Socioeconomic inequalities in the use of dental services in Brazil: an analysis of the 2019 National Health Survey

Fagundes, Maria Laura Braccini; Bastos, Lucelen Fontoura; Amaral Júnior, Orlando Luiz do; Menegazzo, Gabriele Rissotto; Cunha, Amanda Ramos da; Stein, Caroline; Abreu, Lucas Guimarães; Hugo, Fernando Neves; Giordani, Jessye Melgarejo do Amaral; Malta, Deborah Carvalho; Iser, Betine Pinto Moehlecke

doi:10.1590/1980-549720210004.supl.2

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Epidemiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. bras. Epidemiol. 24 (suppl 2) • 2021 • https://doi.org/10.1590/1980-549720210004.supl.2 copy

Socioeconomic inequalities in the use of dental services in Brazil: an analysis of the 2019 National Health Survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey.

Methods:

This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance.

Results:

The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval — 95%CI 52.5–53.9) than older adults (34.3%, 95%CI 33.2–34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio — PR=2.02, 95%CI 1.87–2.18) and higher income (PR=1.54, 95%CI 1.45–1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year — between 49.0 and 57.6% of the population.

Conclusion:

Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.

Keywords:
Health surveys; Dental health services; Delivery of health care; Dental care; Health equity

Variables	%*	Use of dental services in the year prior to the interview (95%CI)	Last dentist appointment in the public service (95%CI)	Direct payment for the last dentist appointment (95%CI)	Having dental insurance (95%CI)
Total prevalence	100	48.2 (47.6–48.8)	24.4 (23.5–25.2)	60.1 (59.1–61.0)	12.9 (12.4–13.3)
Gender
Male	46.8	44.1 (43.2–45.0)	22.9 (21.7–24.1)	61.0 (59.7–62.4)	12.9 (12.3–13.6)
Female	53.2	51.7 (50.9–52.5)	25.5 (24.4–26.5)	59.3 (58.1–60.5)	12.8 (12.3–13.4)
Age (years)
18–59	78.4	53.2 (52.5–53.9)	25.1 (24.2–26.1)	58.8 (57.8–59.8)	14.7 (14.1–15.3)
≥60	21.6	34.3 (33.2–34.4)	20.1 (18.6–21.7)	66.9 (65.0–68.8)	7.9 (7.3–8.5)
Formal education
Illiterate	6.1	16.2 (18.0–20.6)	53.9 (49.9–57.9)	40.0 (36.2–44.0)	1.7 (1.3–2.2)
Incomplete elementary school	28.7	33.3 (32.4–43.2)	41.8 (40.0–43.6)	51.0 (49.1–52.9)	4.4 (4.0–4.8)
Complete elementary school	7.8	46.5 (44.7–48.4)	31.0 (28.0–34.1)	58.3 (55.1–61.5)	8.3 (7.3–9.3)
Incomplete high school	6.7	48.7 (46.5–50.8)	33.7 (30.6–36.9)	54.9 (51.5–58.3)	9.1 (7.7–10.8)
Complete high school	29.8	55.3 (54.3–56.4)	22.2 (20.9–23.5)	62.0 (60.4–63.5)	15.7 (14.9–16.5)
Incomplete higher education	5.1	64.4 (61.9–66.9)	13.4 (11.5–15.7)	63.0 (59.7–66.3)	24.8 (22.6–27.2)
Complete higher education	15.8	71.8 (70.6–73.0)	7.5 (6.4–8.7)	68.5 (66.8–70.2)	28.8 (27.5–30.2)
Ethnicity/skin color
Indigenous	0.5	40.6 (34.1–47.4)	42.7 (32.6–53.3)	44.1 (34.7–54.0)	9.3 (6.1–14.0)
Multiracial/brown	43.8	44.2 (43.3–45.0)	30.6 (29.2–31.9)	55.1 (53.8–56.5)	10.9 (10.3–11.5)
Asian/yellow	0.9	51.0 (45.1–56.9)	13.3 (7.5–22.4)	68.3 (59.1–76.3)	10.9 (7.9–14.7)
Black	11.5	43.3 (41.8–44.9)	30.3 (28.0–32.7)	54.9 (52.4–57.4)	11.8 (10.8–12.9)
White	43.3	53.3 (52.3–54.3)	17.9 (16.8–19.0)	65.3 (64.0–66.6)	15.2 (14.5–15.9)
Smoking
Yes	12.6	38.8 (37.2–40.4)	32.1 (29.5–34.9)	55.0 (52.3–57.8)	8.6 (7.8–9.5)
No	87.4	49.6 (49.0–50.2)	23.5 (22.7–24.3)	60.6 (59.6–61.6)	13.5 (13.0–14.0)
Use of toothbrush
No	1.4	15.8 (14.0–19.1)	54.8 (41.7–67.3)	40.8 (28.4–54.4)	3.1 (2.0–4.8)
Yes	98.6	48.7 (48.0–49.3)	24.2 (23.4–25.1)	60.2 (59.2–61.1)	13.0 (12.6–13.5)
Area
Rural	13.8	35.8 (34.6–37.1)	48.6 (46.5–50.8)	46.9 (44.7–49.1)	3.1 (2.6–3.6)
Urban	86.2	50.2 (49.5–50.8)	21.5 (20.6–22.4)	61.6 (60.6–62.6)	14.5 (13.9–15.0)
Per capita household income
Up to ¼ MW	7.7	35.8 (34.2–37.4)	62.6 (59.6–65.5)	33.1 (30.3–36.1)	1.7 (1.3–2.3)
Over ¼ and up to ½ MW	14.3	39.2 (37.8–40.5)	47.9 (45.5–50.2)	43.7 (41.3–46.1)	4.0 (3.5–4.6)
Over ½ and up to 1 MW	29.1	40.5 (39.5–41.6)	32.4 (30.6–34.2)	56.4 (54.6–58.2)	7.4 (6.8–8.0)
Over 1 and up to 2 MW	28.2	48.8 (47.7–49.9)	17.7 (16.3–19.3)	65.1 (63.3–66.9)	14.5 (13.8–15.3)
Over 2 and up to 3 MW	9.1	59.9 (58.0–61.8)	9.8 (8.2–11.6)	69.7 (67.1–72.1)	21.8 (20.3–23.4)
Over 3 and up to 5 MW	6.4	66.5 (64.5–68.5)	6.6 (5.1–8.5)	69.6 (66.7–72.2)	27.1 (25.3–29.0)
Over 5 MW	5.2	73.5 (71.6–75.2)	2.7 (2.1–3.6)	71.6 (68.9–74.2)	31.4 (29.4–33.4)
Dental loss
20 or more	13.0	19.7 (18.6–20.9)	34.0 (30.8–37.4)	58.9 (55.3–62.4)	4.1 (3.6–4.7)
10–19	7.9	40.6 (39.0–42.2)	33.7 (30.8–36.8)	56.6 (53.4–59.8)	7.6 (6.7–8.7)
1–9	50.9	55.1 (54.33–55.9)	24.2 (23.2–25.2)	60.6 (59.4–61.7)	14.0 (13.4–14.6)
None	28.2	54.6 (53.4–55.7)	20.9 (19.4–22.5)	60.1 (58.3–61.8)	18.1 (17.1–19.1)
Self-perceived oral health
Poor	30.3	39.2 (38.2–40.2)	34.0 (32.5–35.6)	53.8 (52.2–55.5)	8.7 (8.2–9.3)
Good	69.7	52.1 (51.4–52.9)	21.2 (20.2–22.1)	62.1 (61.0–63.2)	14.7 (14.2–15.3)

