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Bomfim RA, de Lucena EHG, Cavalcanti YW, Celeste RK. Racial inequality in complete dental prosthesis delivered: can public services reduce inequities? Clin Oral Investig 2023; 28:17. [PMID: 38135856 DOI: 10.1007/s00784-023-05432-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To investigate the association between access and delivery of complete dental prosthesis according to the proportion of the black population in Brazilian municipalities and to oral health policies. MATERIALS AND METHODS Ecological data from 2017 to 2021 relating to the delivery of complete dentures stratified by race was collected in all Brazilian cities. We calculated a racial inequality indicator by subtracting the percentage of the black population from the percentage of complete dental prostheses that were delivered to blacks in each municipality. Logistic and linear regression models were carried out. RESULTS We found that 49.2% (2737) of municipalities delivered complete prostheses. The service was more frequently available in municipalities where black individuals made up 20-80% (odds ratio [OR] = 1.45, 95% confidence interval [CI] 1.15; 1.81), those with dental specialty centers (DSC) (OR = 3.04, 95%CI 2.50; 3.68), and those with more oral health teams (OHTs) (OR = 3.43, 95%CI 2.81; 4.18). Where dental prostheses were available, racial inequities favored the white population by 7.7 percentage points (p < 0.01). Increased inequality was observed in municipalities with more OHTs and/or a higher proportion of black individuals (>80%). CONCLUSIONS Although municipalities with a DSC, and with more OHTs offer better access to complete dental prosthesis for blacks, racial inequality still impacts the delivery of the service. Primary and secondary healthcare services may even exacerbate this. CLINICAL RELEVANCE Policymakers should monitor racial inequities in healthcare services. The currently unmet needs of black people are critical, especially in cities with more OHTs and/or increased proportions of black people.
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de Souza VGL, Herkrath FJ, Garnelo L, Gomes AC, Lemos UM, Parente RCP, Herkrath APCDQ. Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey. PLoS One 2022; 17:e0277845. [PMID: 36413557 PMCID: PMC9681076 DOI: 10.1371/journal.pone.0277845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence. OBJECTIVE To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas. METHODS A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05. RESULTS 603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss. CONCLUSION Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.
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Affiliation(s)
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
- Superior School of Health Siences, State University of Amazonas, Manaus, Amazonas, Brazil
| | - Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
| | - Andréia Coelho Gomes
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Affonso MVDG, Souza IG, de Rocha ES, Goloni-Bertollo EM, Gomes FDC, do Nascimento LS, de Melo-Neto JS. Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13208. [PMID: 36293789 PMCID: PMC9603184 DOI: 10.3390/ijerph192013208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 06/16/2023]
Abstract
To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age-Period-Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan-Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age-Period-Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams' coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.
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Affiliation(s)
| | - Igor Gonçalves Souza
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | - Emerson Souza de Rocha
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | | | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), Sao Jose do Rio Preto 15090-000, Brazil
| | | | - João Simão de Melo-Neto
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
- School of Physiotherapy and Occupational Therapy, Federal University of Pará (UFPA), Street Augusto Corrêa, 01, Belem 66075-110, Brazil
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Galvão MHR, Souza ACOD, Morais HGDF, Roncalli AG. Inequalities in the profile of using dental services in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2437-2448. [PMID: 35649030 DOI: 10.1590/1413-81232022276.17352021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to examine the influence of socioeconomic factors on inequality in the use of dental services within the Brazilian population. The methodology was based on a sectional study, using secondary data from the 2013 National Health Survey (PNS, in Portuguese). The database contains information on 60,202 individuals over 18 years of age. The dependent variables were "frequency of dental appointments" and "type of dental treatment performed in the last appointment". The independent variables were sex, age group, education, social class measured using the Brazil criterion, and geographic region. The odds-ratio of outcomes were evaluated in the multivariate analysis using a multinomial logistic regression model. It was noticed that the population subgroups comprising Blacks and those residing in the North/Northeast, with lower social class and education, had a greater chance of having irregular follow-up and never having been to the dentist. In addition, this population stratum also had a greater chance of undergoing surgical or emergency dental procedures in the last dental appointment. Data from the 2013 PNS reveal a picture of social inequality in access to dental services in Brazil.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Ava Conceição Oliveira de Souza
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Hannah Gil de Farias Morais
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Angelo Giuseppe Roncalli
- Departamento de Odontologia, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
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de Lucena EHG, da Silva RO, Barbosa ML, de Araújo ECF, Pereira AC, Cavalcanti YW. Influence of socioeconomic status on oral disease burden: a population-based study. BMC Oral Health 2021; 21:608. [PMID: 34847895 PMCID: PMC8638103 DOI: 10.1186/s12903-021-01970-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Dental caries is associated with Biological, behavioral, socioeconomic, and environmental factors; however, socioeconomic status is a distal determinant of dental caries development that modulates exposure to risk and protective factors. This study aimed to analyze the socioeconomic factors associated with the concentration of oral diseases in a population-based study in Brazil.
