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The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study
Author(s) -
Aguiar Violeta Rodrigues,
Pattussi Marcos Pascoal,
Celeste Roger Keller
Publication year - 2018
Publication title -
community dentistry and oral epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.061
H-Index - 101
eISSN - 1600-0528
pISSN - 0301-5661
DOI - 10.1111/cdoe.12356
Subject(s) - water fluoridation , socioeconomic status , medicine , sanitation , environmental health , public health , odds ratio , logistic regression , odds , dental care , cross sectional study , multilevel model , dentistry , demography , population , nursing , inorganic chemistry , chemistry , pathology , sociology , fluoride , machine learning , computer science
Objectives It is known that fluoridation has a contextual effect on oral health socioeconomic inequalities, but broad public policies have not been investigated. Thus, the aim of this study was to determine the effects of municipal public policies on oral health across different social strata. Methods This was a cross‐sectional study with 7328 12‐year‐old children and 5445 15‐19‐year‐old adolescents from 177 Brazilian municipalities. Information at municipal level was collated for dental services, educational services, sanitation and water fluoridation. The main individual‐level exposure was the disposable equivalent household income. The dichotomous outcomes were as follows: untreated dental caries (≥1 tooth), missing teeth (≥1 tooth) and filled teeth (≥1 tooth). Analyses were carried out using multilevel logistic regression. Interaction terms were tested between individual‐level income and policy variables. Results The prevalence of untreated dental caries, missing and filled teeth was 47.0%, 15.1% and 47.5%, respectively. There was no significant interaction between income and policy indicators. Individuals living in municipalities with no water fluoridation had 1.42 (95% CI : 1.08‐1.86) higher odds of having untreated dental caries; the odds ratio ( OR ) for those in municipalities with less education policies was 1.36 (95% CI : 1.07‐1.73); those in municipalities with less sanitation had OR = 1.05 (95% CI : 0.78‐1.40); and those in municipalities with less dental care had OR = 1.36 (95% CI : 1.02‐1.80). Conclusions Fluoridation and policies about sanitation, education and dental care were similarly associated with oral health in different social strata. Other policies on social and economic fields may be further explored.