Oral health care in the LGBTQIA+ population

Soares, Michele de Oliveira; Girianelli, Vania Reis

doi:10.1590/2358-28982023E18970I

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ORIGINAL ARTICLE • Saúde debate 47 (spe1) • Dec 2023 • https://doi.org/10.1590/2358-28982023E18970I copy

Oral health care in the LGBTQIA+ population

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study analyzes oral health care for the LGBTQIA+ population in view of the lack of information on oral health in this population and the recent changes in the National Oral Health Policy (PNSB), that have weakened progress and enabled setbacks in this area. A descriptive cross-sectional study was carried out, using a semi-structured questionnaire that was self-applied online. A total of 359 people answered, 329 (91.9%) were eligible. Of these, 38% gays, 23.4% lesbians, and 13.4% transgenders. Most were between 18 and 39 years old (73.3%) and Black (51.4%). The percentage of people receiving care was high in the five years prior to the survey (92.9%), as well as in the last six months (44.7%); it was lower in the transgender population (88.7% and 18.2% respectively). Only 18.8% of this population had been treated in the public health system, and this was higher among transgender people (45.5%) and Black people (25.4%). The self-perception of oral health for the majority was good or very good (53.2%); but bad or very bad (45.5%) for transgender. Most reported preferring to be assisted by an LGBT professional (69.0%). The transgender and Black population were the most vulnerable to assistance, indicating that race, gender, and sexuality directly influence access to health care, so an intersectional approach is essential for the organization of the service.

KEYWORDS
Human rights; Sexual and gender minorities; Oral health; Intersectional framework

			Gender identity
	Total		Cisgender		Transgender
Sexual Orientation	N	%	N	%	N	%
Lesbian	77	23.4	76	26.7	1	2.3
Gay	125	38.0	121	42.5	4	9.1
Bisexual	89	2 7.1	74	26.0	15	34.1
Asexual	3	0.9	2	0.7	1	2.3
Other	19	5.8	12	4.2	7	15.9
Heterosexual	16	4.9	-	-	16	36.4
Total	329	100.0	285	100.0	44	100.0

Characteristics	Total		Cisgender		Transgender		p	Lesbians		Other		p
Characteristics	N	%	N	%	N	%	p	N	%	N	%	p
Age range
18 to 39 years old	241	73.3	207	72.6	34	7 7.3	0.064	46	59.7	195	7 7.4	0.004
40 years or older	88	26.7	78	2 7.4	10	22.7		31	40.3	57	22.6
Race/skin color
White	156	4 7.4	143	50.2	13	29.5	0.028	32	41.6	124	49.2	0.297
Black	169	51.4	140	49.1	29	65.9		44	5 7.1	125	49.6
Yellow or indigenous	4	1.2	2	0.7	2	4.5	-	1	1.3	3	1.2	-
Schooling
Up to complete elementary school	12	3.6	3	1 .1	9	20.5	< 0.001^* * Chi-squared approximation may be incorrect.	3	3.9	9	3.6	0.401
High school incomplete or	88	26.7	67	23.5	21	47.7		16	20.8	72	28.6
complete	229	69.6	215	75.4	14	31.8		58	75.3	171	6 7.9
Region of Residence
North	22	6.7	11	3.9	11	25.0	< 0.001^* * Chi-squared approximation may be incorrect.	1	1.3	21	8.3	<0.001^* * Chi-squared approximation may be incorrect.
North East	28	8.5	25	8.8	3	6.8		15	19.5	13	5.2
Southeast	262	79.6	233	81.8	29	65.9		58	75.3	204	81.0
South	7	2.1	7	2.5	0	0.0		0	0.0	7	2.8
Midwest	10	3.0	9	3.2	1	2.3		3	3.9	7	2.8
Profession
Public servant, occupation of secondary, technical or higher level	144	43.8	139	48.8	5	11.4	< 0.001^* * Chi-squared approximation may be incorrect.	42	54.5	102	40.5	0.001^* * Chi-squared approximation may be incorrect.
Student and/or intern	42	12.8	37	13.0	5	11.4		3	3.9	39	15.5
Other occupations	104	31.6	81	28.4	23	52.3		23	29.9	81	32.1
Retired	8	2.4	6	2.1	2	4.5		2	2.6	6	2.4
Self-Employed	10	3.0	8	2.8	2	4.5		2	2.6	8	3.2
Unemployed	21	6.4	14	4.9	7	15.9		5	6.5	16	6.3
Total	329	100.0	285	100.0	44	100.0	-	77	100.0	252	100.0	-

