Influência das desigualdades econômicas e raciais na saúde bucal: uma análise comparativa e interseccional no Brasil e Colômbia

Abstract

Latin America, with a history marked by socioeconomic and racial inequalities, presents a context that fosters health inequities, exacerbated by the unequal distribution of financial resources. These disparities are reflected in oral diseases, which are chronic, progressive, and disproportionately affect individuals from lower socioeconomic sectors. Understanding the relationships between race/color, economic status, and health is essential to bridging gaps in care and promoting equity in oral health. In this context, intersectionality provides a framework to analyze how social factors interact to generate complex inequalities, offering a more comprehensive perspective on health experiences. The general aim of this study is to investigate the influence of racial/color and income inequalities on oral health outcomes from an intersectionality perspective in Brazil and Colombia. Study 1 aims to explore the effects of the intersectionality between race/color and income on dental caries outcomes in Brazil and Colombia. Study 2 seeks to identify whether there is an intersectionality between race/color and income in periodontal disease among Brazilian and Colombian adults. Both studies are cross-sectional and were conducted using data from the 2010 Brazilian National Oral Health Survey (SBBrasil 2010) and the 2014 Colombian National Oral Health Survey (ENSAB-IV). In Study 1, untreated caries outcomes were analyzed for children, adolescents, and young people, while tooth loss outcomes were analyzed for adults and older adults. In Study 2, severe periodontal disease outcomes were assessed for individuals aged 35-44 and 65-74 years. Intersectionality was evaluated using the Relative Excess Risk due to Interaction (RERI). Data were analyzed according to participants' race/color and income, with adjustments for sex, age, and sampling weight. All analyses were performed using Stata 18 software. In Study 1, for Brazil, a higher average number of decayed/missing teeth was observed in the group with both exposure factors (race/color and income), with a sub-additive effect, indicating independence in the influence of these factors. For Colombia, a similar scenario was observed, except for tooth loss among older adults, where Afro-Colombians with lower income had a lower average than the reference group. In Study 2, the RERI results were non-significant, making it impossible to confirm the presence of an interaction between the exposure variables. The prevalence data for severe periodontal disease varied depending on race/color, income, age, and country, without representing a consistent pattern. In conclusion, individuals of low income and mixed-race, Black, or Afro-Colombian backgrounds generally exhibited poorer oral health. However, the exposure factors tended to act independently, indicating a sub-additive effect.