Individual- and City-Level Socioeconomic Factors and Tooth Loss among Elderly People: A Cross-Level Multilevel Analysis

Vettore, Mário Vianna; Vieira, Janete Maria Rebelo; Gomes, José Felipe Freitas; Martins, Nara M O; Freitas, Yan Nogueira Leite de; Lamarca, Gabriela de Almeida; Rebelo, Maria Augusta Bessa

doi:10.3390/ijerph17072345

Cited by 11 publications

(11 citation statements)

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“…Higher household income was an individual protective factor against self-reported tooth loss. A huge body of evidence supports this relationship between income and tooth loss in adults, whether in Brazilian [ 10 , 15 , 16 , 20 , 22 , 25 ] or other countries populations [ 21 , 26 , 76 ], including two systematic reviews [ 77 , 78 ]. The authors consider some possible explanations for this association, ranging from the structural to individual levels.…”

Section: Discussionmentioning

confidence: 99%

“…The complexity of the tooth loss depicts the endpoint of the most frequent oral diseases, dental caries and periodontal diseases [13], combined with the access and utilization of dental services, the hegemonic curative and mutilating dental care model and the individual healthrelated behaviors [14][15][16][17][18][19][20]. The socioeconomic conditions are the underlying factors that play a significant role in tooth loss [15,[19][20][21][22]. These factors involved in the causal pathway of tooth loss are expressed either contextually or individually.…”

Section: Introductionmentioning

confidence: 99%

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Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

et al. 2022

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Background Tooth loss is an oral health condition with high prevalence and negative impact on quality of life. It is the result of the history of oral diseases and their treatment as well as provision of dental care and access to dental services. Socioeconomic characteristics are determinants of tooth loss and living in rural areas is also a risk factor for its incidence. Objective To identify contextual and individual factors associated with self-reported tooth loss among adults and elderly people living in rural riverside areas. Methods A cross-sectional household-based survey was conducted in 2019 with rural riverside communities on the left bank of the Rio Negro River, Manaus, Amazonas. These communities are covered by a fluvial health team and two riverside health teams. Interviews were conducted in a representative random sample of dwellers aged ≥ 18 years, using electronic forms to obtain information on oral health conditions, demographic and socioeconomic characteristics, and use of and access to health services. The outcome was self-reported tooth loss. After the descriptive analysis of the data, a multilevel Poisson regression analysis was performed to estimate the prevalence ratio for the outcome. Variables with p-value ≤0.20 in the bivariate analyses were included in the multiple analysis considering the hierarchy between individual and contextual variables in the multilevel model. Variables with p-value ≤0.10 were kept in the final model and the significance level adopted was 0.05. Results 603 individuals from 357 households were assessed (mean age 44.1 years). The average number of missing teeth was 11.2 (±11.6); 27.4% of individuals had lost more than 20 teeth (non-functional dentition) and 12.1% were completely edentulous. Contextual characteristic of primary healthcare offered was associated with the outcome. The tooth loss was lower in territories covered by riverside health teams. At individual level, tooth loss was greater in older individuals who had experienced dental pain over the past six months and whose sugar consumption was high. Black or brown individuals, individuals whose household income was higher, those who were on the Bolsa Família cash transfer program, those who consulted a dentist over the past year, and those who reported satisfaction with their teeth/oral health reported less tooth loss. Conclusion Tooth loss was associated with contextual territorial factors related to the healthcare service and individual demographic, behavioral, socioeconomic, and service-related characteristics as well as self-perceived oral health conditions. The findings suggest that actions focused on the oral health of these populations involve not only changes in the healthcare service organization, but also intersectoral policies that contribute to reducing social inequalities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

et al. 2022

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“…Or Do public policies have more effect on groups that are already socially advantaged? The double disadvantage, characterized by concomitantly presenting a worse social situation in the individual and contextual level, has been reported on oral epidemiology [37,38].…”

Section: Introductionmentioning

confidence: 99%

Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference?

Ferreira

Senna

Rodrigues

et al. 2020

Preprint

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Background: Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. Methods: Data from the 2010 National Oral Health Survey of 9,633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:<0.699 versus high: >0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed. Results: At the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95%CI: 7.93-11.13) and 6.95 (95%CI: 6.43-7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI.Conclusions: There was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas.

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“…Elani et al 11 , for example, demonstrated, using algorithms to assess the risk of tooth loss among adults, that the performance of models that incorporate the socioeconomic characteristic was better when compared to those based only on clinical dental indicators. Research shows that older individuals living in cities with low income and low education have a higher prevalence of tooth loss 12,13 . On the other hand, richer and more educated older people seek more preventive care 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Construction of a multidimensional oral health indicator for the older population in the city of Manaus-Amazonas

Birman¹,

Rebelo²,

Freitas³

et al. 2021

Rev. bras. geriatr. gerontol

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Objective: Produce a multidimensional indicator of oral health, based on dental and nondental variables, for the older adult in the urban area of the city of Manaus-AM. Method: The data used are from a cross-sectional population-based study conducted in 2008 with randomly selected individuals aged 65 to 74 years, residing in the city of Manaus. To produce the proposed indicator, the dental variables (DMFT-Decayed, Missing and Filled Teeth; CPI-Community Periodontal Index; PIP-Periodontal Insertion Loss Index) and non-dental (socioeconomic and index GOHAI-General Oral Health Assessment Index) were considered. An exploratory factor analysis synthesized these variables, facilitating the construction of the multidimensional indicator. Results: The analysis generated three factors that, together, explained 72.9% of the model's variance (KMO = 0.749 and p<0.001 for Bartlett's test of sphericity). These three factors were reduced to the "sum" variable, calculated from the sum of the factor scores per individual. The median of this new variable was the reference value for categorizing the individual's oral health condition into "favorable" or "unfavorable". Conclusion: The indicator was able to aggregate several dimensions of oral health into a single measure, in addition to enabling its reproducibility for the construction of other health status indicators.

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Individual- and City-Level Socioeconomic Factors and Tooth Loss among Elderly People: A Cross-Level Multilevel Analysis

Cited by 11 publications

References 19 publications

Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

Contextual and individual factors associated with self-reported tooth loss among adults and elderly residents in rural riverside areas: A cross-sectional household-based survey

Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference?

Construction of a multidimensional oral health indicator for the older population in the city of Manaus-Amazonas

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