Contextual inequalities in specialized dental public health care in Brazil

PIRES, Ana Luiza Cardoso; COSTA, Francine dos Santos; D’ÁVILA, Otávio Pereira; CARVALHO, Rodrigo Varella de; CONDE, Marcus Cristian Muniz; CORREA, Marcos Britto; DEMARCO, Flávio Fernando; CHISINI, Luiz Alexandre

doi:10.1590/1807-3107bor-2024.vol38.0023

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Research/Social/Community Dentistry • Braz. oral. res. 38 • 2024 • https://doi.org/10.1590/1807-3107bor-2024.vol38.0023 copy

Contextual inequalities in specialized dental public health care in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94–4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58–0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09–10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00–1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.

Keywords
Public Health; National Health Programs; Socioeconomic Factors; Dentistry

Groups	Intercept	Standard error	p-value	Linear slope	Standard error	p-value	Quadratic slope	Standard error	p-value	AIC	BIC	Sample adjusted BIC
1	0.73	0.03	< 0.01	-0.01	0.08	0.87	0.00	0.04	0.93	1867.58	1875.20	1873.56
2	0.03	0.07	< 0.01	-0.04	0.14	0.75	0.01	0.07	0.85	1838.65	1856.45	1852.61
	1.05	0.05	< 0.01	0.00	0.11	0.96	-0.00	0.05	0.96
3	0.37	0.11	0.01	-0.04	0.20	0.82	0.01	0.09	0.89	1842.65	1870.62	1964.58
	0.37	0.11	0.01	-0.04	0.22	0.83	0.01	0.10	0.90
	1.05	0.05	< 0.01	0.00	0.11	0.96	-0.00	0.05	0.96
4	0.37	0.12	0.01	-0.04	0.22	0.83	0.01	0.10	0.90	1.846.65	1884.79	1876.55
	0.37	0.10	0.01	-0.04	0.20	0.82	0.01	0.09	0.89
	1.05	0.09	< 0.01	0.00	0.17	0.97	-0.00	0.08	0.97
	1.05	0.08	<0.01	0.00	0.15	0.97	-0.00	0.07	0.97

Regions	Dental Specialty Centers
	Type I	Type II	Type III
	Total (mean)	Total (mean)	Total (mean)
Southeast	132 (29.6)	162 (39.9)	26 (25.7)
North East	212 (47.4)	146 (36.0)	40 (39.7)
Midwest	18 (4.0)	32 (9.8)	9 (8.9)
North	27 (6.0)	20 (4.8)	9 (8.9)
South	58 (13.0)	46 (11.3)	17 (16.8)

Variables	Trajectory of dental specialized production
Variables	Low n (%)	High n (%)
Region			< 0.001
Southeast	143 (47.8)	156 (52.2)
Northeast	297 (78.6)	81 (21.4)
Midwest	26 (49.1)	27 (50.9)
North	27 (54.0)	23 (46.0)
South	68 (60.7)	44 (39.3)
Population			< 0.001
≤ 20,000	132 (82.5)	28 (17.5)
20,001–50,000	230 (73.5)	83 (26.5)
50,001–150,000	159 (58.5)	113 (41.5)
> 150,000	40 (27.2)	107 (72.8)
HDI			< 0.001
Low (<,55)	23 (88.5)	3 (11.5)
Average (0,55–0,699)	317 (78.3)	88 (21.7)
High (0,70–0,799)	219 (51.6)	205 (48.4)
Very high (≥.80)	2 (5.4)	35 (94.6)
Coverage of PHC			< 0.001
Absent	6 (54.5)	5 (45.5)
Incipient	20 (36.4)	35 (63.6)
Intermediate	108 (46.1)	126 (53.9)
Consolidated	427 (72.1)	165 (27.9)
Coverage of PHC (with oral health team)			< 0.001
Absent	27 (58.7)	19 (41.3)
Incipient	78 (41.0)	112 (59.0)
Intermediate	154 (60.6)	100 (39.4)
Consolidated	302 (75.1)	100 (24.9)
Average local wage (tertile)			< 0.001
1^st (low)	274 (78.1)	77 (21.9)
2^nd	180 (64.5)	99 (35.5)
3^rd (high)	107 (40.8)	155 (59.2)
Schooling rates			0.044
1^st (low)	214 (67.7)	102 (32.3)
2^nd	179 (62.6)	107 (37.4)
3^rd (high)	168 (57.9)	122 (42.1)
Infant mortality rate			< 0.001
1^st (low)	166 (56.8)	126 (43.1)
2^nd	167 (57.8)	122 (42.2)
3^rd (high)	208 (71.7)	82 (28.3)

