Revista brasileira de epidemiologia = Brazilian journal of epidemiology最新文献

{"title":"Prevalence, incidence, and years lived with disability due to Autism Spectrum Disorder in Brazil, 1990-2023: Results from the Global Burden of Disease Study 2023.","authors":"Nathalia Avila Dimer, Ana Paula Souto Melo, Damian Santomauro, Deborah Carvalho Malta, Bruce Bartholow Duncan, Bárbara Niegia Garcia de Goulart","doi":"10.1590/1980-549720260025","DOIUrl":"10.1590/1980-549720260025","url":null,"abstract":"<p><strong>Objective: </strong>To describe the prevalence, incidence, and years lived with disability due to autism spectrum disorder in Brazil, as well as the variation of these metrics between 1990 and 2023.</p><p><strong>Methods: </strong>A time-series analysis using data for Brazil from the 2023 Global Burden of Disease study. Estimates of incidence, prevalence, and years lived with disability attributable to autism spectrum disorder were generated for Brazil and its regions. The study reports absolute frequencies, crude rates, and age-standardized rates per 100,000 inhabitants, all with 95% uncertainty intervals (95% UI), stratified by sex and age group.</p><p><strong>Results: </strong>In 2023, more than 1.1 million (95% UI: 0.58; 1.97) individuals on the autism spectrum were living in Brazil, representing 0.53% of the population (95% UI: 0.27; 0.93). The number of cases increased since 1990, while age-standardized prevalence remained stable over time. In 2023, more than 23,000 new autism spectrum disorder cases were estimated, with a rate of 11.19 per 100,000 individuals (95% UI: 2.47-31.39). Autism spectrum disorder was ranked within the top ten causes of years lived with disability for people younger than 20 years, being a non-fatal health burden.</p><p><strong>Conclusion: </strong>In 2023, 0.53% of Brazilians were autistic, corresponding to more than 207,000 years lived with disability. Prevalence was higher in males and children under five years of age. The permanent and complex nature of autism spectrum disorder imposes a significant burden, requiring healthcare and education services to be adequately prepared. Further research is needed to deepen the understanding of autism spectrum disorder and validate screening tools in the Brazilian context.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260025"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tooth loss in Brazilian adolescents: a multilevel cross-sectional study.","authors":"Lara de Souza Cruz Lizardo, Rafaela da Silveira Pinto, Widla Emanuella Pereira Barreto Garcez, Jacqueline Silva Santos, Renata Castro Martins, Mauro Henrique Nogueira Guimarães de Abreu","doi":"10.1590/1980-549720260007.supl.1","DOIUrl":"10.1590/1980-549720260007.supl.1","url":null,"abstract":"<p><strong>Objective: </strong>To investigate factors associated with tooth loss among Brazilian adolescents aged 15 and 19 years.</p><p><strong>Methods: </strong>This is a cross-sectional study conducted based on secondary data from the National Survey of Oral Health (SB Brasil 2023), carried out by the Ministry of Health. Variables were analyzed at the individual (sociodemographic characteristics, oral morbidity, and use of dental services), municipal, and state levels. Multilevel Poisson regression models with robust variance were developed to estimate unadjusted and adjusted prevalence ratios. The present study included 8,053 adolescents who participated in the SB Brasil 2023.</p><p><strong>Results: </strong>The prevalence of tooth loss in this population was 13.77%. Individual and contextual factors were associated with this condition. Each one-year increase in age was associated with a 19% higher prevalence of tooth loss. Higher prevalence was identified among beneficiaries of social programs (25%), adolescents reporting toothache (66%), and users of public health services (23%) compared with those using private services. Greater oral health coverage in Primary Health Care, Gross Domestic Product, and Human Development Index were associated with lower prevalence of the outcome.</p><p><strong>Conclusion: </strong>Tooth loss among Brazilian adolescents aged 15 to 19 years remains a condition influenced by sociodemographic factors, socioeconomic inequalities, oral morbidity, and predominantly curative access to dental services. Our findings highlight the need to strengthen preventive and equitable actions, especially for vulnerable populations, to reduce regional disparities and promote better oral health outcomes at the national level.