Analysis of the association between racial inequities and edentulism in Brazil: a systematic review and meta-analysis

This study aimed to evaluate whether individuals who self-identify as black and/or mixed-race have a higher prevalence of tooth loss compared to white individuals in Brazil, using a systematic review and meta-analysis. Searches were conducted in the PubMed, Scopus, Web of Science, Virtual Health Library, Embase, and gray literature databases. Two independent reviewers performed the searches and article selection processes. The Newcastle-Ottawa Scale was used for observational cohort studies, and its modified version was used for cross-sectional studies. The I2 statistic assessed the heterogeneity of studies included in the meta-analyses. Of the 25 articles eligible for qualitative evaluation, 17 were included in the quantitative assessment. Sample sizes ranged from 101 to 18,718 individuals aged 11 to 74 years. Most studies compared white individuals to non-white individuals (black, mixed-race, Asian, and Indigenous people). In the comparison between white and non-white individuals, no differences were found concerning edentulism (OR = 0.86; 95%CI: 0.71; 1.06), absence of functional dentition (OR = 0.82; 95%CI: 0.33; 2.03), or mean number of missing teeth (MD = -0.21; 95%CI: -2.92; 2.49), but it was associated with tooth loss (OR = 1.40; 95%CI: 1.26; 1.55). When comparing black/mixed-race people to white individuals, tooth loss was higher among those who self-identified as black/mixed-race (OR = 1.41; 95%CI: 1.27; 1.57). This difference was also observed when comparing black/mixed-race individuals to other races/skin color (OR = 1.24; 95%CI: 1.15; 1.33). Overall, studies conducted in Brazil found that tooth loss was more prevalent among self-declared black and/or mixed-race individuals.