Abstract
ABSTRACTOBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health.METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights.RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis.CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.
Highlights
Individual self-perception of health has been increasing its importance as a parameter for health status assessment of the population
Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis
Secondary data were gathered from the PNS 2013 database, the main source of our individual data. This database was linked to two others, both with aggregated data from the state level: (a) the National Census, performed by the Brazilian Institute of Geography and Statistics (IBGE) with data compiled by the Brazilian agency of the United Nations Development Program (UNDP), which has created several indicators such as the Human Development Index (HDI) among others, and (b) the National Health Facilities Register (CNES), which contains information concerning public and private health services for the whole country
Summary
Individual self-perception of health has been increasing its importance as a parameter for health status assessment of the population. As a measure, it can be considered a strong health predictor due to its relationship with clinical conditions and other indicators of both morbidity and mortality[1]. In some countries with huge populations (as in Brazil), performing epidemiological population-based studies is usually very expensive and requires a great amount of both human and technological resources. Some population-based studies such as the National Health Research (PNS), performed between 2013 and 2014, have used the self-perception of the Brazilian population to obtain information about morbidity, risk factors, and healthy lifestyles[4]
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