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29Suppl 1 Suppl 1","pages":"e260007supl1"},"PeriodicalIF":2.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and contextual factors associated with tooth loss among Brazilian older adults.","authors":"Armando Cabral de Lira Neto, Ana Beatriz Rodrigues Moura, Lilian Nadja Silva Brito, Lucas Xavier Bezerra de Menezes, Luciana Leônia Soares Freire, Maria Letícia Barbosa Raymundo, Thayana Maria Navarro Ribeiro de Lima Martins, Rênnis Oliveira da Silva, Yuri Wanderley Cavalcanti, Rafael Aiello Bomfim","doi":"10.1590/1980-549720260005.supl.1","DOIUrl":"10.1590/1980-549720260005.supl.1","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors associated with functional dentition, severe tooth loss, and edentulism among Brazilian older adults, investigating individual sociodemographic characteristics and contextual characteristics of municipal oral health services.</p><p><strong>Methods: </strong>This is a cross-sectional, analytical study with data from the SB Brasil 2023 survey on individuals aged 65-74 years. Tooth loss was evaluated based on three outcomes: functional dentition (≥20 permanent teeth), severe tooth loss (<10 remaining teeth), and edentulism (loss of all permanent teeth). Multilevel logistic regression accounted for the complex sampling design. Individual variables were sex, ethnicity/race, per capita household income, and level of education; contextual variables were oral health coverage in Primary Health Care and the presence of Dental Specialty Centers (CEO) and Regional Dental Prosthesis Laboratories (LRPD) (p<0.05).</p><p><strong>Results: </strong>Oral health coverage in Primary Health Care and the presence of CEO and LRPD were not associated with edentulism (p>0.05). Functional dentition was less likely among women (OR 0.66; 95%CI 0.57-0.76) and among residents of municipalities with oral health coverage ≥80% (OR 0.74; 95%CI 0.56-0.97). Higher income and level of education were associated with higher prevalence of functional dentition (p<0.05). Severe tooth loss and edentulism were more frequent among women and older adults with lower income and lower level of education (p<0.05). Severe tooth loss was less prevalent in municipalities with CEO (p<0.05).</p><p><strong>Conclusion: </strong>Individual socioeconomic variables and contextual characteristics of oral health services were associated with tooth loss among older adults, evidencing the persistence of social inequalities in this outcome.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29Suppl 1 Suppl 1","pages":"e260005supl1"},"PeriodicalIF":2.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial and temporal distribution of Brazilian spotted fever in an endemic area: epidemiological profile of a zoonosis in constant adaptation to anthropogenic actions.","authors":"Jardel Brasil, Adriano Pinter, Rodrigo Nogueira Angerami, Maria Rita Donalisio","doi":"10.1590/1980-549720260020","DOIUrl":"10.1590/1980-549720260020","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the spatial and temporal distribution of probable infection sites (PIS) for Brazilian spotted fever (BSF) and to evaluate changes in the occurrence pattern in an endemic area in the interior of the state of São Paulo.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 40 confirmed cases of BSF (2007-2024) with identified PIS in the municipality of Americana, São Paulo. Data were obtained from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação), epidemiological investigation reports, and acarological surveys. For each georeferenced PIS, data on microclimate, altimetry, slope, Normalized Difference Vegetation Index (NDVI), and proximity to water bodies were analyzed.</p><p><strong>Results: </strong>Cases were atypically concentrated in the first half of the year, differing from the expected pattern for areas of transmission by Amblyomma sculptum, influenced by the outbreak recorded in 2018. PIS were concentrated near water bodies, in areas of degraded riparian forest and microclimates characterized by mild temperatures and high humidity, with low NDVI values, low altitude, and low slope. Spatial clustering was observed, along with an expansion of transmission toward urbanized areas over the study period: initially (2007-2015, nine cases) in the northern/northeastern portion of the municipality, in bordering regions, and more recently (2016-2024, 25 cases) advancing toward central areas, with the formation of large clusters.