Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para a priorização da vacinação

Passos, Valéria Maria de Azeredo; Brant, Luísa Campos Caldeira; Pinheiro, Pedro Cisalpino; Corrêa, Paulo Roberto Lopes; Machado, Ísis Eloah; Santos, Mayara Rocha dos; Ribeiro, Antônio Luiz Pinho; Paixão, Lucas; Pimenta, Fernando Martins; Marinho, Fátima; Malta, Déborah Carvalho

doi:10.1590/1980-549720210025

Cited by 10 publications

(14 citation statements)

References 11 publications

(13 reference statements)

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“…Importantly, our study corroborates previous data from Brazil and other countries, which reveal that the pandemic exacerbated health inequities. 6,9,45,46 More excess mortality and COVID-19 confirmed deaths have been reported in the most vulnerable groups, according to race or neighbourhood. 4,6,9 Herein, we additionally describe that the adverse impact of the pandemic on CVD was also greater in the most vulnerable individuals: deaths at home presented an increasing trend from groups of low to high health vulnerability.…”

Section: Discussionmentioning

confidence: 99%

“…16 During the COVID-19 pandemics, Belo Horizonte's municipality composed a committee of specialists to address the pandemics issues and help local authorities to decide about the timely implementation of regulatory measures, following three daily indicators: transmission rate, and the proportion of occupied hospital and ICU beds. 9 Other actions taken by the municipality to confront the pandemic have been published. 12 We evaluated the effect of the pandemic from epidemiological weeks (EW) 10 to 48, 2020, on CVD outcomes in Belo Horizonte city following the STROBE guidelines for reporting observational studies.…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Previous SIH data quality checks revealed that, on average, after a 3-months period of the hospitalization date, the completeness of data achieves 90% (Supplementary Material 1). 9 Data from both systems were provided by the Belo Horizonte Health Department (Secretaria Municipal de Saúde, SMS, in portuguese). SIH data was extracted in March/2021 and SIM data in May/21.…”

Section: Data Sourcesmentioning

confidence: 99%

“…6,8 As a response to this lack of national coordination, each municipality had the power to implement local policies to mitigate the pandemic's impact, including business and school closures, according to the pandemic course in their location. 9 Belo Horizonte is a city in Brazil with 2.5 million inhabitants, where local authorities daily monitored transmission rates and hospitalizations to guide regulatory measures, and although the city was able to delay the first pandemic wave in comparison to other capital cities -1877 deaths due to COVID-19 occurred in 2020, 10,11 also mainly affecting the most vulnerable groups. 9,12 Moreover, during the 2020 pandemic period, CVD hospitalizations had a 16.3% decline, although the impact on CVD mortality has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…9 Belo Horizonte is a city in Brazil with 2.5 million inhabitants, where local authorities daily monitored transmission rates and hospitalizations to guide regulatory measures, and although the city was able to delay the first pandemic wave in comparison to other capital cities -1877 deaths due to COVID-19 occurred in 2020, 10,11 also mainly affecting the most vulnerable groups. 9,12 Moreover, during the 2020 pandemic period, CVD hospitalizations had a 16.3% decline, although the impact on CVD mortality has not been evaluated. 13 Because the effect of the pandemic on CVD depends on the pandemic course and behavioural changes in a location, a comprehensive analysis of the pandemic's impact on CVD in a city is fundamental to guide future actions.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Mortality during the COVID-19 Pandemics in a Large Brazilian City: a Comprehensive Analysis

Brant

Pinheiro

Ribeiro

et al. 2021

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Introduction: The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality. Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the 6th greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemics phase. Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Wilcoxon rank-sum test was used to test differences, and risk ratios with their 95% confidence intervals were calculated. National demographic estimates was used to calculate rates. Results: We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20-1.46) than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion: The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Settingmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Mortality during the COVID-19 Pandemics in a Large Brazilian City: a Comprehensive Analysis

Brant

Pinheiro

Ribeiro

et al. 2021

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Assessing spatial distribution of COVID-19 prevalence in Brazil using decentralised sewage monitoring

et al. 2021

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Brazil has become one of the epicentres of the COVID-19 pandemic, with cases heavily concentrated in large cities. Testing data is extremely limited and unreliable, which restricts health authorities’ ability to deal with the pandemic. Given the stark demographic, social and economic heterogeneities within Brazilian cities, it is important to identify hotspots so that the limited resources available can have the greatest impact. This study shows that decentralised monitoring of SARS-CoV-2 RNA in sewage can be used to assess the distribution of COVID-19 prevalence in the city. The methodology developed in this study allowed the identification of hotspots by comprehensively monitoring sewers distributed through Belo Horizonte, Brazil's third largest city. Our results show that the most vulnerable neighbourhoods in the city were the hardest hit by the pandemic, indicating that, for many Brazilians, the situation is much worse than reported by official figures.

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Assessing COVID-19 pandemic excess deaths in Brazil: years 2020 and 2021

Colonia

Cardeal

Oliveira

et al. 2022

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We estimated the impact of the COVID-19 pandemic on mortality in Brazil for 2020 and 2021 years. We used mortality data (2015-2021) from the Health Ministry, Brazil government, to fit linear mixed models for forecasting baseline deaths under non-pandemic conditions. An advantage of the linear mixed model is the flexibility to capture year-trend while dealing with the correlations among death counts over time. Following a specified model building strategy, estimation of all-cause excess deaths at the country level and stratified by sex, age, ethnicity and region of residence, from March 2020 to August 2021. We also considered the estimation of excess deaths by specific causes. Estimated all-cause excess deaths was 199,108 (95% PI: 171,007; 227,209, P-Score=17.3%) for weeks 10-53, 2020, and 417,167 (95% PI: 372,075; 462,259, P-Score=50.1%) for weeks 1-32, 2021. P-scores ranged from 5.4% (RS, South) to 36.2% (AM, North) in 2020 and from 29.3% (AL, Northeast) to 94.9%$ (RO, North) in 2021. Differences among men (18.9%) and women (14.2%) appeared in 2020 only, and the P-scores were about 51% for both sexes in 2021. Except for youngsters (<20 years old), all adult age groups were badly hit, especially those from 40 to 79 years old. In 2020, the Indigenous+East Asian population had the highest P-score (27%), and the Black population suffered the greatest impact (61.9%) in 2021. The pandemic impact had enormous regional heterogeneity and substantial differences according to socio-demographic factors, mainly during the first wave, showing some population strata benefits from the social distancing measures when able to adhere to them. In the second wave, the burden was very high for all but extremely high for some, highlighting our society needs to tackle the health inequalities experienced by groups of different socio-demographic and economic status.

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Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para a priorização da vacinação

Cited by 10 publications

References 11 publications

Cardiovascular Mortality during the COVID-19 Pandemics in a Large Brazilian City: a Comprehensive Analysis

Cardiovascular Mortality during the COVID-19 Pandemics in a Large Brazilian City: a Comprehensive Analysis

Assessing spatial distribution of COVID-19 prevalence in Brazil using decentralised sewage monitoring

Assessing COVID-19 pandemic excess deaths in Brazil: years 2020 and 2021

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