Abstract / Summary
Abstract Background Dental care in Switzerland is largely excluded from mandatory health insurance, and many cantons rely on school-based screening to promote equitable access to preventive care for children. We evaluated whether dental care utilization among screened children varies by socioeconomic position across three regional screening systems in the Canton of Valais, Switzerland. Methods We conducted a retrospective, registry-linked study combining an ecological (municipality-level) and an individual (patient-year-level) analysis of dental service utilization across three regionally distinct screening systems (Haut-Valais and Valais Romand, school-based; Cabinet, chairside), 2021–2025. Dental service records (n = 1,203,543; 46,845 patients) were linked to the cantonal screening registry. The primary sample comprised 66,418 screened patient-years, aggregated to 273 municipalities across three service categories for the primary rate-based regression; a supplementary negative binomial model used the same patient-years without aggregation. Socioeconomic position was assessed using the Swiss Neighbourhood Index of Socioeconomic Position (Swiss-SEP), with multiple testing addressed using the Holm correction. Results Municipality-mean Swiss-SEP was not associated with utilization rate in any service category after Holm correction (diagnostic: coefficient = 0.038, 95% CI − 0.240 to 0.316, p = 0.787; treatment: coefficient = 0.024, 95% CI − 0.090 to 0.138, p = 0.681; elective: coefficient = 0.043, 95% CI − 0.288 to 0.374, p = 0.801). In a supplementary, exploratory patient-year negative binomial model, a socioeconomic gradient was detected for curative/treatment consultations (incidence rate ratio = 0.58, 95% CI 0.43–0.78, highest vs lowest quintile, p < 0.001) but not for diagnostic (p = 0.724) or elective consultations (p = 0.951). Screening system, rather than socioeconomic position, was the more consistent predictor of utilization. Conclusions Dental screening reaches children equitably at the diagnostic stage across socioeconomic groups in the Canton of Valais. At the pre-specified municipality-rate level, utilization showed no socioeconomic gradient in any service category. A gradient concentrated in curative treatment was detected only in an individual-level count model that does not appropriately represent utilization as a rate and should be treated as provisional pending replication in an adequately powered analysis. These findings support continued investment in universal school-based screening as a mechanism for equitable diagnostic contact.