Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable?

Oliveira, Luísa Jardim Corrêa de; Correa, Marcos Britto; Nascimento, Gustavo Giacomelli; Goettems, Marília Leão; Tarquínio, Sandra Beatriz Chaves; Torriani, Dione Dias; Demarco, Flávio Fernando

doi:10.1590/S0034-8910.2013047004688

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Original Articles • Rev. Saúde Pública 47 (6) • Dec 2013 • https://doi.org/10.1590/S0034-8910.2013047004688 copy

Inequalities in oral health: are schoolchildren receiving the Bolsa Família more vulnerable?

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

: To evaluate the association between being a recipient of the Bolsa Família program and oral health conditions in Brazilian schoolchildren.

METHODS

: A cross-sectional study was conducted with 1,107 schoolchildren aged between eight and 12 years from 20 public and private schools in Pelotas, RS, Southern Brazil. A list of all children receiving the Bolsa Família program was provided by the participant schools. Demographic, socioeconomic and oral hygiene information were assessed using a questionnaire completed by the schoolchildren and their parents. Dental exams were performed to assess the presence of dental plaque and prevalence of dental caries. Data were analyzed by Chi-square test, Chi-square test for linear trend and multivariate Poisson Regression (prevalence ratio; 95% confidence interval).

RESULTS

: Schoolchildren from non-nuclear families, with a DMFT ≥ 1 and who had never visited a dentist were associated with receiving the Bolsa Família. Final model showed that caries prevalence was twice as high (PR 2.00; 95%CI 1.47;2.69) in schoolchildren benefiting from the Bolsa Família . It was also showed that schoolchildren benefiting from the program presented greater severity of dental caries compared to school children from private schools (RR 1.53; 95%CI 1.18;2.00). After final adjustments, the prevalence of schoolchildren who have never visited a dentist was six times higher in children who received the government benefit (PR 6.18; 95%CI 3.07;12.45) compared to those from private schools.

CONCLUSIONS

: Schoolchildren benefiting from the Bolsa Família program experienced more caries lesions and have less frequently accessed dental care services, which suggest the need to include oral health in the program.

Child; Dental Health Services, utilization; Socioeconomic Factors; Health Vulnerability; Oral Health; Cross-Sectional Studies

Independent variable	Bolsa Família		Total

	n	%
Sex
Male	122	23.1	529
Female	141	24.4	578
Age (years)^a
8	34	19.8	172
9	61	21.5	284
10	59	22.5	262
11	64	26.7	240
12	45	30.2	149
Household income (quartiles)^a
0 to 510.00 BRL^a	116	46.4	250
511.00 to 740.00 BRL	79	37.1	213
744.00 to 1.200.00 BRL	36	14.7	245
> 1,200.00 BRL	2	0.8	238
Maternal schooling (years)^a
12 or more	2	1.5	136
9 to 11	48	14.3	335
5 to 8	156	21.3	225
≥ 4		40.5	385
Family structure^b
Nuclear	147	21.6	680
Non-nuclear	116	27.3	425
Dental plaque index (terciles)^a
First (0 to 2)	82	20.5	400
Second (3 to 5)	77	22.3	346
Third (6 to 20)	104	28.8	361
DMFT^a
0	153	20.7	741
≥ 1	109	29.9	365
Use of dental services during life^b
Yes	164	19.6	839
No	96	36.9	260
Use of dental services in last year^b
Yes	92	16.4	561
No	72	26.1	276

