Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

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Abstract

Background

Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model.

Methods

Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes.

Results

Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics.

Conclusions

Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

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Most cited references 55

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STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions.

Gilbert Gee, Chandra L Ford (2011)

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

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Pesquisa Nacional de Saúde no Brasil: concepção e metodologia de aplicação

Celia Szwarcwald, Deborah Carvalho Malta, Cimar Pereira … (2014)

A Pesquisa Nacional de Saúde (PNS) é um estudo de base domiciliar, de âmbito nacional, realizada pelo Ministério da Saúde em parceria com o IBGE em 2013. Tem como objetivo caracterizar a situação de saúde e os estilos de vida da população, bem como a atenção à sua saúde, quanto ao acesso e uso dos serviços, às ações preventivas, à continuidade dos cuidados e ao financiamento da assistência. O tamanho de amostra é de 80.000 domicílios e permitirá a estimação de alguns indicadores no âmbito das Unidades Federativas, capitais e regiões metropolitanas. O questionário é subdividido em três partes. As duas primeiras são respondidas por um residente do domicílio e abrangem perguntas sobre as características desse domicílio e a situação socioeconômica e de saúde de todos os moradores. O questionário individual é respondido por um morador de 18 anos ou mais, selecionado com equiprobabilidade entre todos os residentes adultos do domicílio e focaliza morbidade e estilos de vida. Para este indivíduo foram feitas aferições de peso, altura, circunferência da cintura e pressão arterial e exames laboratoriais para caracterizar o perfil lipídico, o nível de glicemia no sangue e determinar o teor de sódio na urina. Os exames laboratoriais foram feitos em uma subamostra de 25% dos setores censitários selecionados.

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Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.

L Berkman, S. Syme (1979)

The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices.

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Author and article information

Contributors

Fernando José Herkrath:

ORCID: http://orcid.org/0000-0003-4439-0189

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Mario Vianna Vettore: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Guilherme Loureiro Werneck: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Peter M. Milgrom: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 8 February 2018

Publication date Collection: 2018

Volume: 13

Issue: 2

Electronic Location Identifier: e0192771

Affiliations

[1 ] Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil

[2 ] Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

[3 ] Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil

[4 ] Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom

[5 ] Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

University of Washington, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: fernandoherkrath@ 123456gmail.com

Author information

Fernando José Herkrath http://orcid.org/0000-0003-4439-0189

Article

Publisher ID: PONE-D-17-35935

DOI: 10.1371/journal.pone.0192771

PMC ID: 5805334

PubMed ID: 29420660

SO-VID: c167e1fb-a49f-4f71-975c-ae3f9b5e1524

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 5 October 2017

Date accepted : 30 January 2018

Page count

Figures: 0, Tables: 5, Pages: 17

Funding

The authors received no specific funding for this work.

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Data Availability National Health Survey data is in the public domain and made available from the Instituto Brasileiro de Geografia e Estatística (IBGE) database (ftp://ftp.ibge.gov.br/PNS/2013/microdados/pns_2013_microdados_2017_03_23.zip).

Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

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Most cited references 55

STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions.

Pesquisa Nacional de Saúde no Brasil: concepção e metodologia de aplicação

Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.

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