LAUSR

OBJECTIVES To examine variation in the delivery of fluoride varnish during pediatric medical visits by rurality. METHODS This observational study used private health insurance claims (2016-2018) for children aged 1-5 years from Connecticut, Maine, New Hampshire, and Rhode Island linked to the county-level Rural-Urban Continuum codes. County-level Rural-Urban Continuum codes were categorized into three groups: metropolitan, rural, and remote rural. Logistic regression models were used to estimate the odds of a well-child medical visit including fluoride varnish by county rurality, adjusting for other individual and county characteristics. RESULTS Among 328,661 pediatric well-child visits paid by private insurance, fluoride varnish was included in 4.3% of visits in metropolitan counties, 6.2% of visits in rural counties, and 10.3% of visits in remote rural counties. There were significantly higher odds of a visit including fluoride varnish in rural remote counties (odds ratio [OR] = 3.5, 95% confidence interval [CI] = 2.3-5.3, p < 0.001) and in rural counties (OR = 2.4, 95% CI = 1.4-4.0, p < 0.001) compared to metropolitan counties. Rates of fluoride varnish during well-child visits increased since 2016 in metropolitan counties and remained stable in rural counties. CONCLUSIONS All young children are recommended to receive fluoride varnish applications in medical settings, yet overall rates were low. For privately insured young children, pediatric well-child medical visits were more likely to include fluoride varnish in rural and rural remote counties than metropolitan counties.