School of Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil.
Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK.
Int J Environ Res Public Health. 2020 Mar 30;17(7):2345. doi: 10.3390/ijerph17072345.
This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65-74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.
本研究旨在检验社会环境和个体社会经济地位与巴西 65-74 岁老年人牙齿缺失之间的关联。本研究的数据来源于巴西全国口腔健康调查（2010 年）的 5435 名老年人，这些数据与 27 个州府城市和联邦区的城市级别数据相关联。牙齿缺失情况根据天然缺失牙的数量进行临床评估。社会环境变量包括人类发展指数收入（HDI-收入）和人类发展指数教育（HDI-教育）。个体社会经济衡量指标包括家庭月收入和受教育年限。协变量包括性别、肤色、每个房间的居民人数和商品数量。采用多水平负二项回归模型来估计牙齿缺失与社会环境和个体变量之间的比率比（RR）和 95%置信区间。社会环境和个体收入和教育措施与牙齿缺失之间始终存在关联。生活在人类发展指数收入和人类发展指数教育水平较低的城市中的老年人，牙齿缺失的可能性分别增加了 21%和 33%。交叉水平交互作用表明，收入和教育水平较低与牙齿缺失之间的关系在城市收入水平和城市教育不平等水平上有所不同。减少收入和教育差距的公共政策以及预防性牙科干预措施对于解决老年人牙齿缺失问题至关重要。