Methods This is a quantitative, analytical, cross-sectional study based on secondary data from the SB São Paulo 2015 epidemiological survey. A total of 17,560 subjects were included. The concentration of oral disease in the population was estimated by the oral disease burden (ODB) variable. The ODB consists of four components: dental caries; tooth loss; need for dental prosthesis and periodontal condition. Thus, the total score on the ODB could vary between 0 and 4, with the highest score indicating the worst possible situation. ODB was analyzed in multivariate negative binomial regression, and multivariate binary logistic regression analysis. The following factors were included as independent variables: age group, skin color, socioeconomic factors, family income and Oral Impact on Daily Performance (OIDP).
Results In the sample, 86.9% had no minimum ODP component. Negative multivariate binomial regression showed a statistically significant relationship (p < 0.005) between ODB and all variables analyzed (skin color, family income, education, OIDP results and age range). The adjusted multivariate binary logistic regression showed that the individuals most likely to have at least one component of ODB were nonwhite (25.5%), had a family income of up to R$ 1500.00/month (19.6%), had only completed primary education (19.1%), and reported that their oral health had an impact on their daily activities (57.6%). Older adults individuals were two times more likely than adolescents to have an ODB component. Conclusions ODB is associated with factors related to social inequality. Adults and older adults individuals had the highest cumulative number of ODB components.
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Martinelli DLF, Cascaes AM, Frias AC, Souza LBD, Bomfim RA. Oral health coverage in the Family Health Strategy and use of dental services in adolescents in Mato Grosso do Sul, Brazil, 2019: cross-sectional study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e20201140. [PMID: 34854464 DOI: 10.1590/s1679-49742021000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the association between the coverage by oral health teams in the Family Health Strategy (FHS-OH) and the use of dental services among 12-year-old adolescents in the state of Mato Grosso do Sul, Brazil, 2019. METHODS This is a cross-sectional study involving school-based research, which adopted the use of dental services as its outcome. Structural equation modeling was used to test the association between covariates and the outcome. RESULTS Of the 615 participants, 74.0% used dental services in the last three years. ESF-SB (oral health coverage by family health strategy, acronym in Portuguese) ≥50% was associated with a greater use of public dental services [standardized coefficient (SC) = 0.10 -95%CI 0.01;0.18], a lower use of these services for prevention (SC = -0.07 -95%CI -0.17;0.01) and higher unhealthy food consumption (SC = 0.19 -95%CI 0.11;0.26). CONCLUSION Higher ESF-SB coverage was associated with a lower use of dental services for prevention and higher unhealthy food consumption. Teams must organize the access to oral health service and qualify the work process.
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Affiliation(s)
| | - Andreia Morales Cascaes
- Universidade Federal de Santa Catarina, Departamento de Saúde Pública, Florianópolis, SC, Brasil
| | | | | | - Rafael Aiello Bomfim
- Universidade Federal de Mato Grosso do Sul, Faculdade de Odontologia, Campo Grande, MS, Brasil
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Galvão MHR, Medeiros ADA, Roncalli AG. Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis. PLoS One 2021; 16:e0254310. [PMID: 34242338 PMCID: PMC8270158 DOI: 10.1371/journal.pone.0254310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. METHODS The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. RESULTS The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. CONCLUSIONS Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Constante HM, Bastos JL. Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:155-166. [PMID: 33323017 DOI: 10.1177/0020731420979808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.
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Affiliation(s)
- Helena Mendes Constante
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
| | - João Luiz Bastos
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
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Bomfim RA, Schneider IJC, de Andrade FB, Lima-Costa MF, Corrêa VP, Frazão P, Watt RG, Bastos JL, de Oliveira C. Racial inequities in tooth loss among older Brazilian adults: A decomposition analysis. Community Dent Oral Epidemiol 2020; 49:119-127. [PMID: 33051884 DOI: 10.1111/cdoe.12583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.
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Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil.,Public Health School, University of Sao Paulo, Sao Paulo, Brazil
| | - Ione Jayce Ceola Schneider
- Department of Epidemiology & Public Health, University College London, London, UK.,Health Science Department and Rehabilitation Post-graduate Program, Federal University of Santa Catarina, Araranguá, Brazil
| | | | | | - Vanessa Pereira Corrêa
- Health Science Department and Rehabilitation Post-graduate Program, Federal University of Santa Catarina, Araranguá, Brazil
| | - Paulo Frazão
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Richard Geddie Watt
- Department of Epidemiology & Public Health, University College London, London, UK
| | - João Luiz Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
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