</p><p><strong>Conclusion: </strong>The findings indicate an eco-epidemiological alert scenario associated with the proximity between high densities of vectors, amplifying hosts, and human populations, reinforcing the need for intensified surveillance and targeted health education starting in the second quarter of the year.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260020"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial distribution of HIV/AIDS risk in Campinas-SP (1980-2019): a geospatial analysis by decade.","authors":"Márcio Cristiano de Melo, Celso Stephan, Ricardo Carlos Cordeiro, Valeria Correia de Almeida, Maria Rita Donalisio","doi":"10.1590/1980-549720260021","DOIUrl":"10.1590/1980-549720260021","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to analyze the spatial distribution of AIDS case risk (1980-2019) and HIV infection risk (2000-2019) in Campinas, Brazil.</p><p><strong>Methods: </strong>We conducted a geospatial case-control study using the Notifiable Diseases Information System data. We included all reported AIDS and HIV cases among individuals aged 13 years or older, excluding pregnant women and death notifications. We geocoded the data using the official cartographic base of the municipality and UTM coordinates (SAD69). We modeled spatial risk using generalized additive models (GAMs), applying the Kelsall and Diggle method with pairs of geographic coordinates as non-parametric predictors. We stratified the results by decade and compared them across periods.</p><p><strong>Results: </strong>We identified 11,372 AIDS cases (1980-2019) and 3,329 HIV cases (2000-2019). We observed a persistent pattern of high risk in the central district (Distrito Sede) since the 1980s, with progressive expansion toward peripheral districts (Campo Grande, Ouro Verde, Sousas, and Joaquim Egídio). This peripheralization of the epidemic coincided with accelerated urbanization and socio-spatial inequality. The highest incidence rates of HIV and AIDS occurred among adults aged 20 to 39 years, with a notable increase among older adults. The analysis revealed partial overlaps of hotspots and expansion of risk areas.</p><p><strong>Conclusion: </strong>The spatial distribution of HIV/AIDS in Campinas is heterogeneous and dynamic, characterized by persistence in central areas and expansion into vulnerable peripheral regions. Georeferencing was a strategic tool to guide territorially sensitive prevention and control actions.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260021"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and Contextual Factors Associated with the Need for and Use of Dental Prostheses in Brazil: A Multilevel Analysis of SB Brasil 2023 Data.","authors":"Lucas Xavier Bezerra de Menezes, Laura Maria de Almeida Martins, Maria Letícia Barbosa Raymundo, Rilary Rodrigues Feitosa, Niely Enetice de Sousa Catão, Armando Cabral de Lira Neto, Rennis Oliveira da Silva, Rafael Aiello Bomfim, Yuri Wanderley Cavalcanti","doi":"10.1590/1980-549720260003.supl.1","DOIUrl":"10.1590/1980-549720260003.supl.1","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate how individual and contextual socioeconomic variables influence the prevalence of denture use and need among Brazilian older adults, considering the National Oral Health Survey (SB Brasil 2023) and the expansion of primary and specialized care.</p><p><strong>Methods: </strong>This is a quantitative, analytical, cross-sectional study with 9,745 older adults (65-74 years) from SB Brasil 2023, whose outcomes are \"need\" and \"use\" of dentures. Associations are analyzed using multilevel logistic regression with random intercept by municipality, reporting odds ratios and 95% confidence intervals with a robust estimator.</p><p><strong>Results: </strong>The model for denture need indicated higher odds among self-declared Black older adults, users of public services, and residents of municipalities with a higher proportion of Black people (p<0.05). For denture use, a higher probability was observed among women, people with per-capita income between the poverty line and two minimum wages, and schooling of 5-8 years (p<0.05). Access through the public service was associated with a lower probability of use (p<0.05).</p><p><strong>Conclusion: </strong>Denture use and need among older adults are marked by inequities by skin color, gender, income, and schooling. The availability of public dental services showed no significant effect, and strategies are needed that prioritize vulnerable groups and increase the efficiency of dental care in the Unified Health System.