Postgraduate Program in Dental Sciences, Federal University of Santa Maria, Santa Maria, RS, Brazil.
College of Dentistry, Department of Epidemiology and Health Promotion, New York University, New York, NY, USA.
J Dent. 2024 Jul;146:105008. doi: 10.1016/j.jdent.2024.105008. Epub 2024 Apr 27.
To carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010 and 2019 worldwide.
This ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older.
Countries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18,972.1; 95 %CI 15,960.0 - 21,984.3) and 2010 (16,646.8; 95 %CI: 14,218.3-19,075.4) than those with high government expenditure on health in 2000 (25,196.6; 95 %CI: 23,226.9 - 27,166.2) and 2010 (21,014.7; 95 %CI: 19,317.9 - 22,711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95 %CI: 260.1- 381.9), 2010 (332.0; 95 %CI: 267.7-396.3), and 2019 (331.6; 95 %CI: 266.6-396.5).
The findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism.
This model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.
全面描述 2000 年、2010 年和 2019 年全球健康宏观决定因素对无牙颌的影响。
本生态研究分析了全球疾病负担研究（GBD）的数据，以描述 204 个国家和地区的健康宏观决定因素（治理、宏观经济政策、社会政策、公共政策、社会价值观）导致的无牙颌发病率、患病率和伤残调整寿命年（YLD）率。这些估计值以每 10 万人中有多少例（病例数/10 万人）报告，针对 55 岁及以上的男女。
在所有暴露因素中，属于健康宏观决定因素最不利类别的国家，其无牙颌的患病率、发病率和 YLD 率最低。在 2000 年（18972.1；95%CI：15960.0-21984.3）和 2010 年（16646.8；95%CI：14218.3-19075.4），卫生支出低的国家的无牙颌患病率低于卫生支出高的国家，而在 2000 年（25196.6；95%CI：23226.9-27166.2）和 2010 年（21014.7；95%CI：19317.9-22711.5），SDI 较低的国家 YLDs 最低。在 2000 年（321.0，95%CI：260.1-381.9）、2010 年（332.0；95%CI：267.7-396.3）和 2019 年（331.6；95%CI：266.6-396.5），SDI 较低的国家 YLDs 最低。
研究结果表明，全球各国之间无牙颌的分布存在持续的不平等。经济发展水平较高、治理较好、社会和公共政策较好的最富裕国家，无牙颌发病率较高。
该模型必须通过推进上游和中游战略来重新考虑，而不仅仅是传统的下游临床干预。
