Abstract This study aimed to evaluate the pathways that explain the association between race/skin color and edentulism in elderly Brazilians. This was a cross-sectional study using data from participants aged 60 years or older from the 2019 Brazilian National Health Survey, a nationally representative population-based sample. Data were obtained by a structured interview and participants were classified as edentulous if they reported having lost all natural teeth. Information on race, socioeconomic level, behavioral aspects, psychosocial aspects, and access to dental care was collected by interviewers using a questionnaire. The pathways between race/skin color and edentulism were analyzed using structural equation modeling. The final sample of the study included 22,357 participants. Most participants were white (51.5%; 95% confidence interval [CI]: 50.3–52.6), and 36.8% (95%CI: 35.7–37.9) were edentulous. Race/skin color was indirectly associated with edentulism via enabling factors. These findings suggest that socioeconomic inequalities are key in explaining racial inequalities in edentulism among Brazilian older adults.

Objective: To analyze the association between participation in integrative practices and the regular dental services use in Brazilian older adults. Methods: Cross-sectional study with secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The outcome was the regular dental services use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PR) and their respective confidence intervals at 95% (CI95%). Results: A total of 22,728 older adults were analysed. Most were female (55.5%), self-declared white (51.3%), with incomplete primary education (47.0%); 7.0% (CI95% 6.8;7.5) used some integrative practice and 34.3% (CI95% 33.2;35.4) used the dental service regularly. Individuals who used integrative practices had a higher prevalence of dental service use even after adjusting the model (PR=1.15 – 95%CI 1.07;1.23). Conclusion: The use of integrative practices was associated with the regular use of dental services by Brazilian older adults.

Objetivo: Analizar la asociación entre la participación en prácticas integradoras y el uso regular de servicios odontológicos en ancianos brasileños. Métodos: Estudio transversal con datos secundarios de la Encuesta Nacional de Salud 2019. Se incluyeron todos aquellos de 60 años o más. El resultado fue el uso regular de servicios odontológicos. Se utilizó regresión de Poisson para estimar razones de prevalencia (RP) crudas y ajustadas y sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron 22.728 ancianos. La mayoría eran mujeres (55,5%), blancas (51,3%), con primaria incompleta (47,0%); 7,0% (IC95% 6,8;7,5) utilizaba alguna práctica integradora y 34,3 % (IC95% 33,2 ;35.4) usaba el servicio dental regularmente. Aquellos que utilizaron prácticas integradoras tuvieron una mayor prevalencia de uso de servicios dentales incluso después de ajustar el modelo (RP=1,15 – IC95% 1,07;1,23). Conclusión: El uso de prácticas integradoras se asoció con el uso regular de servicios odontológicos en ancianos brasileños.

Objetivo: Analisar a associação entre participação em práticas integrativas e uso regular de serviços odontológicos em idosos brasileiros. Métodos: Estudo transversal, com dados secundários da Pesquisa Nacional de Saúde de 2019. Foram incluídos todos os idosos com 60 anos ou mais. O desfecho foi o uso regular de serviços odontológicos. Modelos de regressão de Poisson foram utilizados para estimar as razões de prevalências (RPs) brutas e ajustadas, e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram analisados 22.728 idosos. A maioria era do sexo feminino (55,5%), autodeclarados brancos (51,3%), com ensino fundamental incompleto(47,0%); apenas 7,0% (IC95% 6,8;7,5) utilizaram alguma prática integrativa e 34,3% (IC95% 33,2;35,4) utilizaram o serviço odontológico de forma regular. Indivíduos que participaram de práticas integrativas apresentaram maior frequência de uso do serviço odontológico (RP=1,15 – IC95% 1,07;1,23). Conclusão: O uso de práticas integrativas foi associado ao uso regular de serviços odontológicos por idosos brasileiros.

Abstract Objective: To analyze association between participation in integrative practices and regular use of dental services in Brazilian older adults. Methods: This was a cross-sectional study based on secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The study outcome was regular dental service use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PRs) and their respective at confidence intervals 95% (95%CI). Results: A total of 22,728 older adults were analyzed. Most were female (55.5%), reported that they were White (51.3%), had incomplete primary education (47.0%); 7.0% (95%CI 6.8;7.5) had used some form of integrative practice and 34.3% (95%CI 33.2;35.4) had used their dental service regularly. Individuals who used integrative practices had higher prevalence of dental service use even after adjusting the model (PR = 1.15; 95%CI 1.07;1.23). Conclusion: Among Brazilian older adults use of integrative practices was associated with regular use of dental services.

