Magnitude das iniquidades em saúde bucal no Brasil

Abstract

Assessing and monitoring oral health indicators over time are actions that allow us to understand the scope and impact of public policies on oral health inequalities. Complex inequality measures are indicated to assess the magnitude of absolute and relative socioeconomic inequalities and to make comparisons over time across populations. However, no Brazilian studies were identified using this approach for oral health outcomes. The first product of this thesis aimed to assess the magnitude of income and education inequalities in the self-reported of oral health (SROH) of Brazilians between 2013 and 2019 and the differences between Brazilian regions. The second product aimed to assess the magnitude of socioeconomic inequalities in Functional Dentition (FD) and the effect of the use of dental services between the same years. Analytical cross-sectional studies were carried out with secondary public data from the National Health Survey (NHS), conducted in 2013 and 2019. Probabilistc cluster sampling was obtained to select adults (> 18 years old) who answered a structure questionnaire with information about the household, residents, and individual characteristics of the selected resident. SROH was assessed by the question “In general, how do you evaluate your oral health (teeth and gums)?” and FD assessed by self-reporting number of missing teeth (“How many permanent upper/lower teeth have you lost?”). Sex, age, education, income, and use of dental services were the covariables. The indicators education (years of study) and per capita income (minimum wages) were used to measure socioeconomic differences in subgroups of the Brazilian population. The magnitude of absolute and relative inequalities was measured by generalized linear models (log-binomial) adjusted for sex and age to generate complex indicators of inequality: Slope Index of Inequality (SII) and Relative Index of Inequality (RII) (Stata v.17). The prevalence of SROH was 67.50% and 69.68% between 2013 and 2019, respectively. Lower educational level and lower income levels were associated with lower prevalence of this outcome. A significant reduction in the magnitude of RII for education was observed in Brazil and in the North and Northeast of the country. For income, a significant reduction in RII was found only for the North region. A higher prevalence of FD was observed among more educated adults, with higher income and who used dental services regularly in both years. A significant reduction in education-based SII was observed between the years evaluated, while for income the reduction was not significant. Using dental services regularly modifies the magnitude of SII and RII of FD. The results demonstrate that despite the reduction in the magnitude of socioeconomic inequalities in two oral health outcomes, differences in population persist. Brazilian public oral health policies that seek health equity may have contributed to the reduction of inequalities between 2013 and 2019. However, there is a need to implement redistributive power policies that act on the population in the most vulnerable socioeconomic situation to significantly reduce inequities in oral health.