Use of dental services by the Brazilian elderly: latent class analysis

Moreira, Rafael da Silveira; Mauricio, Herika de Arruda; Monteiro, Ive da Silva; Marques, Mônica Maria Motta dos Reis

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Brasil

Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210024 copy

Use of dental services by the Brazilian elderly: latent class analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health.

Methods:

Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable “profile of dental service use” from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%.

Results:

Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile.

Conclusion:

Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.

Keywords:
Comprehensive health care; Dental health services; Dental care for aged; Aged; Latent class analysis

QUESTIONS	CATEGORIES	CLASS 1	CLASS 2	CLASS 3
QUESTIONS	CATEGORIES	Health Insurance (%)	Direct Disbursement (%)	SUS (%)
Location of dental care	In the city of residence	87.5	89.8	95.6
Location of dental care	In another city	12.5	10.2	4.4
Dental appointment covered by health insurance plan	Yes	49.9	2.1	4.1
Dental appointment covered by health insurance plan	No	50.1	97.9	95.9
Paid dental appointment	Yes	23.4	100.0	0.1
Paid dental appointment	No	76.6	0.0	99.9
Dental appointment at SUS	Sim	0.2	0.6	98.6
Dental appointment at SUS	Não	99.8	99.4	1.4
Main reason for the last visit to the dentist	Cleaning, follow-up or prevention	59.9	43.2	48.3
	Pain	2.7	1.6	4.0
	Extraction	4.0	10.2	19.0
	Treatment	15.8	20.7	14.7
	Implant	4.0	5.9	0.2
	Prosthetic maintenance	9.5	15.6	11.2
	Others	4.1	2.8	2.6
Place of last dental appointment	UBS	1.4	0.2	78.2
	CEO	1.0	1.4	6.0
	UPA	0.5	0.3	5.0
	Public hospital	2.0	0.3	5.3
	Private office or hospital	90.3	97.8	4.4
	Others	4.8	0.1	1.2
Form of access to the dental appointment	In the health service, without scheduling	15.6	16.2	32.7
	Scheduled appointment	81.8	82.9	53.7
	Referred or assisted by a Family health group	0.0	0.4	11.4
	Others	2.6	0.6	2.2

Block 1 Sociodemographic	Health insurance profile		SUS Profile		P-value
Block 1 Sociodemographic	OR	95%CI	OR	95%CI	P-value
Marital status
Married	1.00		1.00		0.024
Separated or divorced	0.92	0.55 - 1.53	1.40	0.88 - 2.23
Widow	0.77	0.50 - 1.18	0.89	0.62 - 1.27
Single	0.57	0.34 - 0.93	1.75	1.06 - 2.90
Number of people in the household
≤ Median (1 - 2)	1.00		1.00		0.023
> Median (3 - 12)	1.44	1.02 - 2.04	1.45	1.07 - 1.95	0.023
Schooling
Never attended school	0.75	0.35 - 1.58	30.95	15.89 - 60.30	< 0.001
Literate	0.34	0.11 - 1.07	47.83	17.86 - 128.11
Elementary school	0.63	0.39 - 1.01	15.85	9.04 - 27.78
High School	1.31	0.82 - 2.09	5.72	2.91 - 11.24
Post-gratuation	1.22	0.48 - 3.09	0.62	0.11 - 3.42
Higher Education	1.00		1.00
Block 2 Comorbidities	OR	95%CI	OR	95%CI	P value
Cancer diagnosis
Yes	2.18	1.32 - 3.62	0.65	0.35 - 1.20	0.001
No	1.00		1.00		0.001
Diagnosis of pulmonary disease
Yes	0.16	0.06 - 0.42	0.61	0.32 - 1.15	0.001
No	1.00		1.00		0.001
Block 3 Functionality and oral health self-perception	OR	95%CI	OR	95%CI	P value
Oral health self-perception
Very good or good	1.00		1.00		0.043
Regular	0.83	0.56 - 1.25	1.25	0.87 - 1.79
Ba dor very bad	0.93	0.39 - 2.24	2.12	1.03 - 4.37

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[1] Corresponding author: Rafael da Silveira Moreira. Av. Professor Moraes Rego, s/n, Cidade Universitária, CEP: 50670-420, Recife, PE, Brasil. E-mail: moreirars@cpqam.fiocruz.br