Abstract
BACKGROUND: Brazil has severe socioeconomic inequalities, resulting in major oral health problems for the Brazilian elderly, such as tooth loss and, consequently, a need for oral rehabilitation. The aim of this study was to evaluate inequalities in complete denture need among older Brazilian adults in relation to social determinants at individual and contextual levels. METHODS: This retrospective study was based on data from the national oral health survey, SB Brasil 2010, in which 7,619 older adults aged 65-74 years participated. The dependent variable was complete denture need. The independent variables at the first level were age, sex, race, and socioeconomic status. The independent variables that were used to identify inequality at the contextual level were geographic region of Brazil, the population of the municipality where the subject lived, whether the subject lived in the state capital or not, and the Human Development Index. In order to describe the socioeconomic characteristics, a socioeconomic cluster variable was created using the multivariable cluster analysis technique. Prevalence ratios (PRs) with 95 % confidence intervals (CIs) were determined to evaluate the effect of each variable. Two-level multivariable modeling was performed to examine the individual and contextual effects. RESULTS: There was a high prevalence of complete denture need among older Brazilian adults. The main factors associated with the prevalence of complete denture need were individual socioeconomic status (PR: 1.81; 95 % CI: 1.65-1.99), and the city-level contextual effect (PR: 1.20; 95 % CI: 1.08-1.34). CONCLUSIONS: Consistently poor rates of oral health rehabilitation were found among older Brazilian adults, and were associated with significant social inequality. Complete denture need was strongly associated with individual socioeconomic position. It was also verified that the Human Development Index, the city-level contextual effect, was associated with complete denture need.