Oral health indicators and sociodemographic factors in Brazil from 2008 to 2015

Santos, Juliana Leandro dos; Ferreira, Raquel Conceição; Amorim, Leonardo de Paula; Santos, Anna Rachel Soares; Chiari, Antônio Paulo Gomes; Senna, Maria Inês Barreiros

doi:10.11606/s1518-8787.2021055002763

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002763 copy

Oral health indicators and sociodemographic factors in Brazil from 2008 to 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To evaluate the annual variation of oral health and primary care coverage, the tooth extraction ratio, and the average of supervised toothbrushing in Brazilian municipalities according to social development and population size.

METHODS:

Public secondary data were analyzed. The outcomes were health service indicators (oral health coverage, primary health care coverage, tooth extraction ratio, and average of supervised tooth brushing) estimated for all Brazilian municipalities annually from 2008 to 2015. Mixed-effect multilevel regression models with random intercept and slopes were fitted with a cross-interaction term to estimate the annual percent variation according to the Municipal Human Development Index (MHDI) and population size.

RESULTS:

Municipalities with low MHDI presented an annual increase in oral health and primary care coverage of 2.65% and 2.23%, respectively, which was significantly higher than municipalities with medium and high MHDI. Oral health and primary care coverage were 69.26% and 35.00% lower among municipalities with a large population. Municipalities with medium and high MHDI showed an annual decrease in tooth extractions of 5.15% and 5.02%, respectively. An annual decrease was observed in the average of supervised toothbrushing of 9.81% and 4.57% in municipalities with low and medium MHDI, respectively. The tooth extraction ratio was higher among larger municipalities; the relation is inverse for supervised toothbrushing.

CONCLUSIONS:

The access to primary care and oral health services increased in Brazil, while a decrease occurred in mutilating treatment and provision of preventive actions, with disparities among municipalities with different MHDI levels over time.

DESCRIPTORS:
Public Health Services; Health Services Research; Indicators of Health Services; Oral Health; Longitudinal studies

		Oral health care coverage	Primary care coverage
Year (time)		0.0265 (0.0234–0.0296)	0.0223 (0.0199–0.0244
MHDI
	Medium	26.98 (19.13–34.82)	16.21 (101.47–232.99)
	High + very high	39.29 (31.24–47.34)	178.20 (11.32–243.92)
Population size
	< 5 k
	5–9.9 k	-0.0904 (-0.1211 to -0.0596)	-0.0098 (-0.0270–0.0075)
	10–49.9 k	-0.2823 (-0.3108 to -0.2538)	-0.0891 (-0.1051 to -0.0732)
	> 50 k	-0.6926 (-0.7344 to -0.6507)	-0.3500 (-0.3735 to -0.3266)
Interaction MHDI ^* * The models were adjusted for the proportion of women, older adults, residents in rural areas, and fluoride presence in water supply. year
	Medium	-0.0134 (-0.0173 to -0.0095)	-0.0081 (-0.01112 to -0.0051)
	High + very high	-0.0195 (-0.0235 to -0.0155)	-0.0091 (-0.0122 to -0.0057)
	Intercept	-50.14 (-56.35 to -43.93)	-4039.95 (-445.90 to -364.01)
Random effects parameters
	Variance (standard error) (year)	0.0026 (0.0001)	0.0013 (0.0001)
	Variance (standard error) (_cons)	1057.8 (254.84)	5477.37 (191.96)
	Covariance (standard error) (year,_cons)	-5.25 (0.13)	-2.72 (0.10)
Marginal estimates – Annual variation of the indicator (Y variation / time variation - DY/DT)
	Low + very low MDHI	0.0265 (0.0248–0.0281)	0.0223 (0.01958–0.0243)
	Medium MDHI	0.0131 (0.0119–0.0145)	0.0139 (0.01196–0.0157)
	High + very high MDHI	0.0070 (0.0055–0.0084)	0.0131 (0.0111–0.0151)
Wald test – difference among slopes
	Low + very low x medium	0.0265 (p < 0.001)	0.0081 (p < 0.001)
	Low + very low x high + very high	0.0131 (p < 0.001)	0.0091 (p < 0.001)
	Medium x high + very high	0.0069 (p < 0.001)	0.0004 (p = 0.861)

		Tooth extraction ratio	Average of supervised toothbrushing
Year (time)		-0.0397 (-0.0479 to -0.0315)	-0.0981 (-0.1158 to -0.0800)
MHDI
	Medium	23.35 (2.39–44.32)	-104.87 (-149.91 to -59.83)
	High + very high	20.33 (-1.09–41.76)	-152.89 (-198.98 to -106.80)
Population size
	< 5 k
	5–9.9 k	0.0982 (0.0450–0.1515)	-0.3699 (-0.4828 to -.2571)
	10–49.9 k	0.2030 (0.1539–0.2521)	-0.7794 (-0.8834 to -0.6755)
	> 50 k	0.1057 (0.0338–0.1777)	-1.0731 (-1.2246 to -0.9217
Interaction MHDI ^* * The models were adjusted for the proportion of women, older adults, residents in rural areas, and fluoride presence in water supply. year
	Medium	-0.0118 (-0.0222 to - 0.0014)	0.0523 (0.0300–0.0748)
	High + very high	-0.0105 (-0.0212 to - 0.0002)	0.0764 (0.0539–0.0992)
	Intercept	82.50 (65.93–99.07)	196.95 (161.24–232.66)
Random effects parameters
	Variance (standard error) (year)	0.0153 (0.0004)	0.0644 (0.0020)
	Variance (standard error) (_cons)	6204.22 (181.72)	26102.7 (813.6)
	Covariance (standard error) (year,_cons)	-30.85 (0.90)	-129.74 (4.04)
Marginal estimates – Annual variation of indicator (Y variation / time variation – DY/DT)
	Low + very low MHDI	-0.0397 (-0.0479 to -.0315)	-0.0981 (-0.1158 to -0.0803)
	Medium MHDI	-0.0515 (-0.0579 to -0.0451)	-0.0457 (-0.0593 to -0.0320)
	High + very high MHDI	-0.0502 (-0.0569 to -0.0434)	-0.0217 (-0.0362 to -0.0072)
Wald test – difference among slopes
	Low + very low x medium	0.0118 (p = 0.026)	-0.0524 (p < 0.001)
	Low + very low x high + very high	0.0105 (p = 0.053)	-0.0763 (p < 0.001)
	Medium x high + very high	-0.0013 (p = 0.781)	-0.0239 (p = 0.018)

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[1] Correspondence: Raquel Conceição Ferreira, Av. Presidente Antônio Carlos, 6627 31270-901 Belo Horizonte, Minas Gerais E-mail: raquelcf@ufmg.br