"10.1177\/2380084420962778"},{"key":"2026082607450525000_2026.08.22.26361060v1.3","doi-asserted-by":"publisher","DOI":"10.1177\/23800844231165016"},{"key":"2026082607450525000_2026.08.22.26361060v1.4","doi-asserted-by":"publisher","DOI":"10.64898\/2026.02.07.26345812"},{"key":"2026082607450525000_2026.08.22.26361060v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2015.12.004"},{"key":"2026082607450525000_2026.08.22.26361060v1.6","unstructured":"Williams E , Rudowitz R. Variation in use of dental services by children and adults enrolled in Medicaid and CHIP. Kaiser Family Foundation. Published May 29, 2024. Accessed August 21, 2026. https:\/\/www.kff.org\/medicaid\/variation-in-use-of-dental-services-by-children-and-adults-enrolled-in-medicaid-orchip\/"},{"key":"2026082607450525000_2026.08.22.26361060v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2017.05.017"},{"issue":"1","key":"2026082607450525000_2026.08.22.26361060v1.8","first-page":"17","article-title":"Employment patterns of dental hygienists in the United States during the COVID-19 pandemic","volume":"95","year":"2021","journal-title":"J Dent Hyg"},{"key":"2026082607450525000_2026.08.22.26361060v1.9","unstructured":"Medical Expenditure Panel Survey. Agency for Healthcare Research and Quality. Accessed August 21, 2026. https:\/\/meps.ahrq.gov\/mepsweb\/"},{"key":"2026082607450525000_2026.08.22.26361060v1.10","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306534"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.08.22.26361060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:15Z","timestamp":1787755515000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.08.22.26361060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":10,"URL":"https:\/\/doi.org\/10.64898\/2026.08.22.26361060","relation":{},"subject":[],"published":{"date-parts":[[2026,8,23]]},"subtype":"preprint"}}