Determinantes socioeconômicos contextuais associados às perdas dentárias

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, 2014.Abstract : Tooth loss are important markers of health status and constitute a portrait of social inequalities. This thesis aims to investigate the association between contextual socioeconomic factors and tooth loss, through a systematic review of the literature on the subject and a cross-sectional study with adults living in Florianópolis. The first article is a systematic review of studies that tested associations between contextual socioeconomic factors and tooth loss. Medline, Embase, and LILACS were searched without restricting publication time and language. We also search at the Brazilian Library of Theses and Dissertations (BDTD) to seek unpublished studies. Bibliographical and methodological studies characteristics were evaluated, besides the associations found. We found 348 articles and after review by independent researchers, remaining six articles included in the systematic review. We also identified an unpublished thesis results. The cross-sectional study aimed to identify the associations between tooth loss and contextual socioeconomic conditions, after adjustment for individual sociodemographic characteristics and availability of fluoridated water. To investigate whether the implementation time of water fluoridation was associated with tooth loss, and test possible cross-level interactions. Data from 1,720 adults, aged 20 to 59 years were analyzed. The number of missing teeth was the outcome. The individual variables included sex, skin colour, years of schooling and per capita family income. As control variables we used age and residence time. The contextual exposures were fluoridated water in years and socioeconomic variable for census tracts. Multilevel logistic regression was performed and tested cross-level interactions. Tooth loss were associated to contextual socioeconomic conditions for residents in the intermediate areas (OR = 1.58 - 95% CI 1.51 to 1.66) and poorer (OR = 1.62 - 95% CI 1.54 to 1.66) and shorter fluoridation (OR = 1.01 - 95% CI 1.01 to 1.02). Interaction between treated water and per capita family income was found. The systematic review indicated that the socioeconomic context interferes in tooth loss. Generally, the largest tooth loss turn up when contextual variables are less favorable to residents. To residents in Florianópolis, the worst contextual socioeconomic conditions were associated with tooth loss and the time of water fluoridation was inversely associated with tooth loss in adulthood