Inequidad en el ingreso y caries de la infancia temprana en Colombia: un análisis multinivel / Income inequality and early childhood caries in Colombia: a multilevel analysis

RESUMEN

Resumen Evaluamos la asociación entre inequidad en los ingresos y caries de la infancia temprana en Colombia, utilizando un análisis multinivel. Analizamos datos del último estudio nacional de salud bucal (2014) e información sobre ingresos en términos absolutos y relativos a nivel departamental. Los desenlaces fueron experiencia de caries y caries no tratada. Se utilizó un modelo de regresión logística multinivel con dos niveles niños/familias (nivel 1) anidados en departamentos (nivel 2). En el nivel 1 se consideraron variables de edad, sexo, posición socioeconómica (PSE) de la vivienda, ingresos del hogar y régimen de aseguramiento en salud. Para el nivel 2 las variables fueron coeficiente Gini, Necesidades Básicas Insatisfechas (NBI) y Producto Interno Bruto (PIB). Se evaluaron datos de 5.250 niños de 1, 3 y 5 años, 36.9% tenían experiencia de caries y 33.0% caries no tratada. Los desenlaces mostraron asociaciones significativas con edad, PSE baja del hogar y pertenecer al régimen subsidiado de salud. Para caries no tratada se encontraron asociaciones con PSE baja o muy baja (OR 1.72; IC95% 1.42, 2.07 y OR 1.69; IC95% 1.36, 2.09 respectivamente) y régimen subsidiado de salud (OR 1.58; IC95% 1.11, 2.24). No se encontraron asociaciones significativas con indicadores de coeficiente Gini, PIB y NBI.

ABSTRACT

Abstract The association between income inequality and dental caries on early childhood in Colombia was evaluated using a multi-level analysis. We analyzed data from the latest national oral survey (2014) and information about income in absolute and relative terms on a state-level. The outcomes were caries experience, and untreated caries. A multilevel logistic regression model was used (2 levels) with children/households nested within states. Age, gender, area-level socioeconomic position (SEP), household income and health insurance regime were the level 1 explanatory variables. For level 2, variables were the Gini coefficient, Unsatisfied Basic Needs (UBN) and Gross Domestic Product (GDP). Data from 5.250 children, aged 1, 3 and 5 years were evaluated. Prevalence of caries experience and untreated caries was 36.9% and 33.0% respectively. Both outcomes showed significant associations with age, low SEP and belonging to the subsidized health insurance regime untreated dental caries was associated with living in low and very low SEP (OR 1.72; 95%CI 1.42, 2.07 and OR 1.69; 95%CI 1.36, 2.09 respectively), and subsidized health insurance scheme (OR 1.58; 95%CI 1.11, 2.24). When the Gini, GDP and UBN indicators were included in the models, no significant associations were found.