Racial Inequalities in Oral Health: A Population-Based Study
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Racial Inequalities in Oral Health: A Population‑Based Study Lívia Helena Terra e Souza1 · Sílvia Maria Santiago1 · Marilisa Berti de Azevedo Barros1 · Margareth Guimarães Lima1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The aim of the present study was to determine associations between race/skin color and the use of dental services and selfrated oral health. A cross-sectional population study analyzing data on adults who participated in the 2013/2014 Campinas Health Survey. Sociodemographic characteristics, variables related to dental visits, access to dental care, and subjective oral health conditions were evaluated in relation to race/color. The association between each variable and color/race was investigated using the χ2 test with the Rao–Scott correction (p-value = 0.05). Multivariate Poisson regression analysis was performed to estimate crude and adjusted prevalence ratios for age, schooling, income, and living conditions. The results revealed that assessments of one’s oral health status as poor (PR = 1.26), assessments of the dental care received as poor (PR = 1.68), and dental appointments for the purposes of extraction (PR = 1.13) were more prevalent in the black population, demonstrating independent associations with race. Associations between race and dental appointments for routine checkups, appointments for urgent care, the last appointment more than two years earlier, difficult access to dental care, difficulty eating, and being ashamed of smiling due to one’s dental condition were explained by socioeconomic status. The results point to inequality in oral health and the need to eliminate racism in oral health, which remains pronounced. It is hoped that bringing this situation to light will help our society move forward in the fight against racism in Brazil. Keywords Disparities · Oral health · Adult · Health surveys
Introduction Studies on racial inequalities are incipient in Brazil. The slavery of blacks, the injustices of which lasted 300 years, was legally abolished in 1888 but its vestiges remain impregnated in the living conditions of this population. Blacks currently compose the population with the lowest socioeconomic status, low income, and low schooling and reside in areas of high social vulnerability (Marguti et al. 2017). Average schooling among blacks was 4.5 years in 1995 compared to 6.7 years among whites. 20 Years later, mean schooling among whites was nine years compared to 7.4 years among blacks. In 2016, 18% of blacks had no schooling at all and blacks accounted for only 1/4 of the population at higher education institutions. Income follows a similar pattern, as * Lívia Helena Terra e Souza [email protected] 1
Department of Collective Health, School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
it tends to align with the level of schooling. However, the mean income of blacks with a university education is 25% lower than that of whites with the same level of education (Georges and Maia 2017). Changin
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