Spatial–temporal distribution of incidence, mortality, and case-fatality ratios of coronavirus disease 2019 and its social determinants in Brazilian municipalities

Abstract

The COVID-19 pandemic caused impact on public health worldwide. Brazil gained prominence during the pandemic due to the magnitude of disease. This study aimed to evaluate the spatial–temporal dynamics of incidence, mortality, and case fatality of COVID-19 and its associations with social determinants in Brazilian municipalities and epidemiological week. We modeled incidence, mortality, and case fatality rates using spatial–temporal Bayesian model. “Bolsa Família Programme” (BOLSAFAM) and “proportional mortality ratio” (PMR) were inversely associated with the standardized incidence ratio (SIR), while “health insurance coverage” (HEALTHINSUR) and “Gini index” were directly associated with the SIR. BOLSAFAM and PMR were inversely associated with the standardized mortality ratio (SMR) and standardized case fatality ratio (SCFR). The highest proportion of excess risk for SIR and the SMR started in the North, expanding to the Midwest, Southeast, and South regions. The highest proportion of excess risk for the SCFR outcome was observed in some municipalities in the North region and in the other Brazilian regions. The COVID-19 incidence and mortality in municipalities that most benefited from the cash transfer programme and with better social development decreased. The municipalities with a higher proportion of non-whites had a higher risk of becoming ill and dying from the disease.

Unsuccessful tuberculosis treatment outcomes across Brazil's geographical landscape before and during the COVID-19 pandemic: are we truly advancing toward the sustainable development/end TB goal?

“…The arrival of the novel coronavirus in Brazil and its evolution into a pandemic has led to socioeconomic repercussions that have exacerbated existing social inequities, particularly affecting those individuals who were already facing greater vulnerabilities, as is the case with people with TB [ 25 , 26 ]. Thus, the pandemic has intensified the vicious cycle of TB, where the most vulnerable populations end up suffering greater social repercussions from the disease, further aggravating their vulnerabilities [ 28 ].…”

“…The Southeast region recorded the first cases of COVID-19 in the country and was responsible for the majority of cases [ 25 , 42 ]. In this context, the magnitude of the pandemic in the region may have impacted healthcare services more intensely than in other regions, leading to the interruption of routine actions and losses in follow-up, especially in Primary Health Care, which is primarily responsible for providing care for chronic health conditions such as TB [ 34 , 43 , 44 ].…”