Variables	Crude PR (95%CI)*	Adjusted PR (95%CI)^†
Gender (ref.: male)
Female	1.17 (1.14–1.20)	1.18 (1.15–1.20)
Age (ref.: 18–59 years)
≥60	0.64 (0.62–0.66)	0.84 (0.82–0.87)
Schooling (ref.: illiterate)
Incomplete elementary school	1.72 (1.60–1.86)	1.39 (1.29–1.49)
Complete elementary school	2.41 (2.23–2.61)	1.67 (1.55–1.81)
Incomplete high school	2.52 (2.33–2.73)	1.73 (1.59–1.88)
Complete high school	2.87 (2.67–3.07)	1.82 (1.69–1.96)
Incomplete higher education	3.34 (3.09–3.61)	1.97 (1.81–2.13)
Complete higher education	3.72 (3.47–3.99)	2.02 (1.87–2.18)
Ethnicity/skin color (ref.: indigenous)
Multiracial/brown	1.08 (0.92–1.28)	1.04 (0.90–1.21)
Asian/yellow	1.25 (1.02–1.53)	1.04 (0.87–1.26)
Black	1.06 (0.90–1.26)	1.02 (0.87–1.19)
White	1.31 (1.11–1.55)	1.09 (0.94–1.27)
Area (ref.: rural)
Urban	1.39 (1.34–1.45)	1.02 (0.99–1.06)
Per capita household income (ref.: up to ¼ MW)
Over ¼ and up to ½ MW	1.09 (1.03–1.15)	1.07 (1.01–1.13)
Over ½ and up to 1 MW	1.13 (1.07–1.19)	1.16 (1.10–1.22)
Over 1 and up to 2 MW	1.36 (1.29–1.43)	1.28 (1.21–1.34)
Over 2 and up to 3 MW	1.67 (1.58–1.76)	1.44 (1.35–1.52)
Over 3 and up to 5 MW	1.85 (1.75–1.95)	1.49 (1.41–1.58)
Over 5 MW	2.05 (1.94–2.15)	1.54 (1.45–1.64)

Associação Brasileira de Saúde Coletiva Av. Dr. Arnaldo, 715 - 2º andar - sl. 3 - Cerqueira César, 01246-904 São Paulo SP Brasil , Tel./FAX: +55 11 3085-5411 - São Paulo - SP - Brazil
E-mail: revbrepi@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Betine Pinto Moehlecke Iser. Avenida José Acácio Moreira, 787, Dehon, CEP: 88704-900, Tubarão (SC), Brazil. E-mail: betinee@gmail.com