Saúde bucal no Brasil: desvantagens no emprego e diferenças de gênero. Pesquisa Nacional de Saúde, 2019

Abstract

The oral health of Brazilian male and female workers is analyzed, according to four oral health indicators, based on data from the 2019 National Health Survey (PNS). The results of the literature study added to the perspective of outlining the panorama of oral health in the population of Brazilian adults, given the scarcity of information in this context, fed the elaboration of the research questions: 1) How are oral health indicators distributed in the population of Brazilian workers?; 2) Are the type of insertion in the workforce and employment conditions associated with oral health indicators of the economically active Brazilian population?; and 3) Is there a gender difference in self-reported oral health, according to the type of insertion in the workforce? The objective was to study the association between oral health indicators of Brazilian adults, employment status and gender differences, according to data from the PNS carried out in 2019. The specific objectives were to describe the proportions of three oral health indicators – tooth loss, visit to the dentist and frequency of tooth brushing – according to the type of insertion in the workforce, in the year 2019 (Manuscript 1); and to analyze the prevalence of negative self-rated oral health (AASB) and associated factors, according to gender, in a population of workers, in Brazil, in 2019 (Manuscript 2). The PNS is a household-based and national survey, carried out in 2019. The main exposure variable was type of insertion in the labor force (formal, informal employment and unemployment). Analyzes were performed using the statistical program Stata, version 16.0. The weightings imposed by the specific sampling design of the PNS were considered. Statistical analyzes were performed by calculating the absolute and relative frequencies, in order to describe the distribution of the variables of interest. Odds Ratio (OR) values were estimated with a 95% confidence interval (CI95%) in the bivariate and multivariate analyses. In the final model, the variables remained at the 5% significance level. The models considered stratification by gender. The sample totaled 54,343 adults, employed or unemployed, the majority (53.9%) being men. The proportion of 13 or more teeth lost was higher among employees in the informal sector [10.5% (CI95%9.8;11.2)]. The proportion of those who did not consult a dentist in the last 12 months was higher among employees in the informal sector [51.9% (CI95%50.8;53.0)] and among the unemployed [52.4% (CI95%49, 6;55.2)]. The highest proportion of low frequency of toothbrushing was observed among employees in the informal sector [5.2% (CI95%4.7;5.6)] and men [7.5% (CI95%6.8;8.2)]. The prevalence of negative AASB was 29.3%, being 31.0% among men and 27.2% among women. If compared to the formal ones, the chance of a negative AASB among the informal ones was almost 20% higher among men (OR=1.19; CI95%1.07;1.33) and 13% among women (OR=1.13; CI95%1.00;1.27), after adjusting for all confounding factors. Unemployed women were 33% more likely to have a negative AASB (OR=1.33; CI95%1.09;1.61), a result not observed among men (OR=1.13; CI95%0.90;1.41 ). In short, the worst indicators were found among those employed in the informal sector and the unemployed. Men and women in the informal sector were more likely to have a negative AASB. Unemployed women were more likely to rate their oral health negatively. Among men, no association was observed between unemployment and this indicator. The results presented offer clues for sectoral policies with gender perspectives, with regard to job protection and oral health care.