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Desigualdades em saúde oral e no acesso a cuidados dentários em Portugal
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RESUMO - Introdução: A saúde oral, frequentemente negligenciada nas agendas de saúde pública, é
um determinante essencial do bem-estar e da qualidade de vida. Em Portugal, persistem
desigualdades que influenciam o acesso e os resultados em saúde oral, revelando um padrão
fortemente marcado por fatores socioeconómicos. Este estudo teve como objetivo identificar
e medir as desigualdades socioeconómicas em saúde oral na população residente em
Portugal, avaliando disparidades nos resultados e no acesso/utilização a cuidados dentários.
Métodos: Foi utilizada a mais recente base de microdados do Inquérito Nacional de Saúde
(2019), referente a indivíduos com 15 ou mais anos. O Inquérito é uma amostra representativa
da população civil não institucionalizada em Portugal, conduzido pelo Instituto Nacional de
Estatística e integrado no European Health Interview Survey. Analisaram-se variáveis
relacionadas com a saúde oral (autoapreciação do estado de saúde, dificuldades na
mastigação e frequência de escovagem) e com o acesso a cuidados (consulta recente, motivo
da consulta, necessidade de consulta não satisfeita por dificuldades financeiras e posse de
seguro com cobertura dentária). O grau de escolaridade foi utilizado como indicador
socioeconómico. Para quantificar as desigualdades, recorreu-se a curvas e índices de
concentração, um método extensivamente documentado na literatura, mas ainda com
aplicação limitada na área da saúde oral.
Resultados: Os indivíduos com menor escolaridade reportaram piores níveis de saúde oral,
maior frequência de dificuldades na mastigação e menor regularidade na escovagem
dentária. Em termos de acesso, observaram-se desigualdades no recurso a consultas, no
motivo da última consulta e na prevalência de necessidades não satisfeitas por motivos
financeiros. A posse de seguro com cobertura dentária revelou igualmente um padrão
socialmente desigual, mais frequente entre os indivíduos com maior escolaridade. Os índices
de concentração confirmaram que melhores resultados em saúde oral e a utilização de
cuidados se encontram desproporcionalmente concentrados nos grupos
socioeconomicamente mais favorecidos. Conclusão: Os resultados confirmam a persistência de desigualdades sociais significativas
em saúde oral em Portugal, que afetam simultaneamente os resultados em saúde e o acesso
a cuidados. Estas evidências sublinham a necessidade de políticas públicas integradas,
centradas na promoção da equidade, no reforço da prevenção e no alargamento da cobertura
pública em saúde oral.
ABSTRACT - Introduction: Oral health, often overlooked in public health agendas, is an essential determinant of well-being and quality of life. In Portugal, persistent inequalities affect access to and outcomes in oral health, revealing a pattern strongly shaped by socioeconomic factors. This study aimed to identify and measure socioeconomic inequalities in oral health among the Portuguese population, assessing disparities in outcomes and access/utilization of dental care. Methods: The most recent microdata from the 2019 National Health Interview Survey were used, comprising individuals aged 15 and over. The survey is a representative sample of the non-institutionalised civilian population in Portugal, conducted by the National Institute of Statistics (Statistics Portugal) and integrated in the European Health Interview Survey. Variables analysed included self-perceived oral health, mastication difficulties and toothbrushing frequency, as well as access to care (recent dental visit, reason for visit, unmet need due to financial constraints, and dental insurance coverage). Educational attainment was used as the indicator of socioeconomic status. To quantify inequalities, concentration curves and indices were applied, a method extensively documented in the literature but still underused in oral health research. Results: Individuals with lower educational levels reported poorer oral health, more frequent mastication difficulties and less regular toothbrushing. In terms of access, inequalities were observed in dental visits, the reason for the last visit and the prevalence of unmet needs due to financial reasons. Dental insurance coverage also showed a socially unequal pattern, being more common among those with higher educational levels. Concentration indices confirmed that better oral health outcomes and use of dental care are disproportionately concentrated among the socioeconomically advantaged groups. Conclusion: The results confirm the persistence of significant social inequalities in oral health in Portugal, affecting both health outcomes and access to care. These findings underline the need for integrated public policies focused on promoting equity, strengthening prevention and expanding public coverage in oral health.
ABSTRACT - Introduction: Oral health, often overlooked in public health agendas, is an essential determinant of well-being and quality of life. In Portugal, persistent inequalities affect access to and outcomes in oral health, revealing a pattern strongly shaped by socioeconomic factors. This study aimed to identify and measure socioeconomic inequalities in oral health among the Portuguese population, assessing disparities in outcomes and access/utilization of dental care. Methods: The most recent microdata from the 2019 National Health Interview Survey were used, comprising individuals aged 15 and over. The survey is a representative sample of the non-institutionalised civilian population in Portugal, conducted by the National Institute of Statistics (Statistics Portugal) and integrated in the European Health Interview Survey. Variables analysed included self-perceived oral health, mastication difficulties and toothbrushing frequency, as well as access to care (recent dental visit, reason for visit, unmet need due to financial constraints, and dental insurance coverage). Educational attainment was used as the indicator of socioeconomic status. To quantify inequalities, concentration curves and indices were applied, a method extensively documented in the literature but still underused in oral health research. Results: Individuals with lower educational levels reported poorer oral health, more frequent mastication difficulties and less regular toothbrushing. In terms of access, inequalities were observed in dental visits, the reason for the last visit and the prevalence of unmet needs due to financial reasons. Dental insurance coverage also showed a socially unequal pattern, being more common among those with higher educational levels. Concentration indices confirmed that better oral health outcomes and use of dental care are disproportionately concentrated among the socioeconomically advantaged groups. Conclusion: The results confirm the persistence of significant social inequalities in oral health in Portugal, affecting both health outcomes and access to care. These findings underline the need for integrated public policies focused on promoting equity, strengthening prevention and expanding public coverage in oral health.
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Palavras-chave
Saúde oral desigualdades sociais acesso a cuidados dentários equidade Oral health social inequalities access to dental care equity