Análise espacial de atendimentos odontológicos e práticas de higiene bucal no Brasil: desigualdades regionais e raciais baseadas na pns 2019

Abstract

The relevance of population-based epidemiological studies, such as the 2019 National Health Survey (PNS), lies in the identification of regional disparities, especially when considering sociodemographic factors. This study aimed to analyze the spatial distribution of regional and racial inequalities related to dental care and oral hygiene practices in Brazil, based on social determinants of health and data from the 2019 PNS. This is an analytical, observational, ecological and quantitative research, which considered the five Brazilian macro-regions and their Federative Units. Secondary information available on the SIDRA/IBGE platform was used. The dependent variables analyzed included: "dental visits in the last 12 months, by location of last visit", "tooth brushing at least twice a day, by color/race and sex" and "use of toothbrush, toothpaste and dental floss, by color/race and sex". Thematic maps were created in QGIS software to represent the spatial distribution of these variables. Furthermore, spatial cluster patterns were identified through the Global Moran Index and the Local Indicators of Spatial Association (LISA) using GeoDa software. Statistical analysis was performed using Jamovi software, starting with Pearson correlations and, for independent variables with statistical significance (p<0.05), followed by linear regression, considering adjusted R2 and the global model test. The independent variables included: per capita income, HDI, oral health coverage, proportion of UBS/100,000 inhabitants, proportion of illiterate people, proportion of households without treated water, household Gini index and school enrollment rate. The results showed greater use of public services in the North and Northeast, although the private sector predominated in all regions, especially in the Southeast and Central-West, especially in the Federal District, the state that used basic care services the least. The North stood out for its weakness in secondary oral health care, especially in the states of Acre and Roraima. In contrast, the model of regionalization of oral health in Ceará, integrated with the Dental Specialty Centers, presented itself as an example to be replicated by other regions. There was a positive and counterintuitive correlation between illiteracy and oral hygiene practices in the North (white and black people), Northeast (white, black and brown people), Southeast (white people) and South (brown people) regions, indicating possible health promotion initiatives aimed at illiterate populations. However, racial inequalities in health remain evident, with the black population having a higher prevalence of oral diseases and the National Policy for Comprehensive Health of the Black Population still insufficiently implemented. Women continue to lead self-care practices in oral health, reflecting their social roles. In short, despite

advances with the National Oral Health Policy, significant disparities persist, especially in the North and Northeast regions, in terms of infrastructure, human resources and socioeconomic indicators, which compromises the principle of equity.