ABSTRACT
Brazil ranks second in the number of confirmed cases of COVID-19 worldwide. In spite of this, coping measures differ throughout the national territory, as does the disease's impact on the population. This cross-sectional observational study, with 59 695 cases of COVID-19 registered in the state of Alagoas between March and August 2020, analysed clinical-epidemiological variables, incidence rate, mortality rate, case fatality rate (CFR) and the social indicators municipal human development index (MHDI) and social vulnerability index (SVI). Moran statistics and regression models were applied. Logistic regression analysis was applied to determine the predictors of death. The incidence rate was 1788.7/100 000 inhabitants; mortality rate was 48.0/100 000 and CFR was 2.7%. The highest incidence rates were observed in municipalities with better human development (overall MHDI (I = 0.1668; p = 0.002), education MHDI (I = 0.1649; p = 0.002) and income MHDI (I = 0.1880; p = 0.005)) and higher social vulnerability (overall SVI (I = 0.0599; p = 0.033)). CFR was associated with higher social vulnerability (SVI human capital (I = 0.0858; p = 0.004) and SVI urban infrastructure (I = 0.0985; p = 0.040)). Of the analysed cases, 55.4% were female; 2/3 were Black or Brown and the median age was 41 years. Among deaths, most were male (919; 57.4%) and elderly (1171; 73.1%). The predictors of death were male sex, advanced age and the presence of comorbidities. In Alagoas, Brazil, the disease has undergone a process of interiorisation and caused more deaths in poorer municipalities. The presence of comorbidities and advanced age were predictors of death.
Subject(s)
COVID-19/epidemiology , Adult , Aged , Brazil/epidemiology , COVID-19/mortality , Cross-Sectional Studies , Databases, Factual , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Registries , Risk Factors , Spatial Analysis , Young AdultABSTRACT
INTRODUCTION: The high transmissibility and infectivity of the new coronavirus, the high proportion of asymptomatic transmitters and the rapid and continuous spatial displacement of people, by the different mechanisms of locomotion, are elements that can contribute to the dissemination of COVID-19. This study aims to describe the geographical dispersion of COVID-19 in the state of Bahia and the importance of major airports and highways in the dynamics of disease transmission. METHODS: This is an ecological study involving all cases of COVID-19 registered in the state of Bahia between March 6, date of the first registered case and May 16, 2020. After collection, an exploratory spatial analysis was performed, considering the cases accumulated on the last day of each epidemiological week. RESULTS: The first cases of COVID-19 were concentrated in areas served by three important airport complexes in the state, located in Salvador, Ilhéus and Porto Seguro. From week 16-20, there was a more intense expansion of COVID-19 to the interior of the state. A global spatial autocorrelation was observed (I Moran 0.2323; p = 0.01), with the influence of distance: positive correlation at distances less than 205.8 km (I Moran 0.040; p = 0.01) and greater than 800 km (I Moran 0.080; p = 0.01). CONCLUSIONS: Based on the spatial dispersion pattern of COVID-19 in the state of Bahia, airports and highways that cross the state were responsible for the interiorization of the disease.
Subject(s)
Coronavirus Infections/epidemiology , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Social Conditions/economics , Vulnerable Populations , Brazil , COVID-19 , Coronavirus Infections/prevention & control , Female , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Socioeconomic Factors , Survival AnalysisABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. Since then, the disease has spread throughout the country, reaching the poorest areas. This study analyzes the relationship between COVID-19 and the population's living conditions. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020. METHODS: This is an ecological study evaluating the relationship between COVID-19 incidence, mortality, and case fatality rates and 49 social indicators of human development and social vulnerability. For the analysis, bivariate spatial correlation and multivariate and spatial regression models (spatial lag model and spatial error models) were used, considering a 95% confidence interval and a significance level of 5%. RESULTS: A total of 44.8% of municipalities registered confirmed cases of COVID-19 and 14.7% had deaths. We observed that 56.2% of municipalities with confirmed cases had very low human development (COVID-19 incidence rate: 59.00/100 000; mortality rate: 36.75/1 000 000), and 52.8% had very high vulnerability (COVID-19 incidence rate: 41.68/100 000; mortality rate: 27.46/1 000 000). The regression model showed 17 indicators associated with transmission of COVID-19 in Brazil. CONCLUSIONS: Although COVID-19 first arrived in the most developed and least vulnerable municipalities in Brazil, it has already reached locations that are farther from large urban centers, whose populations are exposed to a context of intense social vulnerability. Based on these findings, it is necessary to adopt measures that take local social aspects into account in order to contain the pandemic.