Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus, Amazonas, 69065-001, Brazil.
Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
BMC Public Health. 2020 Jun 17;20(1):953. doi: 10.1186/s12889-020-09100-x.
The utilisation of health services is determined by complex interactions. In this context, rural populations face greater barriers in accessing dental services than do urban populations, and they generally have poorer oral health status. The evaluation of the determinants of health services utilisation is important to support planning and management of dental services. The aim of this study was to evaluate the predictors of dental services utilisation of Brazilian adults living in rural and urban areas.
Data from 60,202 adults aged 18 years or older who took part in the Brazilian National Health Survey carried out in 2013 were analysed. Predisposing (age, sex, education, social networks), enabling financing (income, durable goods and household's crowding), enabling organisation (health insurance, registration in primary health care [PHC]) and need variables (eating difficulties, self-perceived tooth loss and self-perceived oral health) were selected based upon the Andersen behavioural model. Multi-group structural equation modeling assessed the direct and indirect associations of independent variables with non-utilisation of dental services and the interval since the last dental visit for individuals living in rural and urban areas.
Adults living in urban areas were more likely to use dental services than those living in rural areas. Lower enabling financing, lower perceived dental needs and lack of PHC registration were directly associated with lower utilisation of dental services (non-utilisation, β = - 0.36, β = - 0.16, β = - 0.03, respectively; and interval since last dental visit, β = 1.25, β = 0.82, β = - 0.12, respectively). The enabling financing (non-utilisation, β = - 0.02 [95%CI: - 0.03 to - 0.02], β = 0.00 [95%CI: - 0.01 to 0.00]) and PHC registration (non-utilisation, β = - 0.03 [95%CI: - 0.04 to - 0.02], β = - 0.01 [95%CI, - 0.01 to - 0.01]) non-standardised total effects were stronger in rural areas. Enabling organisation (β = 0.16) and social network (β = - 2.59) latent variables showed a direct effect on the interval since last dental visit in urban areas. Education and social networks influenced utilisation of dental services through different pathways. Males showed less use of dental services in both urban and rural areas (non-utilisation, β = - 0.07, β = - 0.04; interval since last dental visit, β = - 0.07, β = - 0.07) and older adults have used dental services longer than younger ones, mainly in rural areas (β = 0.26, β = 0.17).
Dental services utilisation was lower in rural areas in Brazil. The theoretical model was supported by empirical data and showed different relationships between the predictors in the two geographical contexts. In rural areas, financial aspects, education, primary care availability, sex and age were relevant factors for the utilisation of services.
卫生服务的利用受到复杂相互作用的影响。在这种情况下，农村人口在获得牙科服务方面面临比城市人口更大的障碍，而且他们的口腔健康状况普遍较差。评估卫生服务利用的决定因素对于支持牙科服务的规划和管理很重要。本研究的目的是评估居住在农村和城市地区的巴西成年人牙科服务利用的预测因素。
对 2013 年巴西全国健康调查中 60202 名年龄在 18 岁及以上的成年人的数据进行了分析。根据安德森行为模型选择了倾向因素（年龄、性别、教育、社会网络）、促进因素（收入、耐用商品和家庭拥挤）、组织因素（健康保险、初级卫生保健登记）和需要变量（进食困难、自我感知牙齿缺失和自我感知口腔健康）。多组结构方程模型评估了独立变量对居住在农村和城市地区的个体未使用牙科服务和上次牙科就诊间隔的直接和间接关联。
居住在城市地区的成年人比居住在农村地区的成年人更有可能使用牙科服务。较低的促进资金、较低的感知牙科需求和缺乏初级保健登记与较低的牙科服务利用直接相关（未利用，β=−0.36，β=−0.16，β=−0.03；上次牙科就诊间隔，β=1.25，β=0.82，β=−0.12）。促进资金（未利用，β=−0.02[95%CI：−0.03 至−0.02]，β=0.00[95%CI：−0.01 至 0.00]）和初级保健登记（未利用，β=−0.03[95%CI：−0.04 至−0.02]，β=−0.01[95%CI，−0.01 至−0.01]）的非标准化总效应在农村地区更强。在城市地区，促进组织（β=0.16）和社会网络（β=−2.59）潜变量对上次牙科就诊间隔有直接影响。教育和社会网络通过不同途径影响牙科服务的利用。男性在城市和农村地区都较少使用牙科服务（未利用，β=−0.07，β=−0.04；上次牙科就诊间隔，β=−0.07，β=−0.07），老年人比年轻人使用牙科服务的时间更长，主要是在农村地区（β=0.26，β=0.17）。
巴西农村地区的牙科服务利用率较低。理论模型得到了实证数据的支持，并显示了两个地理背景下预测因素之间的不同关系。在农村地区，财务方面、教育、初级保健的可及性、性别和年龄是服务利用的相关因素。
