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Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study.
Baqui, Pedro; Bica, Ioana; Marra, Valerio; Ercole, Ari; van der Schaar, Mihaela.
  • Baqui P; Núcleo de Astrofísica e Cosmologia, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
  • Bica I; Department of Engineering Science, University of Oxford, Oxford, UK; The Alan Turing Institute, London, UK.
  • Marra V; Núcleo de Astrofísica e Cosmologia, Universidade Federal do Espírito Santo, Vitória, ES, Brazil; Departamento de Física, Universidade Federal do Espírito Santo, Vitória, ES, Brazil. Electronic address: marra@cosmo-ufes.org.
  • Ercole A; Department of Medicine, University of Cambridge, Cambridge, UK; Cambridge Centre for Artificial Intelligence in Medicine, Cambridge, UK.
  • van der Schaar M; The Alan Turing Institute, London, UK; Cambridge Centre for Artificial Intelligence in Medicine, Cambridge, UK; Department of Applied Mathematics and Theoretical Physics and Department of Population Health, University of Cambridge, Cambridge, UK; Department of Electrical and Computer Engineering, Un
Lancet Glob Health ; 8(8): e1018-e1026, 2020 08.
Article in English | MEDLINE | ID: covidwho-624459
ABSTRACT

BACKGROUND:

Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms.

METHODS:

We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics Branco (White), Preto (Black), Amarelo (East Asian), Indígeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation.

FINDINGS:

Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82·0%) of these patients were from the central-south region, and 2043 (18·0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1·45, 95% CI 1·33-1·58 for Pardo Brazilians; 1·32, 1·15-1·52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states.

INTERPRETATION:

We found evidence of two distinct but associated effects increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19.

FUNDING:

None.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Ethnicity / Residence Characteristics / Hospital Mortality / Coronavirus Infections / Health Status Disparities Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: South America / Brazil Language: English Journal: Lancet Glob Health Year: 2020 Document Type: Article Affiliation country: S2214-109X(20)30285-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Ethnicity / Residence Characteristics / Hospital Mortality / Coronavirus Infections / Health Status Disparities Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: South America / Brazil Language: English Journal: Lancet Glob Health Year: 2020 Document Type: Article Affiliation country: S2214-109X(20)30285-0