Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study

Abstract

Background Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms.Methods We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation.Findings Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82•0%) of these patients were from the central-south region, and 2043 (18•0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1•45, 95% CI 1•33-1•58 for Pardo Brazilians; 1•32, 1•15-1•52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states.Interpretation We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.

O potencial de propagação da COVID-19 e a tomada de decisão governamental: uma análise retrospectiva em Florianópolis, Brasil

“…The Brazilian federal government's actions to deal with COVID-19 have faced strong international criticism, especially due to the lack of implementation of non-pharmacological measures 32,33 . States and municipalities had to go to the Supreme Federal Court of Brazil to have the assured right to implement them 34 .…”

Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic and innovative solutions: lessons learned and to be shared with other countries

“…These ethnic and socioeconomic aspects highlighted by Baqui et al (2020) reinforce the need for additional measures by the Brazilian government to address these racial gaps. It is hoped that government initiatives such as guaranteed basic income and the provision of essential supplies may indeed reach people in vulnerable conditions.…”

“…The authors speculate that the regional differences are driven by increasing comorbidity burdens in regions with lower levels of socioeconomic development. They also posit that disparities in hospitalization and mortality measures could be driven by differences in access to health care (including intensive care) across ethnic groups (Baqui et al, 2020).…”

No mar brasileiro agitado pela COVID-19, não estamos todos no mesmo barco

“…Isso reforça o descaso com estas populações, imprimindo a ideia de que o SARS-CoV-2 é "democrático", mas não é! Dados recentes de uma pesquisa conduzida pela Universidade de Cambridge em parceira com a Universidade Federal do Espírito Santo -UFES reforçaram que pessoas pardas e pretas têm mais chances de morrer pela COVID-19 no Brasil, principalmente nas Regiões Norte e Nordeste 17. O estudo apontou, ainda, que as pessoas que vivem nas outras Regiões apresentam menos riscos em relação à infecção, porém, a população negra que vive em São Paulo, por exemplo, apresentava 62% mais chance de morrer pela COVID-19 do que a população branca.…”

“…O estudo apontou, ainda, que as pessoas que vivem nas outras Regiões apresentam menos riscos em relação à infecção, porém, a população negra que vive em São Paulo, por exemplo, apresentava 62% mais chance de morrer pela COVID-19 do que a população branca. Os autores enfatizam que os resultados exigem esforços urgentes por parte das autoridades brasileiras para considerarem nas propostas de enfrentamento da doença alternativas que projetam os pardos e pretos, bem como a população dos estados mais pobres, do maior risco de morte pela COVID-19 17.…”