Human ecological and social determinants of dental caries among the Xavante Indigenous people in Central Brazil

• Published in: PloS one 2018-12, Vol.13 (12), p.e0208312-e0208312
• Main Authors: Arantes, Rui, Welch, James R, Tavares, Felipe Guimarães, Ferreira, Aline Alves, Vettore, Mario Vianna, Coimbra, Jr, Carlos E A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analysis; Biology and Life Sciences; Brazil; Child; Child, Preschool; Chronic illnesses; Cross-Sectional Studies; Demographics; Dental Caries; Dental health; Ecology; Economics; Epidemiology; Ethnic factors; Ethnicity; Female; Food; Genetic transformation; Health aspects; Health care; Health disparities; Health services; Humans; Indicators; Indigenous peoples; Male; Mathematical models; Medicine and Health Sciences; Minority & ethnic groups; Models, Theoretical; Native peoples; Oral health; Oral hygiene; People and places; Physical Sciences; Population growth; Population studies; Prevention; Public health; Risk factors; Social factors; Social Sciences; Socioeconomic Factors; Socioeconomics; Statistical analysis; Studies; Towns; Transformation; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0208312

This community study evaluates complex interactions between macro and micro determinants of oral health in a local Indigenous population based on a theoretical framework of demographic, economic, and healthcare transformation over the last half century. The study population included all residents of eight Xavante villages in Central Brazil. Our hypothetical model posited multiple direct and indirect associations between dental caries and village groups with differentiated territorial and oral care histories, as well as household socioeconomic indicators and food acquisition patterns, individual sociodemographic characteristics, use of dental health services, and oral hygiene practices. Structural equation modelling methods were used to evaluate direct and indirect associations linking exogenous factors and dental caries. Results include 18 direct and 14 indirect statistically significant pathways between determinant variables and dental caries. Significant links with dental caries were shown for socioeconomic indicators, oral healthcare variables, household food acquisition patterns, sex, and age. These findings suggest that the oral health of Xavante residents in the villages studied is associated with determinant factors of different epidemiological and historical scales. The specific historical frame of territorial circumscription and demographic crisis followed by rapid population increase since the 1970s should be considered a cause-of-cause determinant of the economic, healthcare, and sociodemographic profile contributing to oral health among the Xavante. Considering the limitations of cross-sectional studies, our findings underline the importance for oral health determination of historical currents affecting minority ethnic groups within national societies.