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

Lima, Hassan Lavalier de Oliveira; Sousa, Francenilde Silva de; Goes, Paulo Savio Angeiras de; Lucena, Edson Hilan Gomes de; Figueiredo, Nilcema; Gaspar, Gabriela da Silveira; Thomaz, Erika Barbara Abreu Fonseca

doi:10.1590/pboci.2023.086

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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ORIGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 23 • 2023 • https://doi.org/10.1590/pboci.2023.086 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
Economics; Dentists; Income; COVID-19

Variables	N^* * Variance of total N due to missing data for different questions; 95%CI: 95% Confidence Interval; 1Minimum wage equal to R$ 1,045.00; 2N95 mask, face shield, oximeter, or antimicrobe.	%	95%CI
Block 1: Socioeconomic and Demographic
Gender
Male	84	22.3	18.2-26.8
Female	293	77.7	73.2-81.8
Age (in years)
20-29	118	31.3	27.9-37.8
30-39	120	31.8	28.4-38.4
40 or +	123	32.6	29.2-39.2
No information	16	4.2	2.4-6.8
Marital status
With partner	177	47.0	41.8-52.1
No partner	200	53.1	47.9-58.2
Family income (Minimum wage)¹
Up to 2	38	10.1	7.2-13.6
3-4	103	27.3	27.8-38.5
5 or more	171	45.4	49.1-60.4
No information	65	17.2	13.6-21.4
Higher education
Graduate	72	19.1	15.3-23.4
Postgraduate	257	68.2	63.2-72.8
No information	48	12.7	9.5-16.5
Municipality where professional activities take place
Big island	167	44.3	39.2-49.5
Continent	210	55.7	50.5-60.8
Time of graduation (years)
≤ 1 year	37	9.8	8.5-16.0
1-4 years	86	22.8	22.7-32.9
5-9 years	65	17.2	16.5-25.8
10 or + years	124	32.9	34.3-45.4
No information	65	17.2	13.6-21.4
Productive sector
Public	135	35.8	31.0-40.9
Private	77	20.4	16.5-24.9
In both	157	41.7	36.6-46.8
No information	8	2.1	0.9-4.1
Block 2: Health Behaviors
Practiced physical activity
Yes	257	68.2	63.2-72.8
No	120	31.8	27.2-36.8
Block 3: Knowledge about COVID-19
Biosafety training
Yes	221	58.6	65.4-75.8
No	91	24.1	24.2-34.6
No information	65	17.2	0.1-21.4
Knowledge of technical standards and protocols
Yes	336	89.1	85.5-92.1
No	41	10.9	7.9-14.5
Block 4: Access to Health Services
COVID-19 Test
Yes, positive result	61	16.2	12.6-20.3
Yes, negative result	103	27.3	22.9-32.1
Not performed	213	56.5	51.3-61.6
Vaccination Scheme
Yes, for hepatitis and influenza	320	84.9	80.9-88.3
No	57	15.1	11.7-19.1
Block 5: Health Status
Comorbidities
Yes	95	25.2	20.9-29.9
No	282	74.8	70.1-79.1
Flu symptoms
Yes	115	30.5	25.9-35.4
No	262	69.5	64.6-74.5
Block 6: Psychosocial Aspects
Social isolation affected daily humor
Improved	7	1.9	0.7-3.8
Worsened	273	72.4	67.6-76.9
Still unchanged	97	25.7	21.4-30.5
Use of sleeping pills
Yes	59	15.7	12.1-19.7
No	318	84.4	80.3-87.9
Social Isolation Affected Family Relationships
Improved	76	20.2	16.2-24.6
Worsened	83	22.0	17.9-26.5
Still unchanged	218	57.8	52.7-62.9
Social isolation affected relationships with friends
Improved	19	5.0	3.1-7.8
Worsened	20	5.3	3.3-8.1
Still unchanged	338	89.7	86.1-92.5
Block 7: Changes in the Work Process
Face-to-face clinical care
Yes	323	85.7	81.7-89.1
No, continued	54	14.3	10.9-18.3
Remote Care
Yes	134	35.5	37.5- 48.8
No	177	47.0	51.2-62.5
No information	66	17.5	13.8-21.7
Biosecurity²
Yes	328	87.0	58.0-68.0
No	49	13.0	9.8-16.8
Other changes in care
Yes	326	86.7	82.8-90.0
No	50	13.3	10.0-17.2
No information	1	0.3	0.01-1.5
Outcome
Impact on financial life
Not impact	142	37.7	32.8-42.8
Negative impact (reduced income)	209	55.4	50.2-60.5
Positive impact (increased income)	26	6.9	4.6-9.9

