Combined associations of education and health literacy with preventive dental visits in patients with diabetes: a nationwide cross-sectional study

Oral health is important in patients with diabetes. While health literacy may promote preventive dental visits, the evidence is sparse among them. Additionally, because education is indicated as a determinant of health literacy, none clarified whether health literacy can mitigate educational inequalities in healthcare-seeking behaviors. We examined combined associations of education and health literacy with preventive dental visits in patients with diabetes.

We used cross-sectional data from the Japan COVID-19 and Society Internet Survey (JACSIS) in 2020. We included 1441 patients reporting to have diabetes currently. Educational level was self-reported. Health literacy was measured using the validated scale. Preventive dental visits in the past 12 months were self-reported. We estimated multivariable-adjusted prevalence ratio (PR) for preventive dental visits.

54% of the participants had preventive dental visits; 35% had high health literacy. Overall, high health literacy was significantly associated with preventive dental visits. Being more educated and/or having high health literacy were associated with an increased prevalence of preventive dental visits (P for trend < 0.001). Compared with less education and low health literacy group, adjusted PRs (95% confidence intervals) of preventive dental visits were 1.10 (0.93, 1.31) for less education and high health literacy group, 1.14 (1.00, 1.30) for more education and low health literacy group, and 1.29 (1.13, 1.48) for more education and high health literacy group.

The present data suggest that health literacy may help promote preventive dental visits and do not deny the possibility that health literacy can mitigate educational inequalities in patients with diabetes.