Spatiotemporal ecological study of COVID-19 mortality in the city of São Paulo, Brazil: Shifting of the high mortality risk from areas with the best to those with the worst socio-economic conditions

Abstract

Background Currently, Brazil is experiencing one of the fastest increasing coronavirus disease (COVID-19) mortality rates worldwide, with a minimum of 158,000 confirmed deaths presently. The city of São Paulo is particularly vulnerable because it is the most populated city in Brazil. Thus, this study aimed to analyse COVID-19 mortality in a spatiotemporal context in São Paulo, with respect to socio-economic levels. Method We modelled the deaths using spatiotemporal architectures and Poisson probability distributions using a latent Gaussian Bayesian model approach. Results Both total deaths and confirmed deaths showed similar spatial patterns. Mortality was higher in men and increased with age. The most critical period regarding mortality occurred between the 20 th and 23 rd epidemiological weeks, followed by an apparent stabilisation of the epidemiological trend. The risk of death was greater in areas with the worst social conditions during the study period. However, this pattern was not uniform over time, since we identified a shift of high risk from the areas with the best socio-economic conditions to those with the worst conditions. Conclusions Our study corroborated the relationship between COVID-19 mortality and socio-economic conditions, revealing the importance of geographic screening in the integration of better actions to face the pandemic.

What most influences severity and death of COVID-19 patients in Brazil? Is it clinical, social, or demographic factors? An observational study

“…In Paraisópolis, the largest slum of the study region, there was an evident higher density of cases, in agreement with other Brazilian studies that found greater virus spread in highly vulnerable and densely populated locations [28,29]. However, a high incidence of severe cases and deaths was found in two areas of low vulnerability also presenting low density and overall incidence of cases, which is in accordance with the findings of the study by Bermudi et al [29],…”

Prevalence evolution of SARS-CoV-2 infection in the Municipality of São Paulo, 2020 - 2021

“…The prevalence of SARS-CoV-2 infection was inverse to the individual's income and to the HDI of CA-PHU, therefore, the lower the income and HDI in the CA-PHU, the higher the prevalence of SARS-CoV-2 infection. Similar to the studies of Bermudi et al 23 and Menezes et al 24 , vulnerable populations with lower income and poor housing conditions have a higher risk of virus transmission and difficulties to acess healthcare for diagnosis and treatment.…”

Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil

“…Differences in COVID-19 mortality according to education, income and housing conditions described in our study are concordant with findings from a previous ecological study that has used a composite socio-economic index and spatio-temporal analyses to show that socio-economic conditions and COVID-19 mortality were associated in the city of São Paulo. 6 In the UK, COVID-19 mortality rates in the most deprived areas were almost 100% higher than those observed in the least deprived regions, and the effect was not modified after controlling for ethnicity. Similarly to our study, authors reported that, after adjustment for age, geographic region, sex and ethnicity, social disparities were more pronounced among people of working age (most deprived compared with least deprived, 93% higher risk of death) than among elderly persons (most deprived compared with least deprived, 9% higher risk of death).…”

“…Health inequities are recognized worldwide, with most vulnerable populations presenting higher incidence and mortality for communicable and non-communicable diseases. During the COVID-19 pandemic, socio-economic gradients were reported in Brazil, 5 , 6 the USA 7–9 and the UK. 10 Racial and ethnic disparities in infection and disease outcomes were described for many countries, with Blacks, Asians and minority ethnic groups emerging as more vulnerable than the White population.…”

“…Brazil is a highly unequal country, with substantial health and socio-economic differences observed between and within cities. 12 Previous studies have shown racial and socio-economic differences on COVID-19 mortality in Brazil, 5 , 6 but there are still gaps in knowledge regarding the interplay between race and socio-economic factors. This study addresses this issue and aims to characterize mortality patterns from COVID-19 in the city of São Paulo, Brazil and to identify risk factors of mortality considering various socio-demographic indicators.…”