Association between socioeconomic contextual factor, dental care service availability, and prevalence of periodontitis in Brazil: a multilevel analysis

This study aimed to examine the effect of dental care services on periodontitis cases in Brazilian municipalities. The sample comprised 3,426 individuals aged 35-44 years. Moderate to severe periodontitis with clinical attachment loss and probing depth was the dependent variable, both > 3mm. Its exploratory variables were grouped into four categories: (1) individual characteristics; (2) contextual development indicators; (3) health service and structural factors; and (4) dental care use. Data were collected using the SBBrasil 2010 Project, the Brazilian Institute of Geography and Statistics, the Brazilian Information System of Primary and Secondary Care, and the Program to Improve Access and Quality of Dental Specialization Centers (PMAQ-CEO). Multilevel logistic regression was used to assess associations of periodontitis with individual and context variables. Municipalities with > 1 CEO or > 1 of any centers were associated with periodontitis, with OR = 0.97 (95%CI: 0.55-1.71) and OR = 0.41 (95%CI: 0.17-0.97), respectively. Prevalence of periodontitis was more likely in older people, lower education levels, and individuals that sought dental visits for pain/extraction and periodontal treatment. Other dental care services availability were not associated with the prevalence of periodontitis.

本研究旨在探讨牙科护理服务对巴西各市政辖区牙周炎病例的影响。研究样本纳入3426名年龄介于35至44岁的个体。以临床附着丧失与探诊深度均大于3mm的中重度牙周炎作为因变量。本研究的解释变量被划分为四大类别：（1）个体特征；（2）区域发展指标；（3）卫生服务与结构因素；（4）牙科护理利用情况。研究数据来源于巴西SBBrasil 2010项目（SBBrasil 2010 Project）、巴西地理与统计研究所（Brazilian Institute of Geography and Statistics）、巴西初级与二级保健信息系统，以及改善牙科专科中心可及性与质量计划（Program to Improve Access and Quality of Dental Specialization Centers, PMAQ-CEO）。本研究采用多水平logistic回归模型，分析牙周炎与个体及区域层面变量的关联。结果显示，辖区内拥有超过1家牙科专科中心（CEO）的区域与牙周炎发病存在关联，其比值比（OR）为0.97（95%置信区间：0.55-1.71）；拥有超过1家任意类型医疗中心的区域与牙周炎发病亦存在关联，其比值比（OR）为0.41（95%置信区间：0.17-0.97）。牙周炎患病率在老年人群、低学历群体以及因疼痛/拔牙与牙周治疗就诊的个体中显著更高。其余牙科护理服务的可及性与牙周炎患病率无显著关联。