SPATIAL DISTRIBUTION OF RISK FACTORS AND FLUORIDE LEVELS IN PUBLIC WATER SUPPLIES ON A MUNICIPAL SCALE

Barreira Filho, Edenilo Baltazar; Nuto, Sharmênia de Araújo Soares; Saintrain, Maria Vieira de Lima; Silva, Paulo Goberlânio de Barros; Vieira-Meyer, Anya Pimentel Gomes Fernandes

doi:10.4215/rm2022.e21021

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Article • Mercator (Fortaleza) 21 • 2022 • https://doi.org/10.4215/rm2022.e21021 copy

SPATIAL DISTRIBUTION OF RISK FACTORS AND FLUORIDE LEVELS IN PUBLIC WATER SUPPLIES ON A MUNICIPAL SCALE

DISTRIBUCIÓN ESPACIAL DE FACTORES DE RIESGO Y NIVELES DE FLÚOR EN ABASTECIMIENTO PÚBLICO DE AGUA A ESCALA MUNICIPAL

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Fluoridation of public water supplies is an important measure to prevent dental caries and is linked to Sustainable Development Objective 6. This study aimed to evaluate the fluoride content of Ceará's municipalities. The research used secondary data from SISAGUA (municipality; year, date, source and point of collection; form of supply; supply system; chlorine and fluoride concentrations) and the IBGE (HDI, population, FIRJAN Municipal Development Index, and estimated population) for spatial distribution and the analysis of fluoride risk factors. Of the 26,390 samples collected, only 17.8% had ideal fluoride content, with a higher prevalence in samples collected in 2016, in isolated urban areas, in water supply systems, and in chlorine levels above the ideal. Of the 182 municipalities evaluated, 16.7% had most of the samples with ideal fluoride content. In a multivariate analysis, municipalities with a population below 30 thousand inhabitants had a prevalence of inadequate fluoride content (below or above the ideal) 2.12 (95% CI = 1.92-4.88) times higher than municipalities with large populations. It is concluded that less than a fifth of Ceará's population is exposed to adequate public water fluoride levels, and cities with fewer than 30,000 inhabitants are the most affected.

Keywords:
Fluoride; Water Fluoridation; Environmental Health Surveillance; Health Geography

	Total	Fluoride Content			p-Value
	Total	Below Ideal	Ideal	Above Ideal	p-Value
Total	26390	16624 (63.0%)	4707 (17.8%)	5059 (19.2%)	<0.001
Year
2014	9199 (34.9%)	5572 (60.6%)	1606 (17.5%)	2021 (22.0 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	<0.001
2015	9161 (34.7%)	5716 (62.4%)	1591 (17.4%)	1854 (20.2%)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
2016	8030 (30.4%)	5336 (66.4 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	1510 (18.8 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	1184 (14.7%)
Zone
Rural	2083 (8.1%)	1533 (73.6%)	269 (12.9 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	281 (13.5 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	<0.001
Urban	23667 (91.9%)	14669 (62.0 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	4320 (18.2%)	4678 (19.8%)
Area Category
Neighborhood	20995 (81.5%)	12701 (60.5 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	3967 (18.9%)	4327 (20.6%)	<0.001
Quilombola community	5 (0.0%)	5 (100.0 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	0 (0.0%)	0 (0.0%)
Riverine community	4 (0.0%)	3 (75.0 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	1 (25.0%)	0 (0.0%)
Nucleus / rural prop	131 (0.5%)	109 (83.2 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	21 (16.0%)	1 (0.8%)
Village/hamlet	1931 (7.5%)	1408 (72.9 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	244 (12.6%)	279 (14.4%)
Settlement project	12 (0.0%)	8 (66.7 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	3 (25.0%)	1 (8.3%)
District headquarters	2592 (10.1%)	1942 (74.92 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	340 (13.12%)	310 (12.0%)
Isolated urban area	80 (0.3%)	26 (32.5%)	13 (16.2%)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	41 (51.2 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Form
Water supply system	24698 (93.6%)	15279 (61.9 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	4559 (18.5 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	4860 (19.7%)	<0.001
Collective alternative solutions	958 (3.6%)	748 (78.1%)	86 (9.0%)	124 (12.9 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Individual workarounds	734 (2.8%)	597 (81.3%)	62 (8.4%)	75 (10.2 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Origin of Collection
Treatment station	496 (1.9%)	292 (58.9%)	109 (22.0%)	95 (19.1 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	<0.001
Intradomiciliary	2009 (7.6%)	1443 (71.8%)	273 (13.6%)	293 (14.6 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Pickup point	144 (0.5%)	130 (90.3 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	9 (6.2%)	5 (3.5%)
Distribution system	22484 (85.2%)	13775 (61.3%)	4213 (18.7%)	4496 (20.0 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Alternative solution	1257 (4.8%)	984 (78.3%)	103 (8.2%)	170 (13.5 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Free residual chlorine
No chlorine	764 (6.7%)	578 (75.6 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	109 (14.3%)	77 (10.1%)	<0.001
Suboptimal	137 (1.2%)	84 (61.3%)	23 (16.8%)	30 (21.9 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Ideal	1945 (17.1%)	1284 (66.0%)	314 (16.1%)	347 (17.8 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).
Above ideal	8510 (74.9%)	5034 (59.1%)	1757 (20.6 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).	1719 (20.2 %)^* * p<0.05, Fisher's exact test or Pearson's chi-square (n, %).

