A Population Case Study of Structural Racism in Dental Services Utilization in Brazil and Colombia

Racial inequalities are expressions of racism, a phenomenon that is pervasive in different countries in Latin America and reinforced by social structure. This research analyzed the intersections between race and income in dental care utilization in Brazil and Colombia. Two nationwide Brazilian and Colombian population oral health surveys were used, as conducted in 2010 and 2014, respectively. The samples included individuals from different age groups. Three outcomes were considered: 1) Ever been to a dentist (yes/no)? 2) Have you visited a dentist in <1 y (yes/no)? 3) Last dental visit for urgent treatment (yes/no)? The main explanatory variables were race and income (the per capita minimum wage). Relative excess risk due to interaction and synergy index were calculated to verify interactions between race and income, adjusted for age and sex. Specific age group analyses were carried out for both countries to assess pervasive racial inequities. Upper-income White persons in Brazil (odds ratio, 3.61; 95% CI, 3.20 to 4.07) and Colombia (odds ratio, 2.54; 95% CI, 2.21 to 3.07) had higher odds of not using urgent dental services than lower-income Black persons and lower-income Afro-Colombians. Relative excess risk due to interaction and synergy index showed synergistic interactions in both countries. Compounded racial and income-related disparities in dental care utilization were observed in Brazil and Colombia, which may reflect underlying structural inequities. Public policies need to consider the complex intersections between socioeconomic conditions affecting underprivileged racial groups in Latin America.Knowledge Transfer Statement:This study highlights how structural racism and socioeconomic disparities intersect to limit dental care access in Brazil and Colombia, emphasizing the need for public policies addressing racial and economic inequities in oral health.