Resumo Objetivo: Analisar a associação entre participação em práticas integrativas e uso regular de serviços odontológicos em idosos brasileiros. Métodos: Estudo transversal, com dados secundários da Pesquisa Nacional de Saúde (PNS) de 2019. Foram incluídos todos os idosos com 60 anos ou mais. O desfecho foi o uso regular de serviços odontológicos. Modelos de regressão de Poisson foram utilizados para estimar as razões de prevalências (RPs) brutas e ajustadas, e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram analisados 22.728 idosos. A maioria era do sexo feminino (55,5%), autodeclarados brancos (51,3%), com ensino fundamental incompleto (47,0%); apenas 7,0% (IC95% 6,8;7,5) utilizaram alguma prática integrativa e 34,3% (IC95% 33,2;35,4) utilizaram o serviço odontológico de forma regular. Indivíduos que participaram de práticas integrativas apresentaram maior frequência de uso do serviço odontológico (RP = 1,15; IC95% 1,07;1,23). Conclusão: O uso de práticas integrativas foi associado ao uso regular de serviços odontológicos por idosos brasileiros.

Resumen Objetivo: Analizar la asociación entre la participación en prácticas integradoras y el uso regular de servicios odontológicos en adultos ancianos brasileños. Métodos: Estudio transversal con datos secundarios de la Encuesta Nacional de Salud 2019. Se incluyeron todos aquellos con 60 años o más. El resultado fue el uso regular de servicios odontológicos. Se utilizó la regresión de Poisson para estimar razones de prevalencia (RPs) crudas y ajustadas y sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron 22.728 ancianos. La mayoría era del sexo femenino (55,5%), blancas (51,3%), con primaria incompleta (47,0%); 7,0% (IC95% 6,8;7,5) utilizaban alguna práctica integradora y 34,3% (IC95% 33,2;35,4) usaban el servicio dental regularmente. Aquellos que utilizaron prácticas integradoras tuvieron una mayor prevalencia en el uso de servicios dentales incluso después de ajustar el modelo (RP = 1,15; IC95% 1,07;1,23). Conclusión: El uso de prácticas integradoras se asoció con el uso regular de servicios odontológicos en ancianos brasileños.

Abstract Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Abstract Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the “Patient Health Questionnaire-9”) and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.

Resumo Objetivo: Analisar a associação entre participação em práticas integrativas e uso regular de serviços odontológicos em idosos brasileiros. Métodos: Estudo transversal, com dados secundários da Pesquisa Nacional de Saúde (PNS) de 2019. Foram incluídos todos os idosos com 60 anos ou mais. O desfecho foi o uso regular de serviços odontológicos. Modelos de regressão de Poisson foram utilizados para estimar as razões de prevalências (RPs) brutas e ajustadas, e seus respectivos intervalos de confiança de 95% (IC95%). Resultados: Foram analisados 22.728 idosos. A maioria era do sexo feminino (55,5%), autodeclarados brancos (51,3%), com ensino fundamental incompleto (47,0%); apenas 7,0% (IC95% 6,8;7,5) utilizaram alguma prática integrativa e 34,3% (IC95% 33,2;35,4) utilizaram o serviço odontológico de forma regular. Indivíduos que participaram de práticas integrativas apresentaram maior frequência de uso do serviço odontológico (RP = 1,15; IC95% 1,07;1,23). Conclusão: O uso de práticas integrativas foi associado ao uso regular de serviços odontológicos por idosos brasileiros.

Abstract Objective: To analyze association between participation in integrative practices and regular use of dental services in Brazilian older adults. Methods: This was a cross-sectional study based on secondary data from the 2019 National Health Survey. All older adults aged 60 years and over were included. The study outcome was regular dental service use. Poisson regression models were used to estimate crude and adjusted prevalence ratios (PRs) and their respective at confidence intervals 95% (95%CI). Results: A total of 22,728 older adults were analyzed. Most were female (55.5%), reported that they were White (51.3%), had incomplete primary education (47.0%); 7.0% (95%CI 6.8;7.5) had used some form of integrative practice and 34.3% (95%CI 33.2;35.4) had used their dental service regularly. Individuals who used integrative practices had higher prevalence of dental service use even after adjusting the model (PR = 1.15; 95%CI 1.07;1.23). Conclusion: Among Brazilian older adults use of integrative practices was associated with regular use of dental services.

