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

person Maria Laura Braccini Fagundes

schoolPost-Graduate Program in Dental Sciences, Universidade Federal de Santa Maria – Santa Maria (RS), Brazil.

0000-0001-5548-7408

person Lucelen Fontoura Bastos

schoolPost-Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brazil.

0000-0002-1617-9602

person Orlando Luiz do Amaral Júnior

schoolPost-Graduate Program in Dental Sciences, Universidade Federal de Santa Maria – Santa Maria (RS), Brazil.

0000-0002-6611-3871

person Gabriele Rissotto Menegazzo

schoolPost-Graduate Program in Dental Sciences, Universidade Federal de Santa Maria – Santa Maria (RS), Brazil.

0000-0002-4181-0267

person Amanda Ramos da Cunha

schoolPost-Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brazil.

0000-0002-6358-5582

person Caroline Stein

schoolPost-Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brazil.

0000-0003-4777-1630

person Lucas Guimarães Abreu

schoolSchool of Dentistry, Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil.

0000-0003-2258-8071

person Fernando Neves Hugo

schoolDepartment of Preventive and Social Dentistry, Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brazil.

0000-0003-2222-7719

person Jessye Melgarejo do Amaral Giordani

schoolPost-Graduate Program in Dental Sciences, Universidade Federal de Santa Maria – Santa Maria (RS), Brazil.

0000-0002-3825-9734

person Deborah Carvalho Malta

schoolSchool of Nursing, Universidade Federal de Minas Gerais – Belo Horizonte (MG), Brazil.

0000-0002-8214-5734

person Betine Pinto Moehlecke Iser

schoolPost-Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina – Tubarão (SC), Brazil.

0000-0001-6061-2541

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

Conflict of interests: nothing to declare

Authors’ contributions: Fagundes, M. L. B.: formal analysis, data curation, writing – original draft, methodology. Bastos, L. F.: formal analysis, data curation, writing – original draft, methodology. Amaral Júnior, O. L.: formal analysis, data curation, writing – original draft, methodology. Menegazzo, G. R.: formal analysis, data curation, writing – original draft, methodology. Cunha, A. R.: formal analysis, data curation, writing – original draft, methodology. Stein, C.: formal analysis, writing – original draft, writing – review & editing, methodology. Abreu, L. G.: conceptualization, writing – original draft, writing – review & editing, methodology. Hugo, F. N.: conceptualization, writing – review & editing, methodology, validation. Giordani, J. M. A.: conceptualization, writing – review & editing, methodology, validation. Malta, D. C. M.: project administration, conceptualization, data curation, writing – review & editing, investigation, methodology, funding acquisition, validation. Iser, B. P. M.: conceptualization, writing – review & editing, methodology, supervision, validation.

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)

[TFN1] *Considering the sampling weight; 95%CI: 95% confidence interval; MW: minimum wage.

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

ABSTRACT: