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Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil
INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities....
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094342/ https://www.ncbi.nlm.nih.gov/pubmed/33926892 http://dx.doi.org/10.1136/bmjgh-2021-004959 |
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author | Li, Sabrina L Pereira, Rafael H M Prete Jr, Carlos A Zarebski, Alexander E Emanuel, Lucas Alves, Pedro J H Peixoto, Pedro S Braga, Carlos K V de Souza Santos, Andreza Aruska de Souza, William M Barbosa, Rogerio J Buss, Lewis F Mendrone, Alfredo de Almeida-Neto, Cesar Ferreira, Suzete C Salles, Nanci A Marcilio, Izabel Wu, Chieh-Hsi Gouveia, Nelson Nascimento, Vitor H Sabino, Ester C Faria, Nuno R Messina, Jane P |
author_facet | Li, Sabrina L Pereira, Rafael H M Prete Jr, Carlos A Zarebski, Alexander E Emanuel, Lucas Alves, Pedro J H Peixoto, Pedro S Braga, Carlos K V de Souza Santos, Andreza Aruska de Souza, William M Barbosa, Rogerio J Buss, Lewis F Mendrone, Alfredo de Almeida-Neto, Cesar Ferreira, Suzete C Salles, Nanci A Marcilio, Izabel Wu, Chieh-Hsi Gouveia, Nelson Nascimento, Vitor H Sabino, Ester C Faria, Nuno R Messina, Jane P |
author_sort | Li, Sabrina L |
collection | PubMed |
description | INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities. RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45). CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities. |
format | Online Article Text |
id | pubmed-8094342 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-80943422021-05-10 Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil Li, Sabrina L Pereira, Rafael H M Prete Jr, Carlos A Zarebski, Alexander E Emanuel, Lucas Alves, Pedro J H Peixoto, Pedro S Braga, Carlos K V de Souza Santos, Andreza Aruska de Souza, William M Barbosa, Rogerio J Buss, Lewis F Mendrone, Alfredo de Almeida-Neto, Cesar Ferreira, Suzete C Salles, Nanci A Marcilio, Izabel Wu, Chieh-Hsi Gouveia, Nelson Nascimento, Vitor H Sabino, Ester C Faria, Nuno R Messina, Jane P BMJ Glob Health Original Research INTRODUCTION: Little evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities. RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45). CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities. BMJ Publishing Group 2021-04-29 /pmc/articles/PMC8094342/ /pubmed/33926892 http://dx.doi.org/10.1136/bmjgh-2021-004959 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research Li, Sabrina L Pereira, Rafael H M Prete Jr, Carlos A Zarebski, Alexander E Emanuel, Lucas Alves, Pedro J H Peixoto, Pedro S Braga, Carlos K V de Souza Santos, Andreza Aruska de Souza, William M Barbosa, Rogerio J Buss, Lewis F Mendrone, Alfredo de Almeida-Neto, Cesar Ferreira, Suzete C Salles, Nanci A Marcilio, Izabel Wu, Chieh-Hsi Gouveia, Nelson Nascimento, Vitor H Sabino, Ester C Faria, Nuno R Messina, Jane P Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title | Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title_full | Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title_fullStr | Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title_full_unstemmed | Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title_short | Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil |
title_sort | higher risk of death from covid-19 in low-income and non-white populations of são paulo, brazil |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094342/ https://www.ncbi.nlm.nih.gov/pubmed/33926892 http://dx.doi.org/10.1136/bmjgh-2021-004959 |
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