Resumen Objetivo: Analizar la asociación entre la participación en prácticas integradoras y el uso regular de servicios odontológicos en adultos ancianos brasileños. Métodos: Estudio transversal con datos secundarios de la Encuesta Nacional de Salud 2019. Se incluyeron todos aquellos con 60 años o más. El resultado fue el uso regular de servicios odontológicos. Se utilizó la regresión de Poisson para estimar razones de prevalencia (RPs) crudas y ajustadas y sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron 22.728 ancianos. La mayoría era del sexo femenino (55,5%), blancas (51,3%), con primaria incompleta (47,0%); 7,0% (IC95% 6,8;7,5) utilizaban alguna práctica integradora y 34,3% (IC95% 33,2;35,4) usaban el servicio dental regularmente. Aquellos que utilizaron prácticas integradoras tuvieron una mayor prevalencia en el uso de servicios dentales incluso después de ajustar el modelo (RP = 1,15; IC95% 1,07;1,23). Conclusión: El uso de prácticas integradoras se asoció con el uso regular de servicios odontológicos en ancianos brasileños.

Resumo: O estudo buscou verificar a associação entre diferentes indicadores socioeconômicos e autoavaliação da saúde em uma amostra nacionalmente representativa de adultos mais velhos. Este estudo transversal analisou os dados da linha de base do Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI-Brasil), um estudo de coorte de base populacional em indivíduos com 50 anos ou mais. Os dados foram coletados através de um questionário domiciliar e individual no domicílio dos participantes. A autoavaliação da saúde foi avaliada com um item de autoavaliação global. Três indicadores socioeconômicos foram avaliados: renda individual, renda domiciliar per capita e índice de riqueza. Foram construídos modelos de regressão Poisson para estimar a razão de prevalência (RP) e os intervalos de 95% de confiança (IC95%) para autoavaliação da saúde e cada indicador socioeconômico, ajustando para variáveis de confusão. No total, 9.390 idosos responderam à pergunta referente a autoavaliação de saúde geral. Para o indicador de renda individual, apenas o quintil mais rico mostrou uma associação significativa com o desfecho (RP: 0,90; IC95%: 0,87; 0,93); enquanto isso, para a renda domiciliar per capita, o quarto (RP: 0,95; IC95%: 0,91; 0,98) e quinto quintis (RP: 0,90; IC95%: 0,86; 0,94) permaneceram associados com o desfecho. Com relação ao índice de riqueza, apenas o segundo quintil não esteve associado com o desfecho. As menores prevalências de autoavaliação ruim da saúde foram associadas aos quintis mais altos de riqueza, revelando um gradiente social. O índice de riqueza parece ser um indicador mais adequado para uso, na medida em que reflete os recursos acumulados ao longo da vida.

Abstract: We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants’ households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.

Resumen: Nuestro objetivo fue verificar la asociación entre diferentes indicadores socioeconómicos y de salud autoevaluada en una muestra representativa nacional de adultos mayores. Este estudio transversal analizó los datos de referencia del Estudio Longitudinal de Salud de los Ancianos (ELSI-Brasil), un estudio de cohorte basado en población con individuos de 50 años o más. Los datos fueron recogidos usando un cuestionario por domicilio e individual entre los hogares participantes. La salud autoevaluada se evaluó mediante un ítem de autoevaluación global. Se evaluaron tres indicadores socioeconómicos: ingresos individuales, ingresos per cápita por hogar e índice de riqueza. Se realizaron modelos de regresión de Poisson para estimar la ratio de prevalencia (RP) y los intervalos de 95% de confianza (IC95%) de salud autoevaluada y cada indicador socioeconómico, ajustándolos mediante variables de confusión. En total, 9.390 personas mayores respondieron la pregunta sobre la autoevaluación de la salud general. Mientras que para el indicador de ingresos individuales solamente el quintil más rico mostró una asociación estadísticamente significativa con el resultado (RP: 0.90; IC95%: 0.87; 0.93), en los ingresos per cápita por hogar, los quintiles cuarto (RP: 0.95; IC95%: 0.91; 0.98) y quinto (RP: 0.90; 95%CI: 0.86; 0.94) continuaron asociados con el resultado. Respecto al índice de riqueza, solo el segundo quintil no estuvo asociado con el resultado, con prevalencia más baja de salud autoevaluada peor percibida cuanto más rico era el quintil, mostrando un gradiente social. El índice de riqueza parece ser un indicador más adecuado respecto a su uso, puesto que refleja fuentes acumuladas a lo largo del curso de la vida.

