Efeito da desigualdade racial na associação entre fatores socioeconômicos e saúde bucal ao longo da vida

Abstract

Studies have demonstrated the effect of race/skin color on inequalities in oral health. However, most of these studies still attribute this effect to socioeconomic inequalities existing in the Brazilian population. Therefore, the objective of this study was to evaluate the effect of racial inequality on the association between socioeconomic factors and subjective (self-perceived oral health) and objective (tooth loss) outcomes in oral health among participants in the 1982 Pelotas Birth Cohort. The 1982 Cohort is a longitudinal study, with several follow-ups in childhood, adolescence and adulthood that allow different studies on the health of these individuals. For this study, perinatal data, general follow-up at 30 years of age and oral health at 31 years of age were used. The main exposition is the self-declaration of race/color. The covariates used were gender, perinatal income, income at age 30, education at age 30 and social mobility (from birth to adulthood). The outcomes were self-perception of oral health answered by the participants in a questionnaire, and tooth loss assessed by a trained and calibrated dental surgeon using the DMFT index (Decayed, Missing and Filled Teeth). The statistical analyzes carried out were the absolute index of inequality (SII), concentration index (CIX), log binomial models with prevalence ratios (PR) and the “Synergy Index” (S). The prevalence of negative self-perception of oral health was 36.1% and tooth loss 50.8%. A prevalence of negative self-perception of oral health was observed in blacks/Browns/Indigenous people with higher income/education comparable to the prevalence of the outcome in Whites with lower income/education. Higher prevalence for tooth loss was found for Blacks/Browns and an interaction between race and social mobility in the never poor category (S=0.20 [CI95% 0.04-0.99]). Racial inequalities in both self perceived oral health and tooth loss persist or increase in wealthier social strata, suggesting an effect of structural and interpersonal racism on oral health outcomes.