Indicadores sociais contextuais e individuais associados ao edentulismo em idosos brasileiros: análise multinível

Abstract

Despite the reduction in tooth loss worldwide, edentulism is still considered important problem among the elderly. Added to this, the contextual social determinants associated with tooth loss are poorly understood. The aim of this study was to estimate the prevalence and geographical distribution of edentulism in the elderly population residing in state capitals and the Federal District, as well as to test the association of contextual and individual socioeconomic inequalities with edentulism. We used data of the elderly 65 to 74 years who participated in the National Oral Health Survey (SB Brazil 2010) and had completely filled for the investigated variables (n = 5435). Contextual social indicators included Municipal Human Development Index (HDI-M) and the Gini Index. Other contextual variables were assessed as coverage of oral health care by the Family Health Strategy (ESB / ESF) and the water fluoridation. The individual variables included gender, ethnicity, family income, years of education, number of residents per room and number of household assets. Multilevel logistic regression models were used to estimate odds ratios (OR) and 95% intervals of confidence (95% CI) between contextual and individual variables and edentulism. The prevalence of edentulism in the Brazilian elderly was 68.6% (95% CI 64.9, 72.2), with considerable variation between state capitals and the Federal District. The interaction variable (HDI-M and family income) was, in all its categories, independently associated with edentulism. Among the individual variables, it was found that males (OR 0.60, 95% CI 0.52 to 0.66) and with black skin color (OR 0.78, 95% CI 0.63 to 0.96 ) had lower chances for edentulism, while individuals with lower education (OR 4.46, 95% CI 3.61 to 5.52) and fewer household assets (OR 1.30, 95% CI 1.10 to 1 , 54) showed greater risk for tooth loss. The results suggest that the level of contextual economic development as well as individual characteristics of social position are associated with the prevalence of edentulism.