Purpose: This study investigated the relationship between contextual and individual social determinants of oral health-related quality of life (OHRQoL) in Brazilian adults.
Methods: Data of 4594 Brazilian adults aged 35-44 years from the 2010 Brazilian Oral Health Survey were analysed. OHRQoL was measured using the Oral Impacts on Daily Performance (OIDP). Contextual socio-economic characteristics at city level assessed in 1991 and 2000 included social deprivation measured by Human Development Index (HDI) and income inequality (Gini index). Individual socio-economic characteristics included family income, schooling and number of goods. Covariates were age, sex, ethnicity and clinical oral measures. Multilevel multivariable Poisson regression analysis was carried to investigate the association of contextual and individual social characteristics with OIDP extent and with each OIDP item.
Results: Eating and cleaning teeth were the most reported daily activities influenced by oral conditions. In the adjusted analysis, low HDI 1991 and individual social characteristics (lower family income and lower schooling) were associated with OIDP extent. Sex (females) and all clinical oral measures were also associated with OIDP. Adults living in the cities with low HDI 1991 were more likely to have impact on eating and sleeping, whereas living in cities with high Gini index 1991 increased the prevalence of impact on emotional status, work and social contact. Low income was associated with all OIDP items.
Conclusion: Poor contextual social determinants and lower individual socio-economic position are associated with worse OHRQoL among Brazilian adults, even after adjusting for individual socio-demographic and clinical oral health variables.
Keywords: Health inequalities; Multilevel analysis; Oral health; Quality of life; Social determinants of health; Socio-economic factors.