Amaral Júnior Orlando Luiz do, Fagundes Maria Laura Braccini, Bastos Lucelen Fontoura, Menegazzo Gabriele Rissotto, Hugo Fernando Neves, Abreu Lucas Guimarães, Iser Betine Pinto Moehlecke, Hilgert Juliana Balbinot, Giordani Jessye Melgarejo do Amaral
Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stoatology, Santa Maria, RS, Brazil.
Centro Universitário FAI - UCEF, School of Dentistry, Department of Oral Health, Itapiranga, SC, Brazil.
Braz Oral Res. 2023 Jan 16;36:e094. doi: 10.1590/1807-3107bor-2022.vol36.0094. eCollection 2023.
Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the "Patient Health Questionnaire-9") and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.
口腔疾病的决定因素包括行为，而行为又受到一系列社会决定因素的影响，如心理社会因素和牙科护理服务。因此，本研究的目的是调查抑郁症状和牙科护理服务的使用是否介导了社会经济地位（SES）与口腔健康行为之间的关系。这是一项横断面研究，分析了2019年全国健康调查（PNS）参与者的数据（n = 88,531）。纳入标准为18岁及以上的个体，排除标准为居住在特殊或人口稀少的普查区域的家庭。采用结构方程模型（SEM）来测试从SES的潜在变量通过抑郁症状（通过“患者健康问卷-9”评估）和牙科护理服务的使用到口腔健康的直接和间接途径。使用了具有稳健标准误差的复杂样本的最大似然估计器。最终模型呈现出良好的拟合度：RMESA为0.008，CFI为0.998，SMRM为0.005。结果表明，较高的SES与更好的口腔健康相关行为直接相关[标准化系数（SC）：0.428；p < 0.01]，并通过抑郁症状间接相关[（SC）：0.002；p < 0.01]和牙科护理服务间接相关[（SC）：0.089；p < 0.01]。SES对口腔健康相关行为的总效应等于[（SC：0.519（p < 0.01）]。总之，研究结果表明，由抑郁症状和牙科护理服务介导的高社会经济地位对口腔健康有积极影响。
