The equity of access to primary dental care in São Paulo, Brazil: A geospatial analysis

Abstract

Objectives: Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city.

Methods: A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS).

Results: Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts.

Conclusion: Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts.

Keywords: Dentistry; oral health; public dental health; spatial access.

Figure 1.

Distribution of fixed primary dental clinics in São Paulo city, Brazil. Clinics (grey dots) are presented against the city centre, Praça da Sé (black cross). High resolution inset shows districts (thick grey lines) and census tracts (thin grey lines) overlayed with clinics that have 0.5 km and 1 km buffers (green).

Figure 2.

Distribution of fixed primary dental clinics in São Paulo city, Brazil. Clinics (grey dots) are presented against buffers (green) of increasing radii of 2.5 km out from the city centre, Praça da Sé (black cross).

Figure 3.

Practice-to-population ratios of fixed primary dental clinics at various distances out from the city centre (Praça da Sé) in São Paulo city, Brazil. Ratios for census tracts located more than 25 km out from the city centre were excluded.