Covid-19 among the Brazilian Amazon indigenous people: factors associated with death

Abstract

This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.

All-cause mortality rates for indigenous in the states of Brazil and their (non) correlation with socioeconomic and health indicators in the years 2000 and 2010

“…Esse contexto, devido a violência/desproteção, a proximidade cada vez maior das aldeias com as cidades e a busca por possíveis melhores condições de vida, acentua o deslocamento populacional indígena para o meio urbano, com conseguinte mudança de ambiente e de cultura 8,29,30 . Essas mudanças aumentam a exposição a fatores relacionados ao óbito por causas externas, como: acesso a arma de fogo, pobreza e situação de rua, alcoolismo, uso de drogas, depressão, acidentes de transportes, violência e outros 23,[30][31][32][33] . Assim como a fatores ambientais e de hábitos de vida que propiciam óbitos por câncer, doenças crônicas, infecções sexualmente transmissíveis e outras causas 12,23,34,35 .…”

Legacy of covid-19 for indigenous health in the Brazilian Amazon

“…2 By January 2021 in the state of Amapá, the death rate from covid-19 was around 2.9/1000 indigenous people compared with 1.1/1000 in non-indigenous people. 10 And between 20 March 2020 and 29 April 2021, the incidence of covid-19 in indigenous people in Amapá was about 5.6 times higher than among non-indigenous people. 2…”

“…Diagnosis in indigenous communities was badly delayed. 10 Certain demographic aspects also came into play. For instance, social distancing was challenging for the multifamily households of the Xikrin people.…”

“…The indigenous health special district of Amapá and Northern Pará provided personal protective equipment and helped indigenous people to return safely from urban areas to villages, while many primary healthcare facilities on indigenous lands were bolstered during the pandemic. 10 Some organisations found ways to integrate understanding of indigenous circumstances into emergency care. Biolchini says that to work in São Gabriel da Cachoeira, a majority indigenous municipality, MSF had 40 translators because of the diversity of indigenous languages spoken by the residents.…”

“…Diagnosis in indigenous communities was badly delayed 10. Certain demographic aspects also came into play.…”