Impact of structural and interpersonal racism on oral health and dental services
DOI:
https://doi.org/10.11606/Keywords:
Racism, Residential Segregation, Residence Characteristics, Oral Health, Health Services AccessibilityAbstract
OBJECTIVE: To analyze the role of racism in oral health and access to dental services, considering two impact pathways: structural racism and interpersonal racism. METHODS: A cross-sectional study with 686 undergraduate students, which analyzed two categories of outcomes: those related to oral health (self-perception, oral health impairment, and tooth loss) and those related to access to/perception of the quality of dental services (access to services, recent use, and evaluation of care). Exposures were race/color, racial discrimination, and characterization of the neighborhood environment. Prevalence ratios were estimated using Poisson regression with robust variance, with adjustments guided by directed acyclic diagrams. RESULTS: Black and brown people had a higher prevalence of negative self-perception (black: PR = 1.56; 95%CI 1.14–2.13; brown: PR = 1.53; 95%CI 1.14–2.05), tooth loss (black: PR = 1.99; 95%CI 1.33–2.97), lack of access to dental services (black: PR = 3.08; 95%CI 1.06–8.95; brown: PR = 3.78; 95%CI 1.49–9.59), and negative evaluation of care (black: PR = 1.63; 95%CI 1.08–2.45; brown: PR = 1.64; 95%CI 1.12–2.39). Racial discrimination was associated with lack of access (PR = 4.34; 95%CI 1.45–12.95), recent non-use of services (PR = 1.74; 95%CI 1.31–2.31) and negative evaluation of care (PR = 1.51; 95%CI 1.01–2.25). And living in neighborhoods with fewer physical and social problems was associated with a lower prevalence of negative self-perception (PR = 0.70; 95%CI 0.54–0.90), compromised oral health (PR = 0.87; 95%CI 0.76–0.99), lack of access (PR = 0.42; 95%CI 0.18–0.98), and negative evaluation of care (PR = 0.56; 95%CI 0.40–0.79). CONCLUSIONS: The findings show that racism impacts oral health through structural and interpersonal channels and highlight the urgency of broad and effective strategies to reduce the inequities affecting racialized groups.
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