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29Suppl 1 Suppl 1","pages":"e260003.supl.1"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of tobacco use during the pandemic: risk factors in the Brazilian context.","authors":"Deborah Carvalho Malta, Crizian Saar Gomes, Bárbara Aguiar Carrato, Giseli Nogueira Damacena, Paulo Roberto Borges de Souza Júnior, Wanessa da Silva Almeida, Célia Landmann Szwarcwald","doi":"10.1590/1980-549720260014","DOIUrl":"10.1590/1980-549720260014","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the incidence of tobacco use during the COVID-19 pandemic among Brazilian adults and to analyze the factors associated with initiation during this period.</p><p><strong>Methods: </strong>A cross-sectional study using data from the ConVid 2 - Pesquisa de Comportamento (ConVid 2 - Behavior Survey), conducted between July and December 2023 through virtual chain sampling. Prevalence of tobacco use before, during, and after the COVID-19 pandemic, as well as initiation during the pandemic, were assessed. Independent variables included sociodemographic characteristics, health conditions, mental health, and lifestyle factors. Prevalences and 95% confidence intervals (95%CI) were estimated, and factors associated with initiation were investigated using multivariable logistic regression.</p><p><strong>Results: </strong>The prevalence of smoking was 10.35% before the pandemic, 15.88% during (with an incidence of 5.5% of new smokers), and 12.2% in the post-pandemic period. Higher odds of smoking initiation during the pandemic were observed among individuals not living with a partner (OR=1.44; 95%CI 1.06-1.95), those who self-identified as non-white (OR=2.20; 95%CI 1.17-4.13), those reporting worsening feelings of sadness (OR=1.65; 95%CI 1.11-2.44), and those reporting increased alcohol consumption (OR=6.51; 95%CI 2.89-14.61). Lower odds were found among residents of the Southeast (OR=0.33; 95%CI 0.13-0.79) and Northeast (OR=0.25; 95%CI 0.11-0.57) regions.</p><p><strong>Conclusion: </strong>These findings highlight the need for public policies targeting more vulnerable populations.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260014"},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linear regression in ecological studies involving space: methodology and an application example in public health.","authors":"Gleice Margarete de Souza Conceição, Patricia Marques Moralejo Bermudi, Raquel Gardini Sanches Palasio, Gerson Laurindo Barbosa, Camila Meireles Fernandes, Lidia Maria Reis Santana, Ligia Vizeu Barrozo, Daiane Leite da Roza, José Alberto Quintanilha, Francisco Chiaravalloti-Neto","doi":"10.1590/1980-549720260018","DOIUrl":"10.1590/1980-549720260018","url":null,"abstract":"<p><p>Many health-related phenomena can be better understood when the geographic region in which they occur is taken into account. One of the most important aspects to consider in spatial study designs is the presence of autocorrelation in observations measured across space. If this spatial dependence is not properly modeled, the resulting statistics may be biased, compromising the validity of conclusions regarding the presence or absence of associations. Methodologies developed based on the linear regression model allow this dependence to be adequately accommodated, producing precise, robust, and unbiased estimates. With the aim of highlighting the applicability of spatial models and pointing out the necessary precautions in data analysis, this article describes, step by step, one of the most commonly used methodologies for spatial data analysis, as well as the measures to be taken to avoid modeling errors and distortion of results. The linear regression model is presented, along with procedures to evaluate model fit, the most commonly used measure to detect spatial dependence, and two autoregressive models frequently applied to model this dependence (SAR and SEM). An application example is provided using the GeoDa and R software.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260018"},"PeriodicalIF":2.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic determinants of health care in heart failure mortality in Mexico, 019 and 2023.","authors":"Julio Cesar Campuzano, Jorge Martin Rodríguez, Pablo Enrique Chaparro, Diana Carolina Urrego, Anaid Hernández","doi":"10.1590/1980-549720260019.2","DOIUrl":"10.1590/1980-549720260019.2","url":null,"abstract":"<p><strong>Objective: </strong>To analyze sociodemographic determinants associated with medical care before death from heart failure (HF) in Mexico, comparing 2019 and 2023.