Fatores de risco comuns de desfechos de saúde geral e bucal como expressão dos determinantes sociais da saúde no Brasil: análise a partir da Pesquisa Nacional de Saúde 2019

Abstract

Chronic non-communicable diseases (NCDs) are diseases of long or indefinite duration and result from a combination of genetic, physiological, behavioral, social and environmental factors. The main oral diseases are also chronic and progressive in nature. Both disease groups share common risk factors represented by health-related behaviors, which, in turn, are determined by social conditions. Thus, the study tested the hypothesis that health-related behaviors are an expression of structural social determinants and constitute common risk factors for chronic conditions and oral health problems. The study used secondary data from the National Health Survey, a national home-based survey conducted in Brazil in 2019, referring to residents aged 15 years and over selected in the households. Demographic and socioeconomic characteristics, health-related behaviors, general health status and oral health status made up the theoretical-operational model, which had its theoretical support in the World Health Organization's model of social determinants. The model variables were demographic characteristics, represented by age and sex; socioeconomic condition, latent variable manifested in education, income, occupation and number of assets; use of oral health services in the last 12 months; health-related behaviors, estimated by sugar intake, smoking, physical inactivity and poor oral hygiene; general health condition, a latent variable manifested in the burden of chronic diseases, self-perception of health, functional limitation and years lived with the disease; and oral health status, a latent variable manifested in self-reported tooth loss, self-perception of oral health and impact of oral health on daily activities. After the descriptive analysis of the variables, confirmatory factor analysis was performed to test the multidimensionality of the latent variables and the correspondence with their respective indicators. The behavior variable was predicted through latent class analysis. The direct and indirect relationships between observed and latent variables were evaluated using structural equation modeling. All analyzes were performed using the Stata SE program, version 17.0, considering the design and sample weights. The results showed that worse socioeconomic status had a direct effect on general and oral health outcomes, as well as an indirect effect mediated by the use of oral health services and health behaviors. Less use of services was also associated with worse behaviors, both being risk factors for worse general and oral health conditions. Older individuals had worse health outcomes, in addition to lower use of oral health services and worse behaviors. The indirect effect of greater use of services and better behaviors in females attenuated the negative direct effect on general and oral health conditions. The findings highlight the complexity of the relationships between risk factors underlying health outcomes and the need for strategies that act from the approach of common risk factors and that fully integrate oral health into the health promotion agenda and the prevention of chronic diseases.