Independent variable	PR_c	95%CI	p	PR_a	95%CI	p
Maternal schooling (years)			0.015			–
12 or more	1			–
9 a 11	1.31	0.89;1.94
5 a 8	1.81	1.23;2.66
≥ 4	2.16	1.50;3.11
Family structure			0.080			–
Nuclear	1			–
Non-nuclear	1.16	0.98;1.36
Sex			0.272
Male	1			–		–
Female	1.10	0.93;1.29
Age (years)			< 0.001			< 0.001
8	1			1
9	0.98	0.70;1.35		0.94	0.68;1.29
10	1.32	0.98;1.80		1.17	0.87;1.58
11	1.67	1.24;2.24		1.48	1.11;1.96
12	1.87	1.37;2.54		1.52	1.12;2.07
Presence of plaque (terciles)			< 0.001			< 0.001
First	1			1
Second	1.23	0.99;1.54		1.28	1.02;1.60
Third	1.64	1.34;2.00		1.50	1.22;1.84
Fear of dentist			0.119			–
No	1			–
A little	1.26	1.03;1.54
Yes	0.82	0.50;1.35
Very much	1.06	0.73;1.53
Bolsa Família			< 0.001			< 0.001
No (private school)	1			1
No (public school)	1.95	1.47;2.59		1.76	1.32;2.34
Yes	2.29	1.70;3.08		2.00	1.47;2.69

Independent variable	RR_c	95%CI	p	RR_a	95%CI	p
Maternal schooling (years)			< 0.001			< 0.001
12 or more	1			1
9 to 11	1.93	1.38;2.71		1.49	1.03;2.14
5 to 8	2.22	1.57;3.12		1.63	1.11;2.38
≥ 4	2.71	1.95;3.76		1.95	1.34;2.84
Family structure			0.372			–
Nuclear	1			–
Non-nuclear	1.07	0.93;1.23
Sex			0.272
Male	1			–		–
Female	0.81	0.70;0.93
Age (years)			< 0.001			< 0.001
8	1			1
9	0.85	0.69;1.04		0.79	0.64;0.97
10	0.70	0.56;0.87		0.66	0.53;0.82
11	0.52	0.41;0.66		0.48	0.38;0.61
12	0.56	0.43;0.73		0.46	0.35;0.31
Presence of plaque (terciles)			< 0.001			< 0.001
First	1			1
Second	1.43	1.19;1.71		1.38	1.15;1.67
Third	1.65	1.40;1.95		1.57	1.32;1.87
Fear of dentist			0.146			–
No	1
A little	1.01	0.85;1.21		–
Yes	0.69	0.44;1.08
Very much	1.29	0.94;1.77
Bolsa Família			< 0.001			0.007
No (private school)	1			1
No (public school)	1.82	1.46;2.26		1.48	1.17;1.87
Yes	1.95	1.55;2.47		1.53	1.18;2.00

Independent variable	PR_c	95%CI	p	PR_a	95%CI	p
Maternal schooling (years)			< 0.001			< 0.001
12 or more	1			1
9 to 11	2.73	1.34;5.57		1.26	0.63;2.50
5 to 8	4.23	2.09;8.58		1.71	0.84;3.47
≥ 4	6.41	3.23;12.70		2.02	1.01;4.05
Family structure			0.275			–
Nuclear	1			–
Non-nuclear	1.12	0.91;1.37
Sex			0.169
Male	1			–		–
Female	1.15	0.94;1.41
Age (years)			0.319			–
8	1			–
9	0.96	0.70;1.30
10	0.99	0.73;1.35
11	0.73	0.51;1.03
12	0.89	0.61;1.28
Presence of plaque (terciles)			0.118			–
First	1			–
Second	0.92	0.71;1.18
Third	1.18	0.94;1.49
Fear of dentist	1	1.32;2.15	< 0.001			< 0.001
No	1.68	2.26;3.93		1
A little	2.98	1.54;2.93		1.55	1.19;2.00
Yes	2.13			2.56	1.90;3.45	< 0.001
Very much				1.77	1.27;2.48
Dental caries	1	0.58;0.93	0.011
No	0.74			1
Yes				0.63	0.50;0.80
Bolsa Família			< 0.001			< 0.001
No (private school)	1			1
No (public school)	6.61	3.33;12.32		5.01	2.54;9.88
Yes	9.30	4.97;17.44		6.18	3.07;12.45

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[1] Correspondence
: Marcos Britto Correa. Faculdade de Odontologia. Universidade Federal de Pelotas. Rua Gonçalves Chaves, 457 Sala 506. 96015-560 Pelotas, RS, Brasil. E-mail: marcosbrittocorrea@hotmail.com