Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis

BACKGROUND It is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded. METHODS A multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project-a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities. RESULTS In the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services. CONCLUSION The use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.