Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil: a multilevel analysis

Filgueiras, Leonardo Vilar; Cabreira, Fabiana da Silva; Pilotto, Luciane Maria; Celeste, Roger Keller

doi:10.1590/0102-311XEN201522

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ARTICLE • Cad. Saúde Pública 39 (4) • 2023 • https://doi.org/10.1590/0102-311XEN201522 copy

Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil: a multilevel analysis

Associação entre o fator contextual socioeconômico, a disponibilidade de serviços odontológicos e a prevalência de periodontite no Brasil: uma análise multinível

Asociación entre el factor socioeconómico, la disponibilidad de servicios odontológicos y la prevalencia de periodontitis en Brasil: un análisis multinivel

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to examine the effect of dental care services on periodontitis cases in Brazilian municipalities. The sample comprised 3,426 individuals aged 35-44 years. Moderate to severe periodontitis with clinical attachment loss and probing depth was the dependent variable, both > 3mm. Its exploratory variables were grouped into four categories: (1) individual characteristics; (2) contextual development indicators; (3) health service and structural factors; and (4) dental care use. Data were collected using the SBBrasil 2010 Project, the Brazilian Institute of Geography and Statistics, the Brazilian Information System of Primary and Secondary Care, and the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO). Multilevel logistic regression was used to assess associations of periodontitis with individual and context variables. Municipalities with > 1 CEO or > 1 of any centers were associated with periodontitis, with OR = 0.97 (95%CI: 0.55-1.71) and OR = 0.41 (95%CI: 0.17-0.97), respectively. Prevalence of periodontitis was more likely in older people, lower education levels, and individuals that sought dental visits for pain/extraction and periodontal treatment. Other dental care services availability were not associated with the prevalence of periodontitis.

Keywords:
Dental Care; Periodontitis; Dental Health Care

Characteristics	Total sample		Moderate-severe periodontitis		p-value
Characteristics	%	n	Weighted prevalence (%)	Cases (n)
Total	100.0	3,426	14.5	435
CEO
None	33.2	513	18.2	64	0.14
≥ 1 centers	57.6	2,709	13.8	360
≥ 1 of any referral centers	9.1	201	5.5	11
Primary dental care coverage (%)
< 25	52.3	1,283	12.3	144	0.04
25-75	23.4	1,526	12.0	211
> 75	24.3	617	21.8	80
Rate of primary care centers [per 100,000 inhabitants]
Up to 10	38.7	1,219	11.8	153	0.15
10-20	22.0	1,432	11.2	181
> 20	39.3	775	19.0	101
Presence of a trained periodontist
None	40.9	616	16.9	65	0.33
At least one periodontist	59.1	2,810	12.8	370
Root scaling rate [per 100,000 inhabitants] (national tercile)
Lowest	28.2	960	10.4	125	0.16
Second	30.7	944	13.1	101
Highest	41.2	1,486	18.5	207
Coronal scaling rate [per 100,000 inhabitants] (national tercile)
Lowest	27.4	966	11.2	130	0.22
Second	30.1	918	12.5	94
Highest	42.5	1,506	18.2	209
GDP per capita (BRL)
< 13,700	32.9	1,284	12.5	176	0.69
13,700-20,000	20.5	1,152	14.4	123
> 20,000	46.6	990	16.0	136
M-HDI (income component)
< 0.70	21.0	523	14.8	62	0.92
≥ 0.70	79.0	2,903	14.4	373
Population size (inhabitants)
< 20,000	19.3	311	21.3	37	0.21
20,000-100,000	26.3	419	12.9	46
> 100,000	54.5	2,696	12.9	352
Urban population (%)
< 75	11.0	367	10.3	38	0.23
> 75	89.0	3,059	15.0	397
Gini index
< 0.50	35.8	364	20.8	49	0.01
0.50-0.60	37.0	1,541	10.5	207
> 0.60	27.2	1,521	11.7	179

