Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference?
Abstract Background Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. Methods Data from t...
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | BMC Oral Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12903-020-01238-9 |
| _version_ | 1818942173556506624 |
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| author | Raquel Conceição Ferreira Maria Inês Barreiros Senna Lorrany Gabriela Rodrigues Fernanda Lamounier Campos Andrea Eleuterio Barros Lima Martins Ichiro Kawachi |
| author_facet | Raquel Conceição Ferreira Maria Inês Barreiros Senna Lorrany Gabriela Rodrigues Fernanda Lamounier Campos Andrea Eleuterio Barros Lima Martins Ichiro Kawachi |
| author_sort | Raquel Conceição Ferreira |
| collection | DOAJ |
| description | Abstract Background Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. Methods Data from the 2010 National Oral Health Survey of 9633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:< 0.699 versus high: > 0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed. Results At the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95% CI: 7.93–11.13) and 6.95 (95% CI: 6.43–7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI. Conclusions There was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas. |
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| format | Article |
| id | doaj.art-9c649e2d033e4df391531e3d7ad1379f |
| institution | Directory Open Access Journal |
| issn | 1472-6831 |
| language | English |
| last_indexed | 2024-12-20T07:07:13Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Oral Health |
| spelling | doaj.art-9c649e2d033e4df391531e3d7ad1379f2022-12-21T19:49:00ZengBMCBMC Oral Health1472-68312020-09-0120111310.1186/s12903-020-01238-9Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference?Raquel Conceição Ferreira0Maria Inês Barreiros Senna1Lorrany Gabriela Rodrigues2Fernanda Lamounier Campos3Andrea Eleuterio Barros Lima Martins4Ichiro Kawachi5Department of Community and Preventive Dentistry, School of Dentistry, Federal University of Minas GeraisDepartment of Dental Clinic, Surgery and Pathology, School of Dentistry, Federal University of Minas GeraisSchool of Dentistry, Federal University of Minas GeraisSchool of Dentistry, Federal University of Minas GeraisUniversity of Montes Claros, Campus Universitário Professor Darcy RibeiroHarvard T.H. Chan School of Public Health, Harvard UniversityAbstract Background Socioeconomic inequalities in tooth loss might be minimized or potentialized by the characteristics of the context where people live. We examined whether there is contextual variation in socioeconomic inequalities in tooth loss across Brazilian municipalities. Methods Data from the 2010 National Oral Health Survey of 9633 adults living in 157 Brazilian municipalities were used. The individual socioeconomic indicators were education and household income. At the municipal level, we used the Municipal Human Development Index (HDI) as our contextual indicator of socioeconomic status (low:< 0.699 versus high: > 0.70). The Relative (RII) and Slope (SII) Indexes of Inequality, Relative (RCI), and Absolute (ACI) Concentration Indexes were calculated to compare the magnitude of education and income-based inequalities among municipalities with low versus high HDI. Multilevel Poisson regression models with random intercepts and slopes were developed. Results At the individual level, adults with lower education & income reported more tooth loss. The mean number of missing teeth was 9.52 (95% CI: 7.93–11.13) and 6.95 (95% CI: 6.43–7.49) in municipalities with low and high HDI, respectively. Municipalities with high HDI showed higher relative and absolute education-based inequality. For income-based inequalities, higher SII and RCI was observed in municipalities with lower HDI. A significant cross-level interaction indicated that high-education adults reported fewer missing teeth when they lived in municipalities with high HDI compared to adults with the same education level living in low HDI municipalities. For individuals with the lowest education level, there was no difference in the number of teeth between those from municipalities with high and low HDI. Conclusions There was a social gradient in tooth loss by education and income. Living in disadvantaged municipalities cannot overcome the risk associated with low schooling. The protective effect of higher education can be reduced when people live in disadvantaged areas.http://link.springer.com/article/10.1186/s12903-020-01238-9Tooth lossSocioeconomic factorsHealth status disparitiesAdultMultilevel analysis |
| spellingShingle | Raquel Conceição Ferreira Maria Inês Barreiros Senna Lorrany Gabriela Rodrigues Fernanda Lamounier Campos Andrea Eleuterio Barros Lima Martins Ichiro Kawachi Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? BMC Oral Health Tooth loss Socioeconomic factors Health status disparities Adult Multilevel analysis |
| title | Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? |
| title_full | Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? |
| title_fullStr | Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? |
| title_full_unstemmed | Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? |
| title_short | Education and income-based inequality in tooth loss among Brazilian adults: does the place you live make a difference? |
| title_sort | education and income based inequality in tooth loss among brazilian adults does the place you live make a difference |
| topic | Tooth loss Socioeconomic factors Health status disparities Adult Multilevel analysis |
| url | http://link.springer.com/article/10.1186/s12903-020-01238-9 |
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