</p><p><strong>Methods: </strong>A retrospective cross-sectional analytical study was conducted using national mortality records from the General Directorate of Epidemiology (DGE). HF deaths (ICD-10: I50.0-I50.9) from 2019 and 2023 were selected, representing pre- and post-pandemic (COVID-19) contexts. The variables included gender, age, education, marital status, health insurance coverage, area of residence, region, place of death, and year of occurrence. Multiple logistic regression was applied to estimate odds ratios (OR) with 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>In the 2019-2023 period, 13,510 HF deaths were recorded (6,077 in 2019 and 7,433 in 2023). The probability of receiving medical care before death was 22% higher in 2023 compared to 2019 (OR 1.22; 95%CI 1.10-1.36). Medical care was more likely among individuals aged ≥80 years old, with higher educational levels, living in urban areas, and with health insurance coverage. Being male, lacking health coverage, and dying at home were associated with a lower probability of receiving medical care. The interaction between health insurance coverage and place of death revealed reduced access to medical care among individuals without social security who died at home.</p><p><strong>Conclusions: </strong>Substantial gaps in access to medical care persist, associated with structural and social inequalities. The post-pandemic recovery of coverage indicates a partial strengthening of the health system. Strengthening primary health care, expanding effective universal coverage, and developing strategies targeting vulnerable groups are recommended.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29 ","pages":"e260019"},"PeriodicalIF":2.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in the use of public oral health services among older adults in Brazil: a national population-based study, 2023.","authors":"Breno Marques de Mello, Debora Lana Alves Monteiro, Ayla Miranda de Oliveira, Bárbara Rachelli Farias Teixeira, Raissa Taynnar Albuquerque Lopes, Rênnis Oliveira da Silva, Yuri Wanderley Cavalcanti, Rafael Aiello Bomfim","doi":"10.1590/1980-549720260004.supl.1","DOIUrl":"10.1590/1980-549720260004.supl.1","url":null,"abstract":"<p><strong>Objective: </strong>To analyze individual and contextual factors associated with the use of public dental services among Brazilian older adults, using data from SB Brasil 2023.</p><p><strong>Methods: </strong>A total of 9,745 older adults were included in this cross-sectional study. The outcome was the use of public oral health services versus private services. Analyses accounted for the complex sampling design and applied multilevel logistic regression with a random intercept at the municipal level, guided by Andersen's Behavioral Model. Independent variables included predisposing factors (race/skin color, sex, and level of education), enabling factors (per capita income and oral health coverage in Primary Health Care) and need factors (edentulism and perceived need for dental treatment and prostheses).</p><p><strong>Results: </strong>The weighted prevalence of public dental service use was 39.2% (95%CI 35.7-42.9). After adjustment, higher odds of using the public system were observed among Black (OR 1.97; 95%CI 1.60-2.40), mixed-race (OR 1.38; 95%CI 1.19-1.61), and Indigenous older adults (OR 5.16; 95%CI 2.01-13.21), as well as among those with edentulism (OR 1.44), perceived need for dental treatment (OR 1.26), and need for prostheses (OR 1.39). Living in municipalities with oral health coverage above 70% was associated with greater use of public services (OR 2.47; 95%CI 1.83-3.31). The proportion of variance attributable to the municipal level decreased from 28.3% in the null model to 16.7% in the final model.</p><p><strong>Conclusion: </strong>Public dental service use among older adults in Brazil is socially stratified and strongly associated with social vulnerability and oral health needs, highlighting the pro-equity role of the Brazilian Unified Health System.</p>","PeriodicalId":74697,"journal":{"name":"Revista brasileira de epidemiologia = Brazilian journal of epidemiology","volume":"29Suppl 1 Suppl 1","pages":"e260004supl1"},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}