Resumo: O estudo buscou verificar a associação entre diferentes indicadores socioeconômicos e autoavaliação da saúde em uma amostra nacionalmente representativa de adultos mais velhos. Este estudo transversal analisou os dados da linha de base do Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI-Brasil), um estudo de coorte de base populacional em indivíduos com 50 anos ou mais. Os dados foram coletados através de um questionário domiciliar e individual no domicílio dos participantes. A autoavaliação da saúde foi avaliada com um item de autoavaliação global. Três indicadores socioeconômicos foram avaliados: renda individual, renda domiciliar per capita e índice de riqueza. Foram construídos modelos de regressão Poisson para estimar a razão de prevalência (RP) e os intervalos de 95% de confiança (IC95%) para autoavaliação da saúde e cada indicador socioeconômico, ajustando para variáveis de confusão. No total, 9.390 idosos responderam à pergunta referente a autoavaliação de saúde geral. Para o indicador de renda individual, apenas o quintil mais rico mostrou uma associação significativa com o desfecho (RP: 0,90; IC95%: 0,87; 0,93); enquanto isso, para a renda domiciliar per capita, o quarto (RP: 0,95; IC95%: 0,91; 0,98) e quinto quintis (RP: 0,90; IC95%: 0,86; 0,94) permaneceram associados com o desfecho. Com relação ao índice de riqueza, apenas o segundo quintil não esteve associado com o desfecho. As menores prevalências de autoavaliação ruim da saúde foram associadas aos quintis mais altos de riqueza, revelando um gradiente social. O índice de riqueza parece ser um indicador mais adequado para uso, na medida em que reflete os recursos acumulados ao longo da vida.

Abstract: We aimed to verify the association between different socioeconomic indicators and self-rated health in a nationally representative sample of older adults. This cross-sectional study analyzed the baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based cohort study of persons aged 50 years or older. Data was collected using a household and an individual questionnaire at participants’ households. Self-rated health was assessed by a global self-rating item. Three socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression models were performed to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI) of self-rated health and each socioeconomic indicator, adjusting for covariates. In total, 9,390 older adults answered the outcome question. Whilst for the individual income indicator only the richest quintile showed a statistically significant association with the outcome (PR: 0.90; 95%CI: 0.87; 0.93), for the per capita household income, the fourth (PR: 0.95; 95%CI: 0.91; 0.98) and the fifth quintiles (PR: 0.90; 95%CI: 0.86; 0.94) remained associated with the outcome. Regarding the wealth index, only the second quintile was not associated with the outcome, with lower prevalence of poor self-rated health as richer was the quintile, showing a social gradient. The wealth index seems to be a more adequate indicator, as it reflects resources accumulated over the life course.

Resumen: Nuestro objetivo fue verificar la asociación entre diferentes indicadores socioeconómicos y de salud autoevaluada en una muestra representativa nacional de adultos mayores. Este estudio transversal analizó los datos de referencia del Estudio Longitudinal de Salud de los Ancianos (ELSI-Brasil), un estudio de cohorte basado en población con individuos de 50 años o más. Los datos fueron recogidos usando un cuestionario por domicilio e individual entre los hogares participantes. La salud autoevaluada se evaluó mediante un ítem de autoevaluación global. Se evaluaron tres indicadores socioeconómicos: ingresos individuales, ingresos per cápita por hogar e índice de riqueza. Se realizaron modelos de regresión de Poisson para estimar la ratio de prevalencia (RP) y los intervalos de 95% de confianza (IC95%) de salud autoevaluada y cada indicador socioeconómico, ajustándolos mediante variables de confusión. En total, 9.390 personas mayores respondieron la pregunta sobre la autoevaluación de la salud general. Mientras que para el indicador de ingresos individuales solamente el quintil más rico mostró una asociación estadísticamente significativa con el resultado (RP: 0.90; IC95%: 0.87; 0.93), en los ingresos per cápita por hogar, los quintiles cuarto (RP: 0.95; IC95%: 0.91; 0.98) y quinto (RP: 0.90; 95%CI: 0.86; 0.94) continuaron asociados con el resultado. Respecto al índice de riqueza, solo el segundo quintil no estuvo asociado con el resultado, con prevalencia más baja de salud autoevaluada peor percibida cuanto más rico era el quintil, mostrando un gradiente social. El índice de riqueza parece ser un indicador más adecuado respecto a su uso, puesto que refleja fuentes acumuladas a lo largo del curso de la vida.

