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Profile of COVID-19 in Brazil: Risk Factors and Socioeconomic Vulnerability Associated with Disease Outcome
26 Pages Posted: 12 Apr 2022
More...Abstract
Background: COVID-19 spread at different rates across the globe, and severe outcomes of the disease are influenced by clinical and socioeconomic elements. By leveraging the most comprehensive, real-world dataset on Brazilian COVID-19 hospitalizations available to date, we aimed at classifying and ranking the risk factors and vulnerabilities associated with poorer outcomes of the disease. Our results will help guide and adapt current and future interventions aimed at reducing inequities associated with the burden of COVID-19 in Brazil.
Methods: In this retrospective study, individualized non-identified data on suspected mild/moderate to severe COVID-19 cases in Brazil were used to characterize the disease profile and factors associated with hospitalization characteristics and mortality. The impact of socioeconomic disparities on vaccination rates, cases/deaths and ascertainment thereof, was also considered.
Results: From 26 February 2020 to 15 November 2021, Brazil reported 15.6 million cases of SARS-CoV-2 with 584,761 documented deaths. We estimated case underascertainment varying from 79.8% (in less deprived regions) to ≈ 90% (in more deprived regions), yielding ≈ 80 million undocumented cases as of August 2021. Overall, men presented a higher risk of death than women (odds ratio [OR]=1.14, 95% CI 1.13-1.15), but puerperal patients admitted to hospital wards were at increased risk of dying (OR=1.23; 95% CI 1.13-1.34) compared to individuals without reported comorbidities. Death in younger age groups was notably higher in most deprived areas, while individuals <40 belonging to indigenous backgrounds presented two-fold in-hospital mortality compared to white patients. Ethnic/racial backgrounds exhibited a continuum of decreasing survival chances of mixed-race (OR=1.11, 95% CI 1.10-1.12), black (OR=1.34, 95% CI 1.32-1.36) and indigenous (OR=1.42, 95% CI 1.31-1.54) individuals, while those in most deprived areas also presented an increased risk of death (OR=1.38 (95%; CI 1.36-1.40).
Interpretation: Strong socioethnic effects compounded the mortality rate of COVID-19 in Brazil, and the divide between the extremes of economic strata also impacted disease detection rates in the country.
Funding: This work was supported by the International COVID-19 Data Alliance (ICODA), an initiative funded by the COVID-19 Therapeutics Accelerator and convened by the Health Data Research UK, as well as the Fiocruz Innovation Promotion Program (INOVA-Fiocruz, Fundação Oswaldo Cruz, Brazil).
Declaration of Interest: The authors declare no competing interests.
Keywords: SARS-CoV-2, Risk factors, Clinical Epidemiological Profile, logistic regression model, Brazil
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