Bof de Andrade Fabíola, Antunes José Leopoldo Ferreira, Boing Alexandra Crispim, Andrade Flávia Cristina Drumond, da Cruz Teixeira Doralice Severo, Pavez Paola Carvajal, Mrejen Matías, Gomes Glenda Nunes, Guarnizo-Herreño Carol C
Fundação Oswaldo Cruz, Fiocruz, Instituto René Rachou, Av. Augusto de Lima, 1715, Barro Preto, Belo Horizonte, Minas Gerais, 30190-002, Brazil.
School of Public Health, University of São Paulo, São Paulo, Brazil.
BMC Oral Health. 2025 Sep 1;25(1):1392. doi: 10.1186/s12903-025-06709-5.
The use of dental services is low among older adults, particularly among vulnerable or disadvantaged groups from various countries. Nonetheless, there is a gap in the literature regarding the factors that contribute to inequalities in the use of dental services. This study aimed to evaluate socioeconomic inequalities in recent and preventive use of dental services among older adults in Brazil and evaluate the factors contributing to these inequalities.
This cross-sectional study used data from the 2019 Brazilian National Health Survey. The dependent variables were the use of recent and preventive dental services (among those who reported using dental services within one year prior to the interview). Socioeconomic status was measured by education level [no formal education vs. some education] and household per capita income [low (≤ 1 minimum wage [MW]) vs. higher (≥ 1 MW)]. Explanatory variables included socioeconomic factors [education, household per capita income]; demographic characteristics [sex; age; living alone; rural residence]; general health status [limitations in basic activities of daily living (BADL); multimorbidity]; and oral health [use of prostheses; self-rated oral health; number of teeth; difficulty eating due to teeth or prostheses; dental insurance]. The Oaxaca-Blinder two-fold decomposition for binary outcomes was used to assess the factors contributing to educational and income-related inequalities in the use and preventive use of dental services.
Participants with no formal education and those in the lowest income group had lower recent and preventive use of dental services. The number of teeth was the most significant contributing factor for the observed inequality, accounting for 30.6-51.8% of its increase across models. Difficulty eating made the second largest contribution to the explained inequality gap for preventive use and rural residence contributed to widening the gap for both outcomes.
Socioeconomic inequalities in recent and preventive use of dental services among older adults are mainly explained by the number of remaining teeth, but other demographic, oral health, and health service factors play a role.
老年人对牙科服务的利用率较低，尤其是来自不同国家的弱势群体或处境不利群体。尽管如此，关于导致牙科服务使用不平等的因素，文献中仍存在空白。本研究旨在评估巴西老年人近期和预防性牙科服务使用方面的社会经济不平等，并评估导致这些不平等的因素。
这项横断面研究使用了2019年巴西全国健康调查的数据。因变量是近期和预防性牙科服务的使用情况（在那些报告在访谈前一年内使用过牙科服务的人群中）。社会经济地位通过教育水平[未接受正规教育与接受过一些教育]和家庭人均收入[低（≤1最低工资[MW]）与高（≥1MW）]来衡量。解释变量包括社会经济因素[教育、家庭人均收入]；人口特征[性别、年龄、独居、农村居住]；总体健康状况[日常生活基本活动（BADL）受限、多种疾病并存]；以及口腔健康[假牙使用情况、自评口腔健康、牙齿数量、因牙齿或假牙导致的进食困难、牙科保险]。采用二元结果的奥瓦卡-布林德双重分解法来评估导致牙科服务使用和预防性使用方面教育和收入相关不平等的因素。
未接受正规教育的参与者和最低收入组的参与者近期和预防性牙科服务的使用率较低。牙齿数量是观察到的不平等的最主要促成因素，在各个模型中其增加量占比为30.6 - 51.8%。进食困难对预防性使用方面解释的不平等差距贡献第二大，农村居住对两种结果的差距扩大都有影响。
老年人近期和预防性牙科服务使用方面的社会经济不平等主要由剩余牙齿数量来解释，但其他人口、口腔健康和卫生服务因素也起作用。