Variables	IRR^u (95% CI)	p-value	IRR^a (95% CI)	p-value
Region		< 0.001		0.005
Southeast	1		1
Northeast	0.41 (0.33–0.51)		0.76 (0.56–1.02)
Midwest	0.97 (0.73–1.29)		1.14 (0.87–1.50)
North	0.88 (0.64–1.21)		1.19 (0.86–1.65)
South	0.75 (0.58–0.97)		0.73 (0.58–0.92)
Population		< 0.001		< 0.001
≤ 20,000	1		1
20,001–50,000	1.51 (1.03–2.22)		1.35 (0.91–1.97)
50,001–150,000	2.37 (1.64–3.41)		1.88 (1.29–2.73)
> 150,000	4.16 (2.93–5.91)		2.84 (1.94–4.14)
HDI		< 0.001		< 0.001
Low (< 0,55)	1		1
Average (0,55–0,699)	1.88 (0.64–5.55)		1.56 (0.53–4.52)
High (0,70–0,799)	4.19 (1.44–12.21)		2.20 (0.73–6.63)
Very high (≥ 0.80)	8.20 (2.81–23.84)		3.34 (1.09–10.24)
Coverage of PHC		0.053		-
Absent	1
Incipient	1.40 (0.71–2.76)		-
Intermediate	1.18 (0.61–2.29)
Consolidated	0.61 (0.32–1.18)
Coverage of PHC (with oral health team)		< 0.001		-
Absent	1
Incipient	1.42 (1.00–2.05)		-
Intermediate	0.95 (0.65–1.39)
Consolidated	0.60 (0.41–0.88)
Average municipal wage (tertile)		< 0.001		-
1^st (low)	1
2^nd	1.62 (1.26–2.08)		-
3^rd (high)	2.69 (2.16–3.36)
Schooling rates		0.046		0.047
1^st (low)	1		1
2^nd	1,16 (0.93–1.44)		0.99 (0.80–1.23)
3^rd (high)	1.30 (1.06–1.61)		1.23 (1.00–1.50)
Infant mortality rate		< 0.001		-
1^st (low)	1
2^nd	0.98 (0.81–1.18)		-
3^rd (high)	0.65 (0.52–0.82)

Variable	Trajectory of dental specialized production
Variable	SII (95%CI)	p-value	CIX (95%CI)	p-value
Average municipal wage	52.1 (42.8–61.3)	< 0.001	20.3 (15.4–25.2)	< 0.001
HDI	61.0 (52.5–69.3)	< 0.001	22.5 (17.8–27.2)	< 0.001
Infant mortality rate	-22.1 (-33.4–10.8)	< 0.001	- 10.5 (-15.2–-5.8)	< 0.001
Schooling rates	14.8 (3.3–26.2)	0.012	2.0 (-2.4–7.4)	0.320

Sociedade Brasileira de Pesquisa Odontológica - SBPqO Av. Prof. Lineu Prestes, 2227, 05508-000 São Paulo SP - Brazil, Tel. (55 11) 3044-2393/(55 11) 9-7557-1244 - São Paulo - SP - Brazil
E-mail: office.bor@ingroup.srv.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author: Flávio Fernando Demarco E-mail: ffdemarco@gmail.com