Abstract INTRODUCTION Epidemiological surveys revealed that Brazil has a high burden of oral diseases. However, no prior study has reported estimates of untreated dental caries, periodontitis, and edentulism over a three-decade period. The objective of this study is to report the trends of prevalence, incidence, and years-lived with disability (YLDs) due to untreated dental caries in primary and permanent teeth, periodontitis, and edentulism in Brazil between 1990 and 2019. METHODS Estimates of prevalence, incidence, and YLDs due to dental caries in primary and permanent teeth, periodontitis, and edentulism were produced for Brazil, by sex and age, between 1990 and 2019, using Dismod-MR 2.1, as part of the Global Burden of Disease Study 2019 (GBD 2019). Trends of oral disorders were analyzed using generalized linear regression models applying the Prais-Winsten method. RESULTS Almost 100 million Brazilians presented at least one oral disorder in 2019, which was equivalent to a prevalence of 45.3%. All oral diseases combined ranked eighth among all causes of disability, causing more than 970,000 YLDs. Untreated dental caries in primary teeth were estimated to affect 13.5 million children, and untreated dental caries in permanent teeth affected more than 52 million people. Periodontitis affected 29.5 million people, and edentulism affected almost 22 million. The generalized linear regression models revealed a trend of stability of oral disorders between 1990 and 2019. CONCLUSIONS The burden of oral diseases in Brazil is extremely high. Oral disorders, edentulism in particular, caused disability at levels that are comparable to other important chronic diseases.

Objective: To describe the prevalence of use of dental services in Brazil according to the states and its association with socioeconomic variables and types of services in the Brazilian Health Survey of 2019. Methods: A population-based, cross-sectional study using data from the Brazilian Health Survey of 2019, including 88,531 individuals with 18 years of age or more. Results: Dental services utilization in the year prior to the study was more frequent among adults (53.2%, 95% CI:52.5-53.9) than in older adults (34.3%, 95% CI: 33.2-34.4). The multivariate analysis revealed that the use of dental services was more in people with more schooling (PR=2.02, 95% CI: 1.87-2.18) and higher income (PR=1.54, 95% CI: 1.45-1.64). The prevalence of dental services utilization in the year prior to the survey was higher among participants of the southeast, south and Midwest regions, ranging between 49.0% and 57.6%. Conclusion: Inequalities in dental services utilization were common in adults and older adults, with important regional differences; women, younger participants, those with more schooling and higher income, people with better oral health-related behaviors, better self-perceived oral health and those who paid for their lasts dental consultation were more likely to have used dental services in the year prior to the study.

Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde (PNS) de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, incluindo 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, IC95%: 52,5-53,9) do que entre os idosos (34,3%, IC95% 33,2-34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (RP:2,02, IC95%: 1,87-2,18) e de maior renda (RP:1,54, IC95%: 1,45-1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram com dentista no último ano, entre 49,0 a 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre as mulheres, indivíduos mais jovens, escolarizados e de maior renda, e entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico.

Abstract: This study aimed to evaluate the influence of choosing different socioeconomic status indicators in research regarding older adults’ oral health. This is a cross-sectional study that analyzed baseline data from the Brazilian Longitudinal Study on Aging (ELSI-Brazil). The outcomes were edentulism (n = 9,073) and self-reported oral health (n = 9,365). The following socioeconomic indicators were assessed: individual income, per capita household income, and wealth index. Poisson regression analysis with robust variance was performed to estimate prevalence ratios (PR), with their respective 95% confidence intervals (CI), after adjusting for socioeconomic and oral health behavior variables. Absolute inequality measures were also estimated. The individual income indicator was not statistically associated with the results after adjustments. When using per capita household income indicator, individuals in the richest quintile showed a 12% lower prevalence of poor self-reported oral health [PR: 0.88 (CI: 0.78–0.98)], relative to the poorest, and there was no association with edentulism. When the wealth index was chosen, there was a 22% lower prevalence of edentulism [PR: 0.78 (CI: 0.64–0.94)] and 15% lower prevalence of self-reported poor oral health [PR: 0.85 (CI: 0.78–0.93)] in individuals of the richest quintile, both relative to the poorest quintile. Regarding absolute inequality measures, for edentulism, the wealth index showed the highest absolute inequality. When considering self-reported oral health, per capita household income showed the greatest absolute inequality. Despite scientific challenges and the difficulty of socioeconomic indicator metrics, further investments in its development are critical to measure, promote, and improve population oral health.

