Social Determinants and Oral Health Among Indigenous and Non-Indigenous Older Adults in La Araucanía, Chile: Cross-Sectional Study.

چکیده اصلی

BACKGROUND: Social disparities in oral health persist, disproportionately affecting Indigenous populations. OBJECTIVE: This study aims to compare oral health status, dental care access, treatment needs, and social determinants between Mapuche and non-Mapuche older adults in the La Araucanía Region of Chile, within a hybrid dental care model, and to explore whether ethnicity is associated with these outcomes, guided by the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) framework. METHODS: We conducted a cross-sectional exploratory analytic study using data from 480 adults aged 60 years or older who received dental care through a hybrid teledentistry and mobile clinic model (Geriatric Dental Specialties Tele-Platform [TEGO]) in 4 municipalities of La Araucanía. The analytic sample was restricted to community-dwelling, functionally independent older adults. Outcomes included oral health status (nonfunctional dentition, edentulism, cavitated caries, and periodontitis), dental care access (fixed prosthetic rehabilitation and unmet denture need), and dental treatment needs (restorative and prosthetic). Structural (sex, age, education, rurality, and ethnicity) and intermediary determinants (behavioral, biological, psychosocial, and health system access) were analyzed following the WHO-CSDH framework. Bivariate analyses compared outcomes between Mapuche and non-Mapuche participants. Multivariable logistic regression models examined associations between determinants and outcomes. RESULTS: A total of 471 older adults (mean age 72.8, SD 7.7 years) were included; 76.9% (362/471) had nonfunctional dentition, 18% (85/471) were edentulous, 25.6% (98/383) had cavitated caries, and 46% (154/335) had periodontitis. In bivariate analyses, Mapuche participants showed lower educational attainment, higher rural residence, poorer oral health, more behavioral risk factors (eg, infrequent toothbrushing and higher sugar intake), greater restorative needs, and reduced access to complex dental care compared with non-Indigenous peers. In multivariable analyses, female sex was associated with increased odds of edentulism but lower odds of periodontitis. Lower education was associated with nonfunctional dentition (odds ratio [OR] 4.28, 95% CI 2.34-7.88; P<.001) and edentulism (OR 3.04, 95% CI 1.52-6.09; P=.002). Mapuche ethnicity was associated with higher prevalence of cavitated caries (OR 2.40, 95% CI 1.25-4.63; P=.009) and periodontitis (OR 2.43, 95% CI 1.21-4.88; P=.01). Dental care access was associated with behavioral factors (brushing, interproximal hygiene, and sugar intake) and structural determinants (age, sex, and rurality), while restorative and prosthetic needs were linked to sugar consumption and tobacco use, respectively. CONCLUSIONS: Oral health inequalities among older adults in La Araucanía were associated with both structural and behavioral determinants. Although Mapuche participants exhibited poorer oral health, higher restorative needs, and reduced access to complex dental care in bivariate analyses, ethnicity remained associated only with cavitated caries and periodontitis in adjusted models. These findings underscore the importance of incorporating social determinants into oral health planning for underserved older adults and highlight the potential utility of data generated through digitally supported territorial care models for informing equity-oriented oral health strategies.

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