Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016

Fonseca, Suelen Garcia Oliveira da; Fonseca, Emílio Prado da; Meneghim, Marcelo de Castro

doi:10.1590/1413-81232020251.04562018

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FREE THEMES • Ciênc. saúde coletiva 25 (1) • Jan 2020 • https://doi.org/10.1590/1413-81232020251.04562018 copy

Factors associated with public dental service use by adults in the state of São Paulo, Brazil, 2016

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Abstract

The aim of this study was to investigate the factors associated with public dental care use by adults in the State of São Paulo, Brazil. A cross-sectional study was conducted with a representative sample of adults aged 35 to 44 years using data from the 2015 Epidemiological Survey of the Oral Health Status of the Population of the State of São Paulo (SBSP-2015). Multivariate logistic regression was performed using variables based on a model proposed by Andersen for predicting access to public dental services. Results: 3,421 (59.9%) adults visited private services and 2,288 (40.1%) visited public services. Prevalence of the use of public dental services was greatest among women (41.8%) and adults with a lower education level (50.2%). Being non-white (OR = 1.32, 95% CI: 1.16, 1.50), lower household income (OR = 2.37, 95% CI: 2.11, 2.65), having had toothache (OR = 1.60, 95% CI: 1.39, 1.83), and need for endodontic treatment (OR = 1.44, 95% CI: 1.12, 1.85) were associated with public dental service use. Predisposing, enabling, and need factors were associated with public dental care use.

Key words
Adult; Access to health services; Oral health; Cross-sectional studies

Variables	Private/Health Plan			Public			Total (%)	p-value^b
Variables	n	%	95% CI^a	n	%	95% CI^a	Total (%)	p-value^b
Age								0.204
35 to 39 years	1,728	59.1	(58.4;59.8)	1,195	40.9	(40.8;50.0)	2,923 (51.2)
40 to 45 years	1,693	60.8	(60.0;61.6)	1,093	39.2	(39.1;39.3)	2,786 (48.8)
Sex								< 0.001
female	2,259	58.2	(57.6;58.8)	1,621	41.8	(41.1;42.5)	3,880 (68.0)
male	1,162	63.5	(62.2;64.8)	667	36.5	(34.8;38.2)	1,829 (32.0)
Education level (years)								< 0.001
≤ 9 years	1,405	49.8	(49.7;49.9)	1,418	50.2	(50.1;50.3)	2,823 (49.5)
≥ 10 years	2,016	69.9	(69.1;70.7)	869	30.1	(28.9;31.3)	2,885 (50.5)
Skin color								< 0.001
White	2,270	63.7	(63.0;64.4)	1,293	36.3	(36.2;36.4)	3,563 (62.4)
Non-white	1,151	53.6	(52.4;54.8)	995	46.4	(45.1;47.7)	2,146 (37.6)
Toothache								< 0.001
Yes	872	48.9	(47.3;50.5)	913	51,1	(49,6;52,6)	1,785 (31.5)
No	2,522	65.1	(64.6;65.6)	1,353	34,9	(34,2;35,6)	3,875 (68.5)

Variables	Private/Health Plan			Public			Total (%)	p-value^b
Variables	n	%	95% CI^a	n	%	95% CI^a	Total (%)	p-value^b
Household income (R$)								< 0.001
≤ 1,500	1,016	47.9	(46.6;49.2)	1,104	52.1	(50.9;53.3)	2,120 (41.3)
≥ 1,501 and ≤ 2,500	1,080	61.8	(60.4;63.2)	667	38.2	(37.5;38.9)	1,747 (34.0)
≥ 2,501	986	77.8	(76.1;79.5)	282	22.2	(19.0;25.4)	1,268 (24.7)
Last dental visit								0.035
Less than a year	1,940	61.3	(60.6;62.0)	1,222	38.7	(38.6;38.8)	3,162 (56.1)
More than a year	1,448	58.6	(58.5;58.7)	1,024	41.4	(40.2;42.6)	2,472 (43.9)
Reason for visit								< 0.001
Check-up	938	67.8	(66.2;69.4)	446	32.2	(30.2;34.2)	1,384 (25.0)
Treatment/pain/extraction	2,358	56.9	(56.4;57.4)	1,789	43.1	(42.5;43.7)	4,147 (75.0)
Satisfaction with treatment								0.434
Satisfied	2,916	59,8	(59,3;60,3)	1,963	40.2	(39.6;40.8)	4,879 (86.0)
Indifferent/unsatisfied	488	61,2	(58,8;63,6)	309	38.8	(35.6;42.0)	797 (14.0)

Variables	Private/Health Plan			Public			Total (%)	p-value^b
Variables	n	%	CI_95%^a	n	%	CI_95%^a	Total (%)	p-value^b
Endodontic treatment								< 0.001
Yes	164	46.7	(46.0;47.4)	187	53.3	(46.9;59.7)	351 (6.1)
No	3,257	60.8	(60.4;61.2)	2,101	39.2	(38.6;39.8)	5,358 (93.2)
Upper prosthesis								< 0.001
Yes	948	51.7	(50.3;53.1)	887	48.3	(46.9;49.7)	1,835 (32.2)
No	2,463	63.8	(63.3;64.2)	1,398	36.2	(35.5;36.9)	3,861 (67.8)
Lower prosthesis								< 0.001
Yes	1,434	54.0	(53.0;55.0)	1,220	46.0	(44.9;47.1)	2,654 (46.6)
No	1,977	65.0	(64.3;65.7)	1,064	35.0	(34.0;36.0)	3,041 (53.4)
Satisfaction with oral health/teeth								< 0,001
Satisfied	1,624	64.1	(63.1;65.1)	909	35.9	(34.6;37.2)	2,533 (44.7)
Indifferent/unsatisfied	1,777	56.7	(55.9;57.5)	1,355	43.3	(42.3;44.3)	3,132 (55.3)

Variables	OR^a	95% CI^b	p-value^c	p-value^d
Predisposing
Sex			0.012	0.002
Female	1			1
Male	0.85	(0.74;0.96)		1.21 (1.07;1.37)
Education level (years)			< 0.001	< 0.001
≤ 9 years	1			1
≥ 10 years	0.52	(0.46;0.60)		0.47 (0.42;0.53)
Skin color			< 0.001	< 0.001
White	1			1
Non-white	1.32	(1.16;1.50)		1.36 (1.21;1.53)
Toothache			< 0.001	< 0.001
No	1			1
Yes	1.60	(1.39;1.83)		1.64 (1.45;1.86)
Enabling
Household income			< 0.001	-
≥ R$ 1,500	1			-
≤ R$ 1,501	2.37	(2.11;2.65)		-
Need
Endodontic treatment			0.005	0.003
No	1			1
Yes	1.44	(1.12;1.85)		1.41 (1.12;1.78)
Nagelkerke's R2	0.13

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[1] Collaborations

SGO Fonseca and MC Meneghim participated in study conception and design and in drafting the article. EP Fonseca participated in data analysis and interpretation. MC Meneghim participated in the critical revision of the article. All authors approved the final version to be published.