Epidemiology and Health

Original Articles

Social capital and regional influences: key predictors of unmet dental care needs among older adults in Korea: Ji-Yeon Lim, Ju-Mi Lee, Hae-Sung Nam; Epidemiol Health. 2025;47:e2025025. Published online May 7, 2025; DOI: https://doi.org/10.4178/epih.e2025025

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Abstract

OBJECTIVES
Access to dental services is essential for improving quality of life, and social capital plays a key role in facilitating that access. This study aimed to identify individual-level and regional-level factors, including social capital, that predict unmet dental care needs among older adults.

METHODS

We analyzed data from 59,414 older adults obtained from the 2023 Korea Community Health Survey and the Korean Statistical Information Service, employing a 2-level multilevel model. The dependent variables comprised 3 types of unmet dental care needs: overall, due to lack of acceptability, and due to economic reasons. Twelve independent variables, including social capital and other individual and regional factors, were examined.

RESULTS

The prevalence of unmet needs was 14.15% overall, 8.70% for acceptability reasons, and 4.85% for economic reasons. Lower individual social capital was associated with higher odds of unmet dental care needs, whereas regional social capital factors demonstrated no significant association. Residing in regions with higher fiscal independence ratios was related to an increased likelihood of economic unmet needs (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.09 to 1.52). In contrast, a greater density of dentists per 10,000 population was inversely associated with overall and acceptability-related unmet needs (OR, 0.82 for both; 95% CI, 0.73 to 0.92 and 0.73 to 0.93, respectively).

CONCLUSIONS

Individual social capital and specific regional factors—namely, fiscal independence and density of dentists—may represent important determinants of unmet dental care needs among older adults. Policy interventions aimed at reducing unmet needs should consider these variables.

Summary

Korean summary
· 낮은 사회적 자본(이웃에 대한 낮은 신뢰, 적은 연락빈도, 배우자의 부재, 낮은 사회참여)은 노인의 미충족 치과의료경험을 증가시킨다. · 지역의 높은 재정자립도는 경제성 결여로 인한 미충족 치과의료경험을 증가시키며, 인구 1만명당 치과의사수가 높을수록 전체, 수용성 결여로 인한 미충족 치과의료경험을 감소시킨다.

Key Message
· Lower social capital (lower levels of trust in neighbors, less frequent contact, absence of a spouse, and lack of social participation) increases the risk of unmet dental care needs among older adults. · Higher regional fiscal independence increases unmet dental care needs due to economic reasons, while a greater density of dentists reduces overall unmet dental care needs and those due to lack of acceptability.

Citations

Citations to this article as recorded by

Mobility Limitations and Self-Perceived Unmet Dental Needs Among Korean Adults: A Nationwide Multilevel Analysis for Integrated Care
Han-Nah Kim, Nam-Hee Kim
International Dental Journal.2026; 76(2): 109371. CrossRef

Validity analysis on merged and averaged data using within and between analysis: focus on effect of qualitative social capital on self-rated health: Sang soo Shin, Young-jeon Shin; Epidemiol Health. 2016;38:e2016012. Published online April 8, 2016; DOI: https://doi.org/10.4178/epih.e2016012

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents’ survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis.

METHODS

Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents’ responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result.

RESULTS

Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, p<0.001), although there was no substantial difference in comparison to analysis using SC variables without cluster mean centering or multi-level analysis.

CONCLUSIONS

As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.

Summary

Korean summary
이 연구는 개인의 주관적 건강감에 미치는 지역 사회 자본의 효과를 보기 위하여 개인 응답치의 합산 평균한 자료를 지역 변인으로 활용하는 것이 타당한지 WABA 를 수행하였다. 분석 결과 다수준 분석을 하는 것이 적절치 않았으며 개인 수준의 사회자본에서 지역 수준의 사회자본을 뺀 값을 단수준 분석에 활용할 것을 제안하였다.

Citations

Citations to this article as recorded by

Progressing Discourse From “How Much a Human’s Life is Cultural?” to “Which Life Domains Are Cultural?”
Ewa Palikot, Brian W. Haas, Kuba Kryś
Journal of Cross-Cultural Psychology.2025;[Epub] CrossRef
Social capital and physical health: An updated review of the literature for 2007–2018
Justin Rodgers, Anna V. Valuev, Yulin Hswen, S.V. Subramanian
Social Science & Medicine.2019; 236: 112360. CrossRef
Kennedy’s disease 1234 scale: Preliminary design and test
Ming Lu, Haixiao Guo, Dongsheng Fan
Journal of Clinical Neuroscience.2017; 40: 185. CrossRef

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