Economic Impact of the COVID-19 Pandemic among Dentists in One of the Poorest Brazilian States: A Cross-Sectional Study

ABSTRACT Objective: To analyze the impact of the COVID-19 pandemic on dentists' income and to identify associated factors in one of the poorest Brazilian states. Material and Methods: A cross-sectional study including dentists who volunteered to answer an electronic questionnaire in Maranhão. Hierarchical multinomial logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) and respective 95% confidence intervals (95%CI) (alpha=5%). Results: The COVID-19 pandemic impacted the professionals´ income negatively [55.44% (50.26-60.52%)] and also positively [6.9% (4.55-9.94%)]. The negative impact on income was greater among male dentists (OR=2.54; 95%CI: 1.16-5.53), over 30 years of age (OR=3.03; 95%CI: 1.34-6.87), with family income below two minimum wages (OR=4.63; 95%CI: 1.50-14.30), who worked in the continent instead of in the capital island (OR=2.21; 95%CI: 1.14-4.29) and in the private sector (OR=31.43; 95%CI: 11.59-85.22). Moreover, those who had been tested for COVID-19, with a negative result, had a 21.3-fold greater chance of having an increased household income when compared to those who had not been tested. Conclusion: The COVID-19 pandemic negatively impacted the dentists' income in Maranhão, especially the older, males, with lower incomes, and who worked in the private sector, living far from the capital. The SUS played an important role in the social protection of dentists during the COVID-19 pandemic, mitigating the economic impacts on the public sector working class.

Persistem iniquidades sociais na distribuição da cárie dentária em adolescentes maranhenses? Contribuições de um estudo de base populacional / Do social inequalities persist in the distribution of dental caries in adolescents from Maranhão? Contributions of a population-based study

Resumo O objetivo foi analisar a associação de fatores socioeconômicos com a prevalência de cárie dentária em adolescentes de São Luís, Maranhão, para responder se as iniquidades sociais persistem na distribuição desta doença. Este é um estudo transversal aninhado a uma coorte prospectiva. Incluímos 2.413 adolescentes de 18-19 anos, avaliados em 2016 (2º seguimento). O desfecho foi a ocorrência de dentes com cárie dentária não tratada (sim ou não), avaliada pelo índice CPO-D. Características socioeconômicas e demográficas foram as variáveis independentes. Foram realizadas análises estatísticas descritivas e de regressão de Poisson, calculando-se razões de prevalência (RPs) brutas e ajustadas (alpha=5%). Pertencer às classes econômicas C (RP=1,23; IC95%:1,11-1,37) ou D-E (RP=1,48; IC95%: 1,32-1,65), estar casado/morar com companheiro (RP=1,22; IC95%:1,07-1,39), ter pais separados (RP=1,11; IC95%1,03-1,19) e maior número de pessoas na residência (RP=1,05; IC95%:1,03-1,07) foram associadas a maior prevalência de cárie dentária. Apesar da implementação da Política Nacional de Saúde Bucal, as iniquidades sociais em saúde bucal de adolescentes persistem. É fundamental que o modelo de atenção à saúde vigente busque a reorientação das estratégias de educação em saúde, direcionando-as a populações vulneráveis.

Abstract This study aimed to analyze the association of socioeconomic factors with the prevalence of dental caries in adolescents from São Luís, Maranhão, Brazil, to answer whether social inequalities persist in distributing this disease. This is a cross-sectional study nested in a prospective cohort. We included 2,413 adolescents aged 18-19 years evaluated in the 2016 second follow-up. The outcome was teeth with untreated dental caries (yes or no) assessed by the DMFT index. Socioeconomic and demographic characteristics were the independent variables. Descriptive statistical and Poisson regression analyses were performed, calculating crude and adjusted prevalence ratios (PRs) (alpha=5%). Belonging to economic classes C (PR=1.23; 95% CI: 1.11-1.37) or D-E (PR=1.48; 95% CI: 1.32-1.65), being married/living with a partner (PR=1.22; 95% CI: 1.07-1.39), having separated parents (PR=1.11; 95% CI 1.03-1.19) and a greater number of people in the household (PR=1.05; 95% CI: 1.03-1.07) were associated with a higher prevalence of dental caries. Social inequalities in adolescent oral health persist despite the implementation of the National Oral Health Policy. The current health care model should seek to reorient health education strategies, targeting them at vulnerable populations.