How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil

Celeste, Roger Keller; Nadanovsky, Paulo

doi:10.1016/j.healthpol.2010.05.015

Cited by 49 publications

(61 citation statements)

References 40 publications

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“…The link between income and oral health has been well documented in the literature. [6][7][8][9]22 Previous studies of the Brazilian population report low income to be associated with higher levels of intake of sugary foods, 15 less access to health care services 22 and poorer standard of oral hygiene. 5 These factors mediate the effect of material privation on the increased risk of dental caries.…”

Section: Discussionmentioning

confidence: 99%

“…10 Previous studies have discussed the occurrence of these health problems as being related to a complex causal network which includes determinants related to individual characteristics and the social and geographical context in hierarchically organized levels. 1,4,9 The action of these factors on the risk of disease does not occur in isolation; on the contrary, multiple interactions should be refl ected in conceptual models which organize the distal and proximal levels in order to explain the disease's distribution. 10 Analyzing epidemiological data without considering variance in the hierarchical levels on which the population is organized may be source of bias and lead to erroneous conclusions.…”

mentioning

confidence: 99%

“…1,24 To deal with this diffi culty, recent studies have used multilevel analysis in order to integrate individual characteristics and geographical variables into one explanatory model. 1,4,9,13 In Brazil, epidemiological surveys assessing the oral health of the population have been carried out on a national scale since the 1980s. Analysis of the results of these surveys has highlighted the infl uence of contextual factors, incorporating socioeconomic and environmental indicators such as the Human Development Index, measures of access to health care services and the availability of a fl uoridated water supply.…”

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confidence: 99%

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Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil

2013

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OBJECTIVE:To evaluate the infl uence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children. METHODS:The data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged fi ve (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fl uorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografi a e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations. RESULTS:The prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher fi gures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fl uoride to the water supply were inversely associated with the prevalence of the outcome. CONCLUSIONS:Inequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil

2013

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“…This index mathematically links the clinical and aesthetic components to achieve a single score (from 13 to 230), which combines the physical and aesthetic aspects of occlusion, 22 allowing for its classification into: normal or mild (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), definite (26)(27)(28)(29)(30), severe (31-35), and very severe or handicapping malocclusion (36-230).…”

Section: Data Collectionmentioning

confidence: 99%

“…14 Nevertheless, Brazilian studies that used last decade's national data to examine the relationship between income inequality at a local level as well as individual factors and malocclusion prevalence found conflicting results. 15,16 Therefore, the role played by individual and contextual socioeconomic determinants in dental occlusion status remains unclear. As there is inequality in dental caries and adverse periodontal conditions, 17,18 socially disadvantaged adolescents were assumed to have a higher prevalence of malocclusion than their more affluent counterparts.…”

Section: Introductionmentioning

confidence: 99%

Individual and contextual determinants of malocclusion in 12-year-old schoolchildren in a Brazilian city

et al. 2015

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The aim of this study was to describe malocclusion prevalence and its association with individual and contextual factors among Brazilian 12-year-old schoolchildren. This cross-sectional study included data from an oral health survey carried out in Goiânia, Brazil (n = 2,075), and data from the files of the local health authority. The data were collected through oral clinical examinations. The Dental Aesthetic Index (DAI) was used to assess occlusion. The presence of malocclusion (DAI > 25) was used as the dependent variable. The individual independent variables consisted of adolescents' sex and race and their mothers' level of schooling. The clinical variables were caries experience and presence of adverse periodontal condition (calculus and/or gingival bleeding). The contextual variables included type of school and the location of schools in the city's health districts. The Rao-Scott test and multilevel logistic regression were performed. The prevalence of malocclusion was 40.1%. In the final model, significantly higher rates of malocclusion were found among those who attended schools located in less affluent health districts and whose mothers had fewer years of education. Rates were also higher among those presenting calculus and/or gingival bleeding. Malocclusion demonstrated a high prevalence rate and the inequalities in its distribution were determined by individual and contextual factors.

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Ecosocial Oral Health Epidemiology

Moysés

Singh

2020

Textbooks in Contemporary Dentistry

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How much of the income inequality effect can be explained by public policy? Evidence from oral health in Brazil

Cited by 49 publications

References 40 publications

Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil

Desigualdades na prevalência de cárie dentária não tratada em crianças pré-escolares no Brasil

Individual and contextual determinants of malocclusion in 12-year-old schoolchildren in a Brazilian city

Ecosocial Oral Health Epidemiology

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