Soares Anna Rachel Dos Santos, da Cruz Carlos Antonio Gomes, Fonseca Maria Luíza Viana, Chamane Líria Sheila, Chalub Loliza Luiz Figueiredo Houri, Ferreira Raquel Conceição
Department of Social and Community Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Front Oral Health. 2025 Jun 13;6:1557008. doi: 10.3389/froh.2025.1557008. eCollection 2025.
This study analyzed the magnitude of education- and income-based inequalities in functional dentition (FD) among Brazilian adults between 2013 and 2019, considering dental service utilization.
This study based on repeated cross-sectional surveys using secondary data from a probabilistic sample of adults (18-59 years old) who participated in the 2013 and 2019 National Health Survey (NHS). Only individuals who reported having used dental services were included. FD was defined as having ≥21 teeth, based on self-reported tooth loss in the maxillary and mandibular arches. Variables included sex, age, education (years of study), and per capita family income (measured in minimum wages). Dental service utilization was assessed using the question "When was the last time you visited a dentist?" with responses dichotomized into ">1 year" and "≤1 year". Absolute and relative inequalities in FD were assessed using the slope index of inequality (SII) and the relative index of inequality (RII), respectively, based on education and income. Generalized linear models (log-binomial regression) were applied with a logarithmic link function to estimate RII (rate ratios) and an identity link function to estimate SII (rate differences), adjusting for sex and age. Trends between 2013 and 2019 and differences in SII and RII by dental service utilization were assessed through two-way interaction terms in the models. All analyses accounted for the survey's complex sampling design and sample weights.
The prevalence of FD was 85.95% (2013) and 89.45% (2019) ( < 0.001). SII and RII indicated greater FD prevalence among higher socioeconomic groups, with the magnitude of education-based inequality higher than income-based inequality. Education-based inequalities decreased from 2013-2019. Educational inequalities were more pronounced among those who used dental services >1 year ( < 0.001), whereas income-based inequalities did not differ by dental service utilization ( > 0.05).
Despite the reduction in FD education-based inequality in Brazil, persistent disparities were observed between socioeconomic groups, with the lowest inequalities found among adults who used dental services ≤1 year. This indicates the importance of interventions aimed at reducing barriers and promoting access to services for the most vulnerable populations.
本研究分析了2013年至2019年巴西成年人中基于教育和收入的功能性牙列（FD）不平等程度，并考虑了牙科服务的利用情况。
本研究基于重复横断面调查，使用了来自参与2013年和2019年全国健康调查（NHS）的成年人（18 - 59岁）概率样本的二手数据。仅纳入报告使用过牙科服务的个体。基于上颌和下颌牙弓自我报告的牙齿缺失情况，FD被定义为拥有≥21颗牙齿。变量包括性别、年龄、教育程度（学习年限）和家庭人均收入（以最低工资衡量）。使用问题“您上次看牙医是什么时候？”评估牙科服务利用情况，回答分为“>1年”和“≤1年”。分别基于教育程度和收入，使用不平等斜率指数（SII）和不平等相对指数（RII）评估FD的绝对和相对不平等。应用广义线性模型（对数二项回归），使用对数连接函数估计RII（率比），使用恒等连接函数估计SII（率差），并对性别和年龄进行调整。通过模型中的双向交互项评估2013年至2019年的趋势以及SII和RII在牙科服务利用方面的差异。所有分析都考虑了调查的复杂抽样设计和样本权重。
FD的患病率在2013年为85.95%，在2019年为89.45%（<0.001）。SII和RII表明社会经济地位较高的群体中FD患病率更高，基于教育的不平等程度高于基于收入的不平等程度。2013 - 2019年基于教育的不平等有所下降。在使用牙科服务超过1年的人群中，基于教育的不平等更为明显（<0.001），而基于收入的不平等在牙科服务利用方面没有差异（>0.05）。
尽管巴西基于教育的FD不平等有所减少，但社会经济群体之间仍存在持续差异，在使用牙科服务≤1年的成年人中不平等程度最低。这表明旨在减少障碍并促进最脆弱人群获得服务的干预措施的重要性。
