Individual factors associated with the use of oral health services by adults according to sex: a structural equation modeling approach.

This study evaluated individual factors associated with the use of oral health services by Brazilian adults according to sex. This cross-sectional analysis used secondary data from the 2019 Brazilian National Health Survey. Data from 65,803 adults aged 18-59 years were included. The outcome was "the use of oral health services". Independent variables were grouped into three constructs: sociodemographic data as predisposing factors, economic and access-related characteristics as capacity factors, and data on oral health conditions as need factors. Data were analyzed in Stata 15.0, using the structural equation modeling. Structural models were estimated for males and females. Analysis stratified by sex presented adequate adjustment indicators: comparative fit index > 0.90, Tucker-Lewis index > 0.90, and standardized root mean square residual < 0.05. The final models showed that predisposing factors effected capacity factors (β = 0.61 for men; β = 0.54 for women), which, in turn, directly affected need factors (β = -0.24 for men; β = -0.26 for women) and the outcome (β = 0.23 for men; β = 1.15 for women). The final structural model demonstrated a good fit, with need factors also directly affecting the outcome (β = 0.10 for men; β = 0.09 for women). All coefficients were statistically significant (p < 0.001). The use of oral health services was indirectly influenced by sociodemographic factors, and directly and indirectly influenced by economic and access-related factors. Oral health conditions had a direct effect on service use, with no variation between sexes. However, men were more affected by predisposing and capacity factors than women.