Objectives To examine the association of contextual and individual determinants with non‐utilization of dental services among Brazilian adults. Methods Data were from adults aged 35‐44 years (N = 7,265) from the 2010 Brazilian Oral Health Survey (SB Brasil Project). Non‐utilization of dental services was assessed whether the individual has never had a dental visit over the whole life time. Independent variables were selected according to Andersen's behavioral model. Contextual variables included Human Development Index‐longevity (HDI‐Longevity) (predisposing demographic), HDI‐Education and Gini index (predisposing social), integration of oral health teams into Primary Care (enabling health policy), and HDI‐Income (enabling financing). Individual data were age and sex (predisposing demographic), ethnicity and schooling (predisposing social), family monthly income (predisposing enabling), perceived dental treatment (perceived need), and decayed teeth (evaluated need). The relationship of contextual and individual variables with non‐utilization of dental services was assessed through multilevel logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (95% CI). Results The prevalence of non‐utilization of dental services was 4.7 percent. Adults living in cities with high HDI‐Income were less likely to never have a dental visit. The odds of non‐utilization of dental services were lower for adults living in cities with high HDI‐Longevity. Sex, skin color, dental treatment needs, poor socioeconomic characteristics, perceived dental treatment needs, and decayed teeth were also associated with non‐utilization of dental services. Conclusions The results suggest that contextual enabling and predisposing factors, individual sociodemographic, and needs‐related characteristics influence non‐utilization of dental services by Brazilian adults.
This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65–74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.
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