	Total	Fluoride Content			p-Value
	Total	Below Ideal	Ideal	Above Ideal	p-Value
Total	182	126 (66.5%)	32 (16.7%)	24 (12.5%)	<0.001
Region
Metropolitan area of Fortaleza	19 (10.4%)	9 (47.9%)	6 (31.6%)	4 (21.1%)	0.090
Interior	163 (89.6%)	117 (71.8%)	26 (16.0%)	20 (12.3%)
2010 HDI
0.500-0.599	48 (26.4%)	36 (75.0%)	8 (16.7%)	4 (8.3%)	0.714
0.600-0.699	130 (71.4%)	88 (67.7%)	23 (17.7%)	19 (14.6%)
0.700-0.799	4 (2.2%)	2 (50.0%)	1 (25.0%)	1 (25.0%)
2010 FIRJAN Index
0.4-0.6	49 (28.8%)	38 (77.6%)	8 (16.3%)	3 (6.1%)	0.166
0.6-0.8	119 (70.0%)	75 (63.0%)	24 (20.2%)	20 (16.8%)
>0.8	2 (1.2%)	1 (50.0%)	0 (0.0%)	1 (50.0%)
2019 Population
up to 15 thousand	51 (28.0%)	38 (74.5%)	9 (17.6%)	4 (7.8%)	0.391
15-30 thousand	66 (36.3%)	44 (66.7%)	12 (18.2%)	10 (15.2%)
30-60 thousand	39 (21.4%)	27 (69.2%)	4 (10.3%)	8 (20.5%)
>60 thousand	26 (14.3%)	17 (65.4%)	7 (26.9%)	2 (7.7%)
Number of water sample points
up to 50	25 (13.7%)	16 (64.0%)	3 (12.0%)	6 (24.0%)	0.296
51-100	38 (20.9%)	27 (71.1%)	4 (10.5%)	7 (18.4%)
101-200	73 (40.1%)	52 (71.2%)	14 (19.2%)	7 (9.6%)
>200	46 (25.3%)	31 (67.4%)	11 (23.9%)	4 (8.7%)
Water System
Isolated – underground spring	57 (31.1%)	41 (71.9%)	9 (15.8%)	7 (12.3%)	0.773
Isolated - surface/mixed water source	34 (18.7%)	23 (67.6%)	8 (23.5%)	3 (8.8%)
Integrated system	91 (50.2%)	62 (68.1%)	15 (16.5%)	14 (15.4%)
Supply Service
SAAE	18 (9.9%)	12 (66.7%)	1 (5.6%)	5 (27.8%)	0.087
Cagece	164 (90.1%)	114 (69.5%)	31 (18.9%)	19 (11.6%)

	p-Value	Adjusted OR (95%CI)
Non-ideal fluoride level
Region (Fortaleza metropolitan area)	0.315	0.55(0.17-1.76)
Number of collection points (up to 100)	0.717	1.21(0.43-3.37)
HDI (up to 0.699)	0.736	0.84(0.32-2.26)
FIRJAN Index (up to 0.6)	0.663	1.24(0.47-3.28)
Population (Up to 30,000)	0.037^* * *p<0.05, multinomial logistic regression ; OR = Oddsratio ; 95%CI = 95% confidence interval of the adjusted OR. HDI = Human Development Index; FIRJAN Index 2010= FIRJAN Index of Municipal Development 2010; SAAE = Autonomous Water and Sewage Service.	2.12(1.924.88)
Water system (isolated)	0.776	1.12(0.51-2.49)
Supply Service (SAAE)	0.148	4.69(0.58-38.01)

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E-mail: edantas@ufc.br

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[1] (*)CORRESPONDING AUTHOR Address: UFC. Av. da Universidade, 2853, Benfica, CEP 60020181, Fortaleza (CE), Brazil. Tel: (+5585) 3366 7300 E-mail: edenilo@ufc.br