Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Dental Research Division, Guarulhos University, São Paulo, Brazil.
Community Dent Oral Epidemiol. 2023 Oct;51(5):829-837. doi: 10.1111/cdoe.12771. Epub 2022 Jul 7.
Tooth loss is a worldwide public health problem affecting mainly socioeconomically disadvantaged groups. Dental services utilization may increase access to preventive actions and conservative treatment, reducing the prevalence of tooth loss. This study evaluated the income- and education-based inequalities in edentulism according to the utilization of dental services among adults and older adults in Brazil.
Data from the National Oral Health Survey (SB Brazil, 2010) of adults (ages 35-44 years, n = 9779) and older adults (ages 65-74 years, n = 7619) were analysed. Socioeconomic indicators (SES) included education and income. The magnitude of inequality in edentulism by education and income levels was estimated by the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). The changes in the RII and SII according to the utilization of dental services were estimated. Regression models estimated the association between SES and edentulism and whether dental services utilization modified this association.
Higher edentulism prevalence was observed among those with lower education and income levels. The utilization of dental services changed the education-based inequality index in edentulism for adults, with percentage changes of 17.4% (RII) and 56.8% (SII). For adults with low education (0-4 years of study), the odds of edentulism were 80% (OR 0.2; 95% CI 0.1-0.6) and 90% (OR 0.1; 95% CI 0.01-0.2) lower for those who had used dental services within the preceding year and within 1-2 years compared with those who had used such services within the preceding 3 or more years, respectively.
There was a social gradient in the prevalence of edentulism in adults and older adults, and the education-based inequalities in edentulism were lower among adults reporting utilization of dental services in the preceding year.
牙齿缺失是一个全球性的公共卫生问题，主要影响社会经济弱势群体。牙科服务的利用可能会增加获得预防措施和保守治疗的机会，从而降低牙齿缺失的发生率。本研究评估了巴西成年人和老年人中，根据牙科服务的利用情况，收入和教育基础的无牙颌不平等现象。
分析了 2010 年巴西全国口腔健康调查（SB Brazil）中成年人（35-44 岁，n=9779）和老年人（65-74 岁，n=7619）的数据。社会经济指标（SES）包括教育程度和收入。通过相对不平等指数（RII）和不平等斜率指数（SII）来评估无牙颌在教育和收入水平上的不平等程度。根据牙科服务的利用情况，估计 RII 和 SII 的变化。回归模型估计 SES 与无牙颌的关联，以及牙科服务的利用是否改变了这种关联。
受教育程度和收入水平较低的人群中，无牙颌的患病率较高。牙科服务的利用改变了成年人中无牙颌的教育基础不平等指数，变化幅度分别为 17.4%（RII）和 56.8%（SII）。对于受教育程度较低（0-4 年）的成年人，在过去一年和过去 1-2 年中使用过牙科服务的人群中，无牙颌的可能性分别降低了 80%（OR 0.2；95%CI 0.1-0.6）和 90%（OR 0.1；95%CI 0.01-0.2），而在过去 3 年或更长时间内使用过牙科服务的人群中，无牙颌的可能性则分别降低了 80%（OR 0.2；95%CI 0.1-0.6）和 90%（OR 0.1；95%CI 0.01-0.2）。
成年人和老年人中无牙颌的患病率存在社会梯度，在过去一年中报告使用过牙科服务的成年人中，无牙颌的教育基础不平等程度较低。