Last time went to the dentist	Total^* * Includes yellow and indigenous population.			Cisgender		Transgender		p^ǂ ǂ The categories of 4 to 5 years and 5 years or more were grouped to allow analysis.	Lesbian		Other		p^ǂ ǂ The categories of 4 to 5 years and 5 years or more were grouped to allow analysis.	White		Black		p^ǂ ǂ The categories of 4 to 5 years and 5 years or more were grouped to allow analysis.
Last time went to the dentist	N	%	IC95%	N	%	N	%		N	%	N	%		N	%	N	%
Up to 6 months	147	44.7	39.4 - 50.1	139	48.8	8	18.2	< 0.001	35	45.5	112	44.4	0.184	71	45.5	75	44.4	0.993
6 months to 1 year	52	15.8	12.3 - 20.1	39	13.7	13	29.5		10	13.0	42	16.7		26	16.7	25	14.8
1 year to 2 years	52	15.8	12.3 - 20.1	47	16.5	5	11.4		19	24.7	33	13.1		24	15.4	27	16.0
2 years to 3 years	35	10.6	7.8 - 14.4	28	9.8	7	15.9		6	7.8	29	11.5		15	9.6	19	11.2
3 years to 4 years	11	3.3	1.9 - 5.9	6	2.1	5	11.4		2	2.6	9	3.6		5	3.2	6	3.6
4 years to 5 years	9	2.7	1.5 – 5.1	8	2.8	1	2.3		1	1.3	8	3.2		5	3.2	4	2.4
5 years or more	23	7.0	4.7 – 10.3	18	6.3	5	11.4		4	5.2	19	7.5		10	6.4	13	7.7
Total	329	100.0	-	285	100.0	44	100.0		77	100.0	252	100.0		156	100.0	169	100.0	-

Characteristics	Total^* * Including yellow and indigenous populations.		Cisgender		Transgender		p	Lesbians		Others		p	White		Black		p
Characteristics	N	%	N	%	N	%	p	N	%	N	%	p	N	%	N	%	p
Type of consultation
Public	62	18.8	42	14.7	20	45.5	< 0.001	11	14.3	51	20.2	0.587	18	11.5	43	25.4	0.007
Health Insurance	95	28.9	90	31.6	5	11.4		22	28.6	73	29.0		48	30.8	47	27.8
Private	166	50.5	147	51.6	19	43.2		40	51.9	126	50.0		86	55.1	77	45.6
Other	6	1.8	6	2.1	0	0.0	-	4	5.2	2	0.8	-	4	2.6	2	1.2	-
Difculty of assistance
Yes	82	24.9	58	20.4	24	54.5	< 0.001	18	23.4	64	25.4	0.835	30	19.2	49	29.0	0.055
No	247	75.1	227	79.6	20	45.5		59	76.6	188	74.6		126	80.8	120	71.0
Experienced discrimination
Yes	11	3.3	5	1.8	6	13.6	< 0.001	1	1.3	10	4.0	0.436	3	1.9	7	4.1	0.190
No	318	96.7	280	98.2	38	86.4		76	98.7	242	96.0		153	98.1	162	95.9
Tooth loss
Yes	151	45.9	124	43.5	27	61.4	0.040	40	51.9	111	44.0	0.277	54	34.6	94	55.6	< 0.001
No	178	54.1	161	56.5	17	38.6		37	48.1	141	56.0		102	65.4	75	44.4
Preference for care by LGBT Professional
Yes	227	69.0	192	6 7.4	35	79.5	0.124	54	70.1	173	68.7	0.704	99	63.5	125	74.0	0.115
No preference	93	28.3	86	30.2	7	15.9		20	26.0	73	29.0		53	34.0	40	23.7
No	9	2.7	7	2.5	2	4.5		3	3.9	6	2.4		4	2.6	4	2.4
Total	329	100.0	285	100.0	44	100.0	-	77	100.0	252	100.0	-	156	100.0	169	100.0	-

Self-evaluation of oral health	Total^* * Including yellow and indigenous populations.		Cisgender		Transgender		p	Lesbians		Other		p	White		Black		p
Self-evaluation of oral health	N	%	N	%	N	%	p	N	%	N	%	p	N	%	N	%	p
Good or very good	175	53.2	164	5 7.5	11	25.0	< 0.001	47	61.0	128	50.8	0.137	93	59.6	80	47.3	0.071
Regular	97	29.5	84	29.5	13	29.5		22	28.6	75	29.8		42	26.9	55	32.5
Bad or very bad	57	17.3	37	13.0	20	45.5		8	10.4	49	19.4		21	13.5	34	20.1
Total	329	100.0	285	100.0	44	100.0	-	77	100.0	252	100.0	-	156	100.0	169	100.0	-

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