Abstract
This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65–74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.
Highlights
Despite the global decline in the occurrence of severe tooth loss observed over the last decades, Latin American countries still experience high prevalence of tooth loss [1]
Dental examinations were conducted by a calibrated dentist under natural light with sterilized instruments following the protocol of oral health surveys proposed by the World Health Organization [19]
This study examined associations between city-level disadvantage, individual socioeconomic background and tooth loss among elderly people using a nationwide and representative sample of Brazilian elders aged 65–74 years of age
Summary
Despite the global decline in the occurrence of severe tooth loss observed over the last decades, Latin American countries still experience high prevalence of tooth loss [1]. Incidence rates of severe tooth loss differ significantly between regions and countries, suggesting that tooth loss remains as one of the main oral health problems in some developing countries [1]. Recent oral health surveys conducted in Brazil revealed an overall decline of dental caries in most age groups [3]. The prevalence of tooth loss among elderly people remained stable according to the last national surveys when around half of the population aged between 65 and 74 years old experienced edentulism [3,4]. The missing component accounted for 91.9% of the
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