ABSTRACT
The COVID-19 pandemic has caused over half a million deaths in Brazil, and public healthcare nearly collapsed. Vaccination differs between states and demographics. Dose shortages delayed access. In this cross-sectional study, data were retrieved from the Brazilian Ministry of Health databases published since 17 January 2021, respectively. We developed a campaign optimality index to characterise inequality in vaccination access caused by age due to premature vaccination towards younger populations before older and vulnerable populations were fully vaccinated. We assessed geographical inequalities in full vaccination coverage and dose by age, sex, race, and socioeconomic status. Generalised linear regression was used to investigate the risk of death and hospitalisation by age group, socioeconomic status, and vaccination coverage. Vaccination coverage is higher in the wealthier South and Southeast. Men, people of colour, and low-income groups were more likely to be only partially vaccinated due to missing or delaying a second dose. Vaccination started prematurely for age groups under 50 years and may have hindered uptake of older age groups. Vaccination coverage was associated with a lower risk of death, especially in older age groups (OR: 10.5-34.8, 95% CI: (10.2, 35.9)). Risk of hospitalisation was greater in areas with higher vaccination rates due to higher access to care and reporting. Vaccination inequality persists between states, age and demographic groups despite increasing uptake. The association between hospitalisation rates and vaccination is attributed to preferential delivery to areas of greater transmission and access to healthcare.
Subject(s)
COVID-19 , DeathABSTRACT
BackgroundLittle evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in Sao Paulo state, Brazil and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. MethodsWe conducted a cross-sectional study using hospitalised severe acute respiratory infections (SARI) notified from March to August 2020, in the Sistema de Monitoramento Inteligente de Sao Paulo (SIMI-SP) database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple datasets for individual-level and spatio-temporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour, and comorbidities. FindingsThroughout the study period, patients living in the 40% poorest areas were more likely to die when compared to patients living in the 5% wealthiest areas (OR: 1{middle dot}60, 95% CI: 1{middle dot}48 - 1{middle dot}74) and were more likely to be hospitalised between April and July, 2020 (OR: 1{middle dot}08, 95% CI: 1{middle dot}04 - 1{middle dot}12). Black and Pardo individuals were more likely to be hospitalised when compared to White individuals (OR: 1{middle dot}37, 95% CI: 1{middle dot}32 - 1{middle dot}41; OR: 1{middle dot}23, 95% CI: 1{middle dot}21 - 1{middle dot}25, respectively), and were more likely to die (OR: 1{middle dot}14, 95% CI: 1{middle dot}07 - 1{middle dot}21; 1{middle dot}09, 95% CI: 1{middle dot}05 - 1{middle dot}13, respectively). InterpretationLow-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to healthcare, adherence to social distancing, and the higher prevalence of comorbidities. FundingThis project was supported by a Medical Research Council-Sao Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) (http://caddecentre.org/). This work received funding from the U.K. Medical Research Council under a concordat with the U.K. Department for International Development.