Resumo O objetivo deste estudo foi avaliar a influência de fatores contextuais e individuais associados à insatisfação dos usuários do Sistema Único de Saúde (SUS) com o atendimento prestado pelo cirurgião-dentista na Atenção Primária à Saúde. Estudo transversal multinível, fundamentado em dados advindos de uma pesquisa de base nacional para avaliação da satisfação dos usuários com o SUS. Os dados foram coletados pelo Departamento de Ouvidoria Geral do SUS por meio de contato telefônico de uma amostra de 35.393 indivíduos de todo o país. Variáveis contextuais e individuais foram associadas à insatisfação com o serviço odontológico prestado pelo SUS. Para as análises, foi utilizado o software Stata versão 11.0 e realizada uma regressão logística multinível de efeitos aleatórios. Um total de 2.331 indivíduos de 61 municípios foram incluídos na amostra final de satisfação com o serviço odontológico. Apenas 43% dos participantes relataram haver resolução de seus pedidos e percebeu-se uma chance sete vezes maior de insatisfação para aqueles indivíduos que tiveram demanda não resolvida em relação aos que a resolveram. A presente pesquisa traz elementos que podem subsidiar o governo em ações voltadas para a melhoria do acesso e qualidade do atendimento prestado na atenção odontológica.

Abstract The scope of this study was to evaluate the influence of contextual and individual factors associated with dissatisfaction of users of the Unified Health System (SUS) with the care provided by dentists in Primary Health Care. It is a cross-sectional and multilevel study, based on secondary data derived from a national basic research project to assess user satisfaction with the SUS. Data were collected by the Ombudsman’s Department of the SUS by telephone contact with a sample of 35,393 individuals from around the country. Contextual and individual variables were associated with dissatisfaction with the dental service provided by the SUS. For the analysis, Stata version 11.0 software was used together with multilevel random effects logistic regression. A total of 2,331 individuals from 61 municipalities were included in the final sample of satisfaction with the dental service. Only 43% of the participants reported that their claims had been resolved, and a seven times greater chance of dissatisfaction was perceived for those individuals who had unresolved demand in relation to those who resolved it. This research provides input that can subsidize the government in actions aimed at improving access and quality of care provided in dental care.

Resumo O objetivo deste estudo foi avaliar a influência de fatores contextuais e individuais associados à insatisfação dos usuários do Sistema Único de Saúde (SUS) com o atendimento prestado pelo cirurgião-dentista na Atenção Primária à Saúde. Estudo transversal multinível, fundamentado em dados advindos de uma pesquisa de base nacional para avaliação da satisfação dos usuários com o SUS. Os dados foram coletados pelo Departamento de Ouvidoria Geral do SUS por meio de contato telefônico de uma amostra de 35.393 indivíduos de todo o país. Variáveis contextuais e individuais foram associadas à insatisfação com o serviço odontológico prestado pelo SUS. Para as análises, foi utilizado o software Stata versão 11.0 e realizada uma regressão logística multinível de efeitos aleatórios. Um total de 2.331 indivíduos de 61 municípios foram incluídos na amostra final de satisfação com o serviço odontológico. Apenas 43% dos participantes relataram haver resolução de seus pedidos e percebeu-se uma chance sete vezes maior de insatisfação para aqueles indivíduos que tiveram demanda não resolvida em relação aos que a resolveram. A presente pesquisa traz elementos que podem subsidiar o governo em ações voltadas para a melhoria do acesso e qualidade do atendimento prestado na atenção odontológica.

