Abstract
BackgroundSocioeconomic 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.MethodsData from the 2010 National Oral Health Survey of 9633 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.ResultsAt 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.ConclusionsThere 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.
Highlights
Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live
This value was 9.52 (SE: 0.82; 95% confidence intervals (CI): 7.93–11.13) in municipalities with low Human Development Index (HDI) and 6.95 (SE: 0.27; 95% CI: 6.43–7.49) in those with high HDI (Fig. 1)
For individuals with the lowest education level, there was no difference in the number of teeth comparing those from municipalities with high versus low HDI
Summary
Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. Tooth loss is an important oral health problem with consequences for physical and psychosocial health as well as the quality of life [1,2,3]. It is a good proxy for the cumulative oral health status [4] summarizing the impacts of adverse circumstances throughout the life course of individuals [5]. The socioeconomic inequalities in tooth loss have been studied considering compositional (individual) and contextual effects based mainly on the pathways linking income inequality to health [10,11,12,13,14]. Income inequality may result from lower social spending on public services and infrastructure, including dental care services and water fluoridation [18]
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