Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic

Abstract

This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018–1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-021-01162-w.

Building an understanding of Indigenous Health Workers’ role in oral health: A qualitative systematic review

“…The World Health Organisation could include oral health as a Core Health Indicator and the United Nations and World Bank could integrate oral health within their health surveillance programmes 61 . While universal dental care is a necessary step in bettering oral health outcomes and experiences for Indigenous communities, it is necessary to highlight that even for health conditions or areas of care where universal coverage is provided, disease and mortality rates remain disproportionate for Indigenous peoples 2,3,6,62 . Therefore, the importance of Indigenous leadership and IHW in oral health promotion and dental care provision cannot be understated.…”

“…61 While universal dental care is a necessary step in bettering oral health outcomes and experiences for Indigenous communities, it is necessary to highlight that even for health conditions or areas of care where universal coverage is provided, disease and mortality rates remain disproportionate for Indigenous peoples. 2,3,6,62 Therefore, the importance of Indigenous leadership and IHW in oral health promotion and dental care provision cannot be understated. A shift in funding provisions for oral health that supports Indigenous models of care, offers competitive salaries, and sufficient budgetary allotments for oral health education and resources in community-controlled health services is needed.…”

Vaccine Coverage and Effectiveness Against Laboratory-Confirmed Symptomatic and Severe COVID-19 in Indigenous People in Brazil: A Cohort Study

“…Two national household surveys of seroprevalence of antibodies against SARS-CoV-2 in 133 cities showed an 87% higher adjusted prevalence among indigenous subjects compared to whites [10]. In addition, in the rst year of the pandemic, mortality among indigenous people was 16.7% higher than that observed in the general Brazilian population [12]. Age-speci c mortality rates [14] as well as hospital case fatality rates in all age groups, were also higher in indigenous subjects compared to other colour/race categories registered in Brazilian health information systems [13,14].…”

“…The Covid-19 pandemic has disproportionally impacted socially disadvantaged population groups in Brazil, including indigenous peoples [10][11][12][13]. In the rst trimester of the pandemic, there was a rapid increase in the risk of sustained transmission of Covid-19 in areas with an indigenous presence [11].…”

Syndemic aspects between COVID-19 pandemic and social inequalities

“…To reinforce the vulnerability of IP, another retrospective study identified that the excess of deaths in the general Brazilian population in 2020 showed an increase of 18.1% in relation to the expected value, while in IP this growth was substantially higher, at 34.8%. It is worth noting that this excess of deaths is directly related to the fatal cases of COVID-19[ 56 ]. This scenario can be even more serious as studies also raise the possibility of under-reported cases of COVID-19, leading to the belief that these rates may have been higher[ 57 , 58 ], and even leading to the possibility of risk of the decimation of the entire indigenous villages in the southern region of the country[ 59 ].…”