School of Dentistry, Federal University of Amazonas, Manaus, Brazil.
Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
J Public Health Dent. 2019 Dec;79(1):60-70. doi: 10.1111/jphd.12295. Epub 2018 Nov 23.
To examine the association of contextual and individual determinants with non-utilization of dental services among Brazilian adults.
Data were from adults aged 35-44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non-utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index-longevity (HDI-Longevity) (predisposing demographic), HDI-Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI-Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non-utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI).
The prevalence of non-utilization of dental services was 4.7 percent. Adults living in cities with high HDI-Income were less likely to never have a dental visit. The odds of non-utilization of dental services were lower for adults living in cities with high HDI-Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non-utilization of dental services.
The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs-related characteristics influence non-utilization of dental services by Brazilian adults.
探讨巴西成年人中，与不利用牙科服务相关的背景和个体决定因素。
数据来自于 2010 年巴西口腔健康调查（SB Brasil 项目）中 35-44 岁的成年人（N=7265）。通过评估个体一生中是否从未进行过牙科就诊来确定是否不利用牙科服务。根据安德森行为模型选择了自变量。背景变量包括人类发展指数-寿命（HDI-Longevity）（倾向于人口统计学）、HDI-教育和基尼指数（倾向于社会）、口腔健康团队整合到初级保健中（有利于卫生政策）以及人类发展指数-收入（有利于融资）。个体数据包括年龄和性别（倾向于人口统计学）、种族和受教育程度（倾向于社会）、家庭月收入（倾向于促进）、对牙科治疗的看法（认为有需要）和龋齿（评估的需要）。通过多层次逻辑回归分析评估背景和个体变量与不利用牙科服务的关系，以估计优势比（OR）和 95%置信区间（95%CI）。
不利用牙科服务的患病率为 4.7%。生活在高人类发展指数收入城市的成年人不太可能从未进行过牙科就诊。生活在高人类发展指数寿命城市的成年人不利用牙科服务的可能性较低。性别、肤色、牙科治疗需求、较差的社会经济特征、对牙科治疗的需求以及龋齿也与不利用牙科服务相关。
结果表明，背景促进因素和倾向因素、个体社会人口统计学和与需求相关的特征会影响巴西成年人不利用牙科服务的情况。
