Social inequalities in the use of implant-supported prostheses among older adults: A cross-sectional study

To estimate the prevalence of implant-supported prostheses and examine socioeconomic and service-related inequalities among Brazilian adults, aged 65-74 years, using nationally representative data.

A cross-sectional analysis was conducted using secondary data from the 2023 Brazilian Oral Health Survey (SB Brasil). Survey-weighted descriptive analyses, Rao-Scott tests, and multivariable logistic regression were applied. Inequalities were assessed using slope and relative indices of inequality for income and education.

Among 9745 individuals, the weighted prevalence of having at least one dental implant was 21.1%, representing approximately 2.49 million individuals nationwide. Implant prevalence was highest among individuals earning ≥5 minimum wages (54.0%), recent dental service users (29.4%), those using private care (26.7%), White individuals (25.7%), and women (23.2%). Conversely, fully adjusted models revealed that the absence of implants was independently associated with the lowest household income category (≤1 minimum wage; OR=4.06, 95% CI: 2.36-6.99), infrequent dental visits (>3 years, OR=2.56; 95% CI: 1.78-3.70), reliance on public healthcare (OR=1.98, 95% CI: 1.47-2.66), Black/Brown race (OR=1.47, 95% CI: 1.10-1.97), and male sex (OR=1.40; 95% CI:1.02-1.91). Income showed the strongest and most persistent inequality gradient, whereas educational inequalities were attenuated after adjustment. Model discrimination was moderate.

Access to implant-supported oral rehabilitation among older Brazilians is strongly patterned by socioeconomic position, with income appearing as the dominant determinant.

Socioeconomic disparities, particularly income, substantially influence access to implant-supported rehabilitation among older Brazilian adults. These findings highlight the need for policies that expand equitable access to advanced oral rehabilitation within public health systems.