Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
J Dent Res. 2024 Aug;103(9):863-869. doi: 10.1177/00220345241258459. Epub 2024 Aug 5.
In 2020, the Brazilian federal government launched the "Prevent Brazil" program to incentivize cities to improve their performance across 7 health care indicators, including prenatal dental care. Our study examines the impact of this policy on the use of oral health care among pregnant women in Brazil. We used a series of cross-sectional data from the Brazilian Public Health System from 2018 to 2023. We linked publicly available data from the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. Our outcome was the proportion of pregnant women receiving prenatal care who had at least 1 dental visit during the past year. Covariates included city-level socioeconomic (income and literacy), demographic (gender, race, and urban areas), and workforce variables (number of dentists working in the public health system per city/year). We estimated the impact of the policy on prenatal dental visits nationwide and stratified by geographic region using interrupted time-series analysis. Our analyses included 99.9% of all Brazilian cities ( = 5,562). The use of oral health care among pregnant women increased from 15% in 2018 to 69% in 2023. Adjusted estimates show that, after initiation of the Prevent Brazil, dental care use among pregnant women increased nationally at a rate of 4.6 percentage points per 4-mo period (95% confidence interval [CI] 4.5; 4.7). The policy's largest impact was in the North and Northeast regions, which have the lowest socioeconomic profiles (adjusted time-series rate 5.7 [95% CI 5.3; 6.1] and 5.2 [5.0; 5.4] percent points, respectively). Our findings support the positive impact of the Prevent Brazil policy on prenatal dental care in Brazil. The policy was associated with a countrywide improvement in prenatal dental care use, with a greater impact in socioeconomically disadvantaged regions.
2020 年，巴西联邦政府启动了“预防巴西”计划，以激励城市在 7 项医疗保健指标（包括产前牙科保健）上提高绩效。我们的研究考察了该政策对巴西孕妇使用口腔保健的影响。我们使用了 2018 年至 2023 年巴西公共卫生系统的一系列横断面数据。我们将来自巴西卫生部和巴西地理与统计研究所的公开数据进行了链接。我们的结果是在过去一年中至少进行过一次牙科就诊的接受产前保健的孕妇比例。协变量包括城市层面的社会经济（收入和文化程度）、人口统计学（性别、种族和城市地区）和劳动力变量（城市/年公共卫生系统中工作的牙医数量）。我们使用中断时间序列分析估计了该政策对全国产前牙科就诊的影响，并按地理区域进行了分层。我们的分析包括了 99.9%的巴西城市（=5562）。孕妇对口腔保健的使用从 2018 年的 15%增加到 2023 年的 69%。调整后的估计表明，在启动“预防巴西”计划后，全国孕妇的牙科保健使用率以每 4 个月增加 4.6 个百分点的速度增加（95%置信区间[CI]4.5；4.7）。该政策的最大影响是在社会经济状况最差的北部和东北部地区，这些地区的社会经济状况最低（调整后的时间序列率分别为 5.7[95%CI5.3；6.1]和 5.2[5.0；5.4]个百分点）。我们的研究结果支持“预防巴西”计划对巴西产前牙科保健的积极影响。该政策与全国产前牙科保健使用率的提高有关，在社会经济处于不利地位的地区影响更大。
