Racial inequalities in public dental service utilization: Exploring individual and contextual determinants among middle‐aged Brazilian adults

Abstract

Objectives To investigate differences between Pardos (mixed) and Blacks with their White counterparts in the use of public dental service among a sample of Brazilian adults taking into consideration the role of individual and contextual characteristics. Methods A total of 6196 adults aged 35‐44 years were sampled from the 2010 Brazilian National Oral Health Survey and nested in one of 27 Brazilian State Capitals. Binary multilevel logistic analyses were conducted. Use of public dental service in the last visit was the outcome, and self‐reported colour/race (Pardo, Black, White) was the explanatory variable. Individual covariates were sex, level of education, family income, self‐reported need for treatment, dental pain in the last 6 months, presence of decayed, filled and missing teeth. The State Capital covariates were proportion of Pardos/Blacks, Human Development Index, Gini coefficient, Integration of dental teams into Brazil Family Health Program and dentist per population rate. Results Pardos and Blacks were 1.25 (95% CI 1.10‐1.42) and 1.73 (95% CI 1.41‐2.11) times, respectively, more likely to visit the public dental service than Whites. Adjustments for level of education and income were more relevant in affecting the estimates between groups than any other covariate, but differences persisted. Colour/race was independently associated with the type of service used in the last dental visit after fully adjusted for individual and State Capital characteristics. Conclusions Racial differences in dental service utilization were evident for middle‐aged adults in Brazil. The results found highlight the importance of investments in public dental service as Pardos and Blacks relied more on this type of service than Whites.

Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States?

“…These and other systems- or contextual-level characteristics directly impact the lives of marginalized racial groups in Brazil, as they depend more heavily on public health services than their white counterparts. 27,28 Even with the country’s latest improvements in healthcare access, 29 current debates highlight the pernicious health effects of recent political crises and austerity measures, as well as the need to expand primary care to effectively address inequities between racially marginalized and dominant groups in the country. 30…”

Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis

“…Last year, dentist appointments were higher among those with more education, income, and private healthcare coverage and living in the country’s wealthiest regions [ 5 ]. Other studies in Brazil revealed that public dental services are more used by black people from low-income families, living in small towns, with more than four household residents, and having more dental treatment need [ 6 , 7 ].…”

Influence of Sociodemographic Factors, and the Coverage and Offer of Health Services on Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-year Analysis

“…In addition, another study in Brazil investigated racial disparities in the use of public dental services and found that blacks and browns depend more on these services than do whites. [39] Delay in diagnosis is a major concern with regard to oral cancer and is responsible for at least 50% of the diagnoses made in advanced stages. [38,40] In Brazil, according to the National Oral Health Policy (PNSB), [21] the prevention and early detection of oral cancer can be attributed to oral health teams in PC, while DSC is responsible for diagnosis and referral for hospital treatment.…”