Silva Janmille Valdivino da, Oliveira Angelo Giuseppe Roncalli da Costa
Universidade Federal do Rio Grande do Norte. Faculdade de Odontologia. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil.
Universidade Federal do Rio Grande do Norte. Faculdade de Odontologia. Departamento de Saúde Coletiva. Natal, RN, Brasil.
Rev Saude Publica. 2018 Apr 9;52:29. doi: 10.11606/S1518-8787.2018052000361.
To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health.
A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights.
Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis.
Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.
分析个体特征与社会环境如何共同影响口腔健康的自我认知。
采用多层次横断面研究，数据来源于2013年巴西国家卫生调查、联合国开发计划署以及国家卫生机构登记处。根据研究框架，将“口腔健康认知”结果的解释变量分为生物学特征（性别、肤色、年龄）、近端社会决定因素（识字率、家庭拥挤程度和社会经济分层）和远端因素（18岁时的预期受教育年限、基尼系数、人类发展指数和人均收入）。进行了上述分析，并进行了双变量泊松分析和多层次泊松分析，以构建口腔健康认知的解释模型。所有分析均考虑了样本权重。
在双变量分析中，生物学特征以及近端和远端社会决定因素均与口腔健康认知相关。口腔健康状况较差的患病率较高与预期受教育年限较低（PR = 1.31）、人均收入较低（PR = 1.45）、收入集中度较高（PR = 1.41）以及人类发展状况较差（PR = 1.45）相关。相反，初级和二级保健中的口腔健康服务与口腔健康认知呈负相关。在多层次分析中，除读写能力外，所有生物学和个体社会特征与人类发展指数的远端社会决定因素以及基本保健覆盖率共同构成了最终的解释模型。
生物学因素、个体和背景社会决定因素与人群的口腔健康认知协同相关。有必要改善个体生活条件并实施公共社会政策，以改善人群的口腔健康。
