Combined association of obesity and other cardiometabolic diseases with severe COVID-19 outcomes: a nationwide cross-sectional study of 21 773 Brazilian adult and elderly inpatients

ObjectivesTo investigate the combined association of obesity, diabetes mellitus (DM) and cardiovascular disease (CVD) with severe COVID-19 outcomes in adult and elderly inpatients.DesignCross-sectional study based on registry data from Brazil’s influenza surveillance system.SettingPublic and private hospitals across Brazil.ParticipantsEligible population included 21 942 inpatients aged ≥20 years with positive reverse transcription-PCR test for SARS-CoV-2 until 9 June 2020.Main outcome measuresSevere COVID-19 outcomes were non-invasive and invasive mechanical ventilation use, intensive care unit (ICU) admission and death. Multivariate analyses were conducted separately for adults (20–59 years) and elders (≥60 years) to test the combined association of obesity (without and with DM and/or CVD) and degrees of obesity with each outcome.ResultsA sample of 8848 adults and 12 925 elders were included. Among adults, obesity with DM and/or CVD showed higher prevalence of invasive (prevalence ratio 3.76, 95% CI 2.82 to 5.01) and non-invasive mechanical ventilation use (2.06, 1.58 to 2.69), ICU admission (1.60, 1.40 to 1.83) and death (1.79, 1.45 to 2.21) compared with the group without obesity, DM and CVD. In elders, obesity alone (without DM and CVD) had the highest prevalence of ICU admission (1.40, 1.07 to 1.82) and death (1.67, 1.00 to 2.80). In both age groups, obesity alone and combined with DM and/or CVD showed higher prevalence in all outcomes than DM and/or CVD. A dose–response association was observed between obesity and death in adults: class I 1.32 (1.05 to 1.66), class II 1.41 (1.06 to 1.87) and class III 1.77 (1.35 to 2.33).ConclusionsThe combined association of obesity, diabetes and/or CVD with severe COVID-19 outcomes may be stronger in adults than in elders. Obesity alone and combined with DM and/or CVD had more impact on the risk of COVID-19 severity than DM and/or CVD in both age groups. The study also supports an independent relationship of obesity with severe outcomes, including a dose–response association between degrees of obesity and death in adults.

­­The Impact of a National Cash Transfer Programme on Reducing Suicide: A Study Using the 100 Million Brazilian Cohort (preprint)

Background: Socio-economic factors have been consistently associated with suicide, and economic recessions are linked to rising suicide rates. This study investigates the effect of the world`s largest conditional cash transfer (CCT) programme on suicide rates in a cohort of half the Brazilian population. Methods: We used data from the 100 Million Brazilian Cohort, covering a 12-year period (2004 to 2015). It comprises socio-economic and demographic information on 114,008,317 individuals, linked to the “Bolsa Família” programme (BFP) payroll database, and nationwide death registration data. We fitted Poisson models to estimate the incidence rate ratios for suicide, associated with exposure to the BFP and Propensity Score (PS) to group BFP beneficiaries and non-beneficiaries. We estimated the PS through multiple logistic regression using baseline socio-demographic and economic characteristics and year of registration, and ran Kernel matching analysis and several sensitivity tests. Results: In the main analysis, 33,281 suicide cases occurred among the 69,707,312 individuals followed for 305,229,883 person-years at risk. Suicide rates among beneficiaries and non-beneficiaries were 5.5 (95%CI=5.44, 5.61) and 11.1 (95%CI=10.41, 11.81) in the matched cohort and 5.4 (95%CI=5.32, 5.47) and 10.7 (95%CI=10.51, 10.87) per 100,000 individuals, in the original cohorts. BFP beneficiaries had a 61% lower suicide rate than non-beneficiaries (IRR=0.39, 95%CI=0.37,0.41) in the main analysis and similar results in all sensitivity analyses. This effect was higher among women (IRR=0.35, 95%IC=0.31,0.39), and younger individuals (IRR=0.40, 95%IC=0.37,0.44). Interpretation: CCT programs play an important role in poverty reduction and well-being improvement for beneficiaries. We have also demonstrated that it contributes towards reduced suicide rates. Targeting social determinants, using cash transfer programmes, could be important tools to limit suicide, predicted to rise in the aftermath of the economic recession, consequent to the Covid-19 pandemic.Funding Statement: The authors received no direct financial support for this article. During the study DBM held a research associate scholarship from Wellcome Trust (202912/Z/16/Z) and CIDACS has received support from the Department of Science and Technology, from the Brazilian Ministry of Health; National Research Council (CNPq), Brazil; Bill and Melinda Gates Foundation (CHAMADA MCTI/CNPq/MS/SCTIE/Decit/Fundação Bill e Melinda Gates N o 47/2014); Health Surveillance Secretariat, Ministry of Health, Brazil; Fundação de Apoio a Pesquisa do Estado da Bahia (FAPESB); Financiadora de Estudos e Projetos (FINEP); Secretaria de Ciência e Tecnologia do Estado da Bahia (SECTI), and Wellcome Trust.Declaration of Interests: All authors have no competing interests.Ethics Approval Statement: This study was approved by the two research ethics committees of the: (i) Federal University of Bahia (application number: 1023107) and (ii) London School of Hygiene & Tropical Medicine (application number: 11581).

Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social

Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.Alternate abstract:Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.