Abstract The scope of this study was to evaluate the influence of contextual and individual factors associated with dissatisfaction of users of the Unified Health System (SUS) with the care provided by dentists in Primary Health Care. It is a cross-sectional and multilevel study, based on secondary data derived from a national basic research project to assess user satisfaction with the SUS. Data were collected by the Ombudsman’s Department of the SUS by telephone contact with a sample of 35,393 individuals from around the country. Contextual and individual variables were associated with dissatisfaction with the dental service provided by the SUS. For the analysis, Stata version 11.0 software was used together with multilevel random effects logistic regression. A total of 2,331 individuals from 61 municipalities were included in the final sample of satisfaction with the dental service. Only 43% of the participants reported that their claims had been resolved, and a seven times greater chance of dissatisfaction was perceived for those individuals who had unresolved demand in relation to those who resolved it. This research provides input that can subsidize the government in actions aimed at improving access and quality of care provided in dental care.

RESUMO: Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, que incluiu 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, intervalo de confiança — IC95% 52,5–53,9) do que entre os idosos (34,3%, IC95% 33,2–34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (razão de prevalência — RP=2,02, IC95% 1,87–2,18) e maior renda (RP=1,54, IC95% 1,45–1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram um dentista no último ano, entre 49,0 e 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre mulheres, indivíduos mais jovens, escolarizados e de maior renda, entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico.

ABSTRACT: Objective: To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey. Methods: This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance. Results: The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval — 95%CI 52.5–53.9) than older adults (34.3%, 95%CI 33.2–34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio — PR=2.02, 95%CI 1.87–2.18) and higher income (PR=1.54, 95%CI 1.45–1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year — between 49.0 and 57.6% of the population. Conclusion: Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.

RESUMO: Objetivo: Descrever a prevalência do uso de serviços odontológicos no Brasil segundo as Unidades Federadas, sua relação com variáveis socioeconômicas e tipos de serviços, com base na Pesquisa Nacional de Saúde de 2019. Métodos: Trata-se de um estudo transversal de base populacional com dados da PNS 2019, que incluiu 88.531 participantes de 18 anos ou mais. Foram analisadas variáveis referentes ao uso de serviços de saúde bucal, segundo características sociodemográficas e comportamentais, por meio de análise multivariada, utilizando modelo regressão de Poisson com variância robusta. Resultados: A utilização de serviços odontológicos no ano anterior à entrevista foi maior entre os adultos (53,2%, intervalo de confiança — IC95% 52,5–53,9) do que entre os idosos (34,3%, IC95% 33,2–34,4). Na análise multivariada, o uso de serviços odontológicos foi maior em pessoas com maior nível educacional (razão de prevalência — RP=2,02, IC95% 1,87–2,18) e maior renda (RP=1,54, IC95% 1,45–1,64). Os estados das regiões Sudeste, Centro-Oeste e Sul apresentaram as maiores porcentagens de indivíduos que consultaram um dentista no último ano, entre 49,0 e 57,6% da população. Conclusão: Desigualdades no uso dos serviços de saúde bucal foram observadas na população adulta e idosa, com diferenças entre as regiões do país; foi identificado maior uso entre mulheres, indivíduos mais jovens, escolarizados e de maior renda, entre a população com melhores comportamentos relacionados à sua saúde, melhor percepção do seu estado de saúde, e aqueles que pagaram pelo último atendimento odontológico.

ABSTRACT: Objective: To describe the prevalence of use of dental services in Brazil according to states and the Federal District and its relationship with socioeconomic variables and types of services, based on the 2019 National Health Survey. Methods: This is a cross-sectional population-based study using data from the 2019 National Health Survey, which included 88,531 participants aged 18 or older. We assessed variables related to the use of dental health services according to sociodemographic and behavioral characteristics through multivariate analysis, using a Poisson regression model with robust variance. Results: The use of dental services in the year prior to the interview was higher among adults (53.2%, confidence interval — 95%CI 52.5–53.9) than older adults (34.3%, 95%CI 33.2–34.4). The multivariate analysis revealed that the use of dental services was greater in people with better schooling (prevalence ratio — PR=2.02, 95%CI 1.87–2.18) and higher income (PR=1.54, 95%CI 1.45–1.64). States from the Southeast, Midwest, and South regions presented the highest percentages of individuals who visited a dentist in the previous year — between 49.0 and 57.6% of the population. Conclusion: Inequalities were found in the use of dental health services among the adult and older adult population, with regional differences; the use was higher among women, younger individuals, those with better schooling, higher income, healthier behaviors, better self-perceived oral health status, and who paid for their last dental treatment.