ABSTRACT
Background: Social inequalities in health have been linked to disproportional impacts in COVID-19 mortality. Therefore, this study aimed to analyze the spatiotemporal distribution of the COVID-19-related mortality and its association with the Social Determinants of Health (SDH) in Sergipe, Northeastern Brazil.Method: Ecological study using spatiotemporal analysis tools. All confirmed deaths related to COVID-19 in Sergipe, Brazil, from March 14 th to October 31 st 2020, were included and we calculated moving averages. Mortality crude rates were smoothed through Empirical Bayesian Method and were used for spatial analysis. We carried out the retrospective spatiotemporal scan statistics using the Poisson’s probability model. We used the spatial regression models to identify the association between COVID-19 mortality and Social Determinants of Health.Findings: 2,206 deaths by COVID-19 were registered in Sergipe. There was an increase of the moving averages, reaching the peak at of July 2020. A spatiotemporal cluster of mortality, comprising the metropolitan area and the neighboring cities. Illiteracy rate of people ≥15 years-old, percentage of children <5 years-old who not attend to school, sub-index of school attendance, and aging rate were predictors of deaths.Interpretation: COVID-19 mortality in Sergipe was increasing until the end of July 2020 and it showed a spatiotemporal risk cluster in the metropolitan area. Educational and aging indicators were associated to mortality, which points out the necessity of prioritization and resources redirection to risk areas.Funding Information: No funding source was required for this study.Declaration of Interests: None to declare. Ethics Approval Statement: This study followed national ethical recommendations and the rules of Helsinki Convention. The research project was approved by the Research Ethics Committee of Federal University of Sergipe (CEP/UFS), registered under the approval 4,086,909.
Subject(s)
COVID-19 , Porphyria, ErythropoieticABSTRACT
The pandemic caused by the new coronavirus disease 2019 (COVID-19) has severely impacted global health. Actions to control the transmission of the virus, such as social distancing measures, can impair the diagnosis, treatment, and control of other infections, especially neglected tropical diseases, as leprosy. Herein, we assessed the impact of the COVID-19 pandemic on leprosy diagnosis in Brazil during 2020, by means of an ecological and population-based study, using spatial analysis techniques. The variables assessed were monthly incidence of leprosy in the general population and children under 15 years old, and also multibacillary (MB) leprosy diagnosis. The p-value approach was used to determine if there was an increase or decrease in the number of leprosy cases in 2020, considering the average monthly cases registered in the last five years (2015 to 2019) as the expected number of cases for 2020. In addition, spatial distribution maps were elaborated, considering the p-value of each Brazilian state. The number of cases diagnosed started to fall in March 2020. It was verified a reduction of 11,357 notifications of leprosy cases in Brazil (P-score = -41.4%) in 2020. Likewise, there was a reduction of leprosy notifications in children under 15 years-old (n = -1,036; P-score = -56.82%). Conversely, the diagnosis of MB leprosy increased (P-score = 8.1%). Spatial distribution maps depicted a reduction of up to 100% regarding new leprosy cases, in some states. Taken together, the results reported attest that along with COVID-19 spread there was a reduction in leprosy diagnosis in the general population and children under 15 years-old, and also an increase in MB leprosy cases diagnosed, signaling a serious impact of the pandemic on leprosy control strategies in Brazil.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: This study used public-domain aggregate secondary data and identification of the individuals was not possible. For this reason, the individual consent form was dispensed. Thus, the research did not have to go through the Ethics and Research Committee with Human Beings. Nevertheless, the ethical precepts of research involving human beings established by Resolution 466/2012 of the National Health Council and the Declaration of Helsinki were followed.