TY - JOUR
T1 - Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil
AU - Li, Sabrina L.
AU - Pereira, Rafael H.M.
AU - Prete, Carlos A.
AU - Zarebski, Alexander E.
AU - Emanuel, Lucas
AU - Alves, Pedro J.H.
AU - Peixoto, Pedro S.
AU - Braga, Carlos K.V.
AU - de Souza Santos, Andreza Aruska
AU - de Souza, William M.
AU - Barbosa, Rogerio J.
AU - Buss, Lewis F.
AU - Mendrone, Alfredo
AU - de Almeida-Neto, Cesar
AU - Ferreira, Suzete C.
AU - Salles, Nanci A.
AU - Marcilio, Izabel
AU - Wu, Chieh Hsi
AU - Gouveia, Nelson
AU - Nascimento, Vitor H.
AU - Sabino, Ester C.
AU - Faria, Nuno R.
AU - Messina, Jane P.
N1 - Funding Information:
Funding SLL is supported by the Oxford Martin Programme on Pandemic Genomics and the Canadian Social Sciences and Humanities Research Council (SSHRC) Doctoral Fellowship. CAPJ is supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Financial Code 001, Fundação Faculdade de Medicina (FFM), and the São Paulo Research Foundation (FAPESP 2019/21858-0). AEZ is supported by the Oxford Martin Programme on Pandemic Genomics. WMS is supported by the São Paulo Research Foundation (FAPESP 2017/13981-0 and 2019/24251-9). VHN is supported by the Brazilian National Council for Scientific and Technological Development (CNPq: 304714/2018-6). NRF is supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z). This project was supported by a Medical Research Council-São Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) (http://caddecentre.org/).
Funding Information:
SLL is supported by the Oxford Martin Programme on Pandemic Genomics and the Canadian Social Sciences and Humanities Research Council (SSHRC) Doctoral Fellowship. CAPJ is supported by Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - Brasil (CAPES) - Financial Code 001, Funda??o Faculdade de Medicina (FFM), and the S?o Paulo Research Foundation (FAPESP 2019/21858-0). AEZ is supported by the Oxford Martin Programme on Pandemic Genomics. WMS is supported by the S?o Paulo Research Foundation (FAPESP 2017/13981-0 and 2019/24251-9). VHN is supported by the Brazilian National Council for Scientific and Technological Development (CNPq: 304714/2018-6). NRF is supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z). This project was supported by a Medical Research Council-S?o Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) (http://caddecentre.org/).
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
PY - 2021/4/29
Y1 - 2021/4/29
N2 - 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. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de São Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.
AB - 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. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de São Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.
KW - cross-sectional survey
KW - epidemiology
KW - geographic information systems
KW - mathematical modelling
KW - public health
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U2 - 10.1136/bmjgh-2021-004959
DO - 10.1136/bmjgh-2021-004959
M3 - Article
AN - SCOPUS:85105241244
SN - 2059-7908
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
IS - 4
M1 - e004959
ER -