Variables	Non-Adjusted						Adjusted
	Negative Impact			Positive Impact			Negative Impact			Positive Impact
	OR	95%CI	p-value	OR	95%CI	p-value	OR	95%CI	p-value	OR	95%CI	p-value
Block 1: Socioeconomic and demographic
Gender (Ref: Female)
Male	2.6	1.4-4.5	0.001	1.9	0.7-5.5	0.208	2.5	1.2-5.5	0.019	3.5	0.9-13.2	0.068
Age (Ref: 20-29 years)
30-39	1.0	0.6-1.8	0.929	0.5	0.2-1.3	0.152	3.0	1.3-6.9	0.008	0.3	0.1-1.2	0.092
≥40	1.2	0.7-2.0	0.617	0.2	0.05-0.7	0.012	6.4	2.4-17.3	<0.001	<0.01	N.E.	0.987
Marital status (Ref: No partner)
With partner	1.1	0.7-1.7	0.609	1.2	0.5-2.8	0.643	0.6	0.3-1.2	0.136	4.0	1.01-15.8	0.048
Family income¹ (Ref: ≥5 minimum wages)
2.0-4.9 minimum wages	1.6	0.9-2.8	0.087	6.9	2.0-23.6	0.002	2.8	1.3-6.3	0.012	4.9	1.2-20.0	0.028
<2 minimum wages	0.8	0.4-1.5	0.431	1.0	0.1-9.1	0.969	4.6	1.5-14.3	0.008	0.5	0.1-6.4	0.601
Municipality (Ref: Island)²
Continent	1.3	0.9-2.1	0.171	2.7	1.1-6.9	0.035	2.2	1.1-4.3	0.018	1.9	0.5-7.5	0.358
Productive Sector (Ref: Public)
Private	8.7	4.4-17.1	<0.001	1.4	0.4-4.6	0.617	31.4	11.6-85.2	<0.001	1.5	0.2-10.4	0.671
Both	9.0	5.2-15.7	<0.001	1.2	0.5-3.2	0.723	15.9	7.0-36.5	<0.001	0.9	0.2-3.7	0.916
Block 2: Health Behaviors
Practiced physical activity (Ref: No)
Yes	1.1	0.7-1.7	0.732	2.1	0.8-6.0	0.149	0.9	0.5-1.7	0.771	9.1	0.8-11.4	0.072
Block 4: Access to Health Services
COVID-19 Test (Ref: Yes, positive result)
Yes, negative result	1.4	0.7-6.5	0.609	1.5	0.3-6.5	0.609	1.2	0.4-3.2	0.737	21.3	1.3-56.9	0.033
Did not perform	1.0	0.6-1.9	0.918	1.7	0.5-6.3	0.422	1.0	0.4-2.5	0.902	7.6	0.6-94.1	0.115
Block 7: Changes in the work process
Distance attendance (Ref: No)
Yes	1.7	1.1-2.8	0.027	1.5	0.5-4.3	0.477	3.4	1.6-7.0	0.001	1.0	0.2-5.0	0.990

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[1] Correspondence: Hassan Lavalier de Oliveira Lima, Graduate Program in Dentistry, Federal University of Maranhão, Avenida dos Portugueses, nº 1966, Cidade Universitária, Bacanga, São Luís, MA, Brazil. 65085-580. E-mail: hassan.lima@gmail.com