Socioeconomic Inequalities and Oral Health Among Adults and Elderly People in Rural Riverside Communities in the Amazon, Brazil.

OBJECTIVES

To examine the extent to which socioeconomic and environmental characteristics are associated with oral health outcomes among adults and elderly people living in rural riverside communities in the Brazilian Amazon. The study also examined the mediating role of self-reported dental status and reason for the last dental visit in these associations.

METHODS

A household-based cross-sectional study included 569 residents from seven riverside communities along the Negro River, Manaus, Brazil. Data on age, sex, family income, conditional and unconditional social cash transfer programmes, housing conditions and sanitation, self-reported dental status, reason for the last dental visit, dental pain and satisfaction with oral health were collected through structured interviews. Structural equation modelling was used in the data analysis.

RESULTS

Poorer self-reported dental status was directly associated with non-enrolment in conditional cash transfer programme, lower income, greater age and female sex. Non-enrolment in conditional cash transfer programme and problem-oriented dental care-seeking behaviour was linked to dental pain. Worse self-reported dental status and inadequate household sanitation were directly associated with problem-oriented dental care-seeking behaviour. Poor satisfaction with oral health was linked to dental pain and problem-oriented dental care-seeking behaviour. Several indirect relationships were detected. Family income, self-reported dental status, reason for the last dental visit and dental pain mediated the relationships between demographics, cash transfer programmes and satisfaction with oral health.

CONCLUSIONS

Participation in income transfer programmes and family income emerged as relevant factors in reducing inequalities in oral health among adults and elderly people living in rural riverside communities. Improving the regularity and frequency of dental services can have a direct impact on satisfaction with oral health. Inter-sectoral actions targeting social and financial protection should be on the political agenda to improve the oral health of people living in rural riverside communities.