Determinantes sociais contextuais e individuais da cárie e da perda dentária entre adultos e idosos

Abstract

The Social Determinants of Health have a significant effect on people’s oral health conditions. This study aimed to understand the contextual and individual social determinants associated with dental caries and tooth loss among adults and older adults. This thesis presents four different studies about such determinants. I) The first article is a systematic review of the scientific literature conducted in order to identify the demographic and socioeconomic factors associated with edentulism among older persons, according to the PRISMA. We identified 343 articles, 24 of which met all the eligibility criteria and were included in the review. Unfavourable demographic and socioeconomic conditions were associated with the highest proportion of edentulous individuals. Age, level of education, and socioeconomic status were the main factors that were found to influence edentulism among elderly individuals. The meta‐analysis results showed a lower risk of edentulism in men and no significant differences in the risk of developing edentulism among different races/ethnicities or skin colours. II) The second study aimed to investigate the contextual and individual factors associated with edentulism among older adults (65-74 years). Individual secondary data from the National Oral Health Survey – SBBrasil 2010, which investigated a probabilistic cluster sample, and secondary contextual data obtained at the municipal level from official public databases were used. Multilevel Poisson regression was conducted, and the Prevalence Ratio (PR) was estimated to obtain the simple and adjusted models. The prevalence of edentulism among Brazilian older adults was 53.1% (95% CI: 49.2%-57.0%). Considering the contextual variables, the prevalence of edentulism was higher among older adults from inland municipalities and who had high and medium/low Municipal Human Development Index (MHDI) when compared to residents in municipalities with very high MHDI. Among the individual variables, the prevalence of edentulism was higher among older, less educated individuals with lower household income, who self-perceived the need for a prosthesis, never went to the dentist, used the dental service for more than a year, and whose visit was due to oral problems. On the other hand, the prevalence of edentulism was lower among male older adults and those who did not self-perceive the need for dental treatment. III) In the third study, the objective was to analyze the contextual and individual factors associated with the number of missing teeth among adults (35-44 years). Individual secondary data from the National Oral Health Survey – SBBrasil 2010 and secondary contextual data obtained at the municipal level from official public databases were used. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. Brazilian adults lost a mean of 7.57 (95% CI 7.1–8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. IV) The fourth study aimed to identify contextual factors associated with “caries occurrence” (measured using the DMFT index) and “untreated caries” (decay component of the DMFT index) among adults (35-44 years). Individual secondary data from the National Oral Health Survey – SBBrasil 2010 and secondary contextual data obtained at the municipal level from official public databases were used. To adjust the models, individual independent and independent contextual variables were considered. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. The mean DMFT among the participants was 16.89 (± 7.27), and the mean number of decayed teeth was 1.79 (± 2.90). In the final model, DMFT was higher for residents in municipalities with lower social inequality (Gini coefficient) and without fluoridated water. On the other hand, the average number of decayed teeth was higher among residents of municipalities with higher social inequality and a lower proportion of dentists per capita, even after adjusting for individual variables. Conclusion: The investigated oral health outcomes were associated with unfavorable contextual and individual conditions, highlighting the effect of social inequalities on individuals’ oral health. Thus, this study’s findings can support the definition of public policies that prioritize the most vulnerable populations to ensure the principle of equity.