Characteristics	Unadjusted coefficients
Characteristics	OR	95%CI
Gender
Men	1.00
Women	0.99	0.79-1.23
Age	1.09	1.05-1.13
Education level
Elementary school	1.00
High school	0.73	0.56-0.93
College/University	0.45	0.32-0.64
Household income per capita (USD)
< 50	1.00
50-100	0.93	0.63-1.77
150-300	0.77	0.53-1.11
> 300	0.78	0.48-1.25
Gini index
< 0.50	1.00
0.50-0.60	0.81	0.48-1.38
> 0.60	0.78	0.43-1.41
HDI-M (income component)
< 0.70	1.00
≥ 0.70	1.09	0.70-1.71
Urban population (%)
< 75	1.00
> 75	1.24	0.73-2.12
GDP per capita (BRL)
< 13,700	1.00
13,700-20,000	0.87	0.52-1.44
> 20,000	1.16	0.71-1.89
Population size (inhabitants)
< 20,000	1.00
20,000-100,000	0.89	0.42-1.87
> 100,000	1.09	0.55-2.17
CEO
None	1.00
≥ 1 center	1.04	0.66-1.64
≥ 1 of any referral centers	0.44	0.20-1.01
Primary dental care coverage (%)
< 25	1.00
25-75	1.14	0.71-1.82
> 75	1.33	0.77-2.32
Rate of primary dental care centers [per 100,000 inhabitants]
Up to 10	1.00
10-20	1.19	0.71-1.99
> 20	1.22	0.70-2.12
Presence of trained periodontist
None	1.00
At least one periodontist	1.23	0.79-1.92
Root scaling rate [per 100,000 inhabitants] (national tertile)
Lowest	1.00
Second	0.92	0.53-1.60
Highest	1.57	0.97-2.55
Coronal scaling rate [per 100,000 inhabitants] (national tertile)
Lowest	1.00
Second	0.84	0.48-1.49
Highest	1.46	0.92-2.38
Reason for last dental visit
Check-up/Prevention	1.00
Pain/Tooth extraction	2.04	1.46-2.86
Treatment	1.43	0.99-2.08
Time since last dental visit (years)
Less than 1	1.00
1-2	1.06	0.86-1.30
3 or more	1.22	0.95-1.57
Fit indices
Second level variance	0.666
VPC	16.6%
R2	0.0%
Akaike information criterion	2,510.67
Bayesian information criterion	2,522.92

Characteristics	M3 *		M4 **		M5 ***
	OR	95%CI	OR	95%CI	OR	95%CI
CEO
None	1.00		1.00		1.00
≥ 1	0.97	0.55-1.71	1.03	0.62-1.71	1.07	0.57-1.73
≥ 1 of any referral centers	0.41	0.17-0.97	0.49	0.19-1.23	0.45	0.20-1.03
Primary dental care coverage (%)
≤ 25	1.00
25-75	1.04	0.59-1.54
> 75	1.40	0.69-2.80
Rate of primary care centers [per 100,000 inhabitants] (%)
Up to 10	1.00
10-20	1.21	0.67-2.19
> 20	1.22	0.59-2.55
Presence of trained periodontist
None	1.00
At least one periodontist	1.19	0.67-2.10
Root scaling rate [per 100,000 inhabitants] (national tercile)
Lowest			1.00
Second			1.00	0.49-2.05
Highest			1.44	0.41-5.07
Coronal scaling rate [per 100.000 inhabitants] (national tertile)
Lowest			1.00
Second			0.80	0.39-1.63
Highest			0.99	0.31-3.16
Reason for last dental visit
Check-up/Prevention			1.00
Pain/Tooth extraction			1.81	1.27-2.58
Treatment			1.39	0.94-2.04
Time since last dental visit (years)
Less than 1			1.00		1.00
1-2			0.98	0.81-1.20	1.81	1.28-2.56
3 or more			1.03	0.79-1.36	1.40	0.95-2.06
Fit indices
Second level variance	0.644		0.669		0.707
VPC	16.4%		16.9%		17.7%
R2	4.8%		6.2%		5.3%
Akaike information criterion	2,464.3		2,437.6		2,446.0
Bayesian information criterion	2,537.7		2,529.1		2,501.0

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[1] Correspondence
L. V. Filgueiras Rua Cel. Aurélio Bittencourt 54, apto. 301, Porto Alegre, RS 90430-080, Brasil. leovilarf@gmail.com