Across the United States: Wealth and Insurance Coverage as Predictors of Delayed Alveolar Bone Graft

Authors

• Hanna Pfershy, Michigan State University College of Human Medicine Medical Student
• Rachel Lee, Michigan State University College of Human Medicine Medical Student
• Jonathan Richard
• Darin Patmon, Plastic Surgery Resident - Corewell Health West
• Elizabeth Bushong, Plastic Surgery Resident - Corewell Health West
• Brooke Dudick, Bioinformatics - Corewell Health West
• Anna Carlson, Pediatrics - Craniofacial Surgery - Corewell Health West
• Jason Pomerantz
• Gregory Fulton
• John Girotto, Corewell Health West - Plastic Surgery

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Prior studies have shown Medicaid insurance status as a predictor for delays in alveolar bone grafting (ABG) at single institutions (1,2). This study aims to study a larger cohort by combining data across three institutions to determine how insurance status, institutional factors, and patient demographics effect a patient's likelihood of receiving timely alveolar bone grafting. These institutions are in three cities and states with vastly different political leanings, median incomes, racial profiles, and population densities.

A retrospective analysis of all patients that received alveolar bone grafting was performed across three institutions. A total of 587 patients were included in the analysis, 251 from Institution #1, 225 from Institution #2, and 111 from Institution #3. Demographic data, insurance status, driving distance, and median income was collected. Age at surgery as a linear variable and binary variable of standard timing (< 12 years) versus late timing (>12 years) was analyzed using Chi-Square, Cochran-Mantel-Haenszel Test, Factor Analysis of Variance, and multiple logistic regression with a significance assessed at α = 0.05.

Results showed 51% of the cohort was male, the average age at surgery was 10.5 years, 29% received ABG after age 12, and 44% had Medicaid insurance. There were higher proportions of male (67% vs. 53%, p< 0.01), Hispanic (23% vs 5.5%, p< 0.0001), and Black/African American (11% vs 2%, p< 0.0001) patients who had Medicaid rather than private insurance. Those with Medicaid were older 11.02 [9.73, 13.48] at the time of surgery compared to those with private insurance 10.28 [9.32, 11.71], p< 0.0001. Those with Medicaid had a higher proportion of late surgeries compared to those with private insurance (38% vs 22%, p< 0.0001). Those with Medicaid had lower absolute median income and lower household median income as a ratio to state median income (HI:SI), p< 0.0001. Results of the logistic regression with late ABG timing as the outcome showed institution, gender, race, median income, and distance to center were not significant predictors.

Our results showed that Medicaid holders were more likely to be male, Hispanic or Black/African American, with lower median household income and have a later age at ABG. Results of this study support that regardless of the institution, patients with Medicaid are more likely to receive their alveolar bone graft after age 12 and that wealth is a predictor of timely care across the country. Further studies are needed to explore how to overcome the delay that patients with Medicaid are facing to provide this patient population with equitable care.

Recommended Citation

Pfershy H, Lee R, Richard R, Patmon D, Bushong E, Dudick B, Carlson A, Pomerantz J, Fulton G, Girotto J. Across the United States: Wealth and insurance coverage as predictors of delayed alveolar bone graft. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1868