Tooth loss in Brazilian middle-aged adults: multilevel effects.
OBJECTIVE
To examine the link between tooth loss and multilevel factors in a national sample of middle-aged adults in Brazil.


METHODS
Analyses were based on the 2003 cross-sectional national epidemiological survey of the oral health of the Brazilian population, which covered 13 431 individuals (age 35-44 years). Multistage cluster sampling was used. The dependent variable was tooth loss and the independent variables were classified according to the individual or contextual level. A multilevel negative binomial regression model was adopted.


RESULTS
The average tooth loss was 14 (standard deviation 9.5) teeth. Half of the individuals had lost 12 teeth. The contextual variables showed independent effects on tooth loss. It was found that having 9 years or more of schooling was associated with protection against tooth loss (means ratio range 0.68-0.76). Not having visited the dentist and not having visited in the last > or =3 years accounted for increases of 33.5% and 21.3%, respectively, in the risk of tooth loss (P < 0.05). The increase in tooth extraction ratio showed a strong contextual effect on increased risk of tooth loss, besides changing the effect of protective variables.


CONCLUSIONS
Tooth loss in middle-aged adults has important associations with social determinants of health. This study points to the importance of the social context as the main cause of oral health injuries suffered by most middle-aged Brazilian adults.
Moreira
Rafael Da Silveira
Rda S
Department of Public Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Ministry of Health, Recife, Brazil. moreirars@cpqam.fiocruz.br
Nico
Lucélia Silva
LS
Barrozo
Lígia Vizeu
LV
Pereira
Júlio César Rodrigues
JC
D000328:Adult; D000367:Age Factors; D001336:Automobiles / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D004522:Educational Status; D016021:Epidemiologic Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006267:Health Education, Dental / Q000706:statistics & numerical data; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012737:Sex Factors; D012923:Social Class; D014081:Tooth Extraction / Q000706:statistics & numerical data; D016388:Tooth Loss / Q000453:epidemiology*; D014504:Urban Health / Q000706:statistics & numerical data