Dataset Information

Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.

ABSTRACT: The study aims to analyze inequalities in Covid-19 outcomes in Brazil in 2020/2021 according to the per capita Gross Domestic Product (pcGDP) of municipalities. All cases of Severe Acute Respiratory Syndrome (SARS) who were hospitalized or died, regardless of hospitalization, registered in Brazil in 2020 and 2021 were analyzed (n = 2,902,742), including those with a confirmed diagnosis of Covid-19 (n = 1,894,165). We calculated lethality due to Covid-19, the performance of diagnostic tests among patients with SARS, and the hospital care received by those with Covid-19 according to the pcGDP of the patients' municipalities of residence. Data were analyzed for each epidemiological week and the risk of each outcome was estimated using Poisson regression. Municipalities in the lowest pcGDP decile had (i) 30% (95%CI 28%-32%) higher lethality from Covid-19, (ii) three times higher proportion of patients with SARS without the collection of biological material for the diagnosis of Covid-19, (iii) 16% (95%CI 15%-16%) higher proportion of SARS patients testing in a period longer than two days from the onset of symptoms, (iv) 140% (95%CI 134%-145%) higher absence of CT scan use. There is deep socioeconomic inequality among Brazilian municipalities regarding the occurrence of Covid-19 negative outcomes.

SUBMITTER: Boing AF

PROVIDER: S-EPMC9547655 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.

Boing Antonio Fernando AF Boing Alexandra Crispim AC Veras Maria Amélia MA de Lacerda Josimari Telino JT da Silva Rafael Lopes Paixão RLP Barbato Paulo Roberto PR Fabrin Caroline C Subramanian S V SV

Preventive medicine 20221008

The study aims to analyze inequalities in Covid-19 outcomes in Brazil in 2020/2021 according to the per capita Gross Domestic Product (pcGDP) of municipalities. All cases of Severe Acute Respiratory Syndrome (SARS) who were hospitalized or died, regardless of hospitalization, registered in Brazil in 2020 and 2021 were analyzed (n = 2,902,742), including those with a confirmed diagnosis of Covid-19 (n = 1,894,165). We calculated lethality due to Covid-19, the performance of diagnostic tests among ...[more]

PMID: 36220401

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Project description:BackgroundBrazil started the COVID-19 mass vaccination in January 2021 with CoronaVac and ChAdOx1, followed by BNT162b2 and Ad26.COV2.S vaccines. By the end of 2021, more than 317 million vaccine doses were administered in the adult population. This study aimed at estimating the effectiveness of the primary series of COVID-19 vaccination and booster shots in protecting against severe cases and deaths in Brazil during the first year of vaccination.MethodsA cohort dataset of over 158 million vaccination and severe cases records linked from official national registries was analyzed via a mixed-effects Poisson model, adjusted for age, state of residence, time after immunization, and calendar time to estimate the absolute vaccine effectiveness of the primary series of vaccination and the relative effectiveness of the booster. The method permitted analysis of effectiveness against hospitalizations and deaths, including in the periods of variant dominance.FindingsVaccine effectiveness against severe cases and deaths remained over 25% and 50%, respectively, after 19 weeks from primary vaccination of BNT162b2, ChAdOx1, or CoronaVac vaccines. The boosters conferred greater protection than the primary series of vaccination, with heterologous boosters providing marginally greater protection than homologous. The effectiveness against hospitalization during the Omicron dominance in the 60+ years old population started at 61.7% (95% CI, 26.1-86.2) for ChAdOx1, 95.6% (95% CI, 82.4-99.9) for CoronaVac, and 72.3% (95% CI, 51.4-87.4) for the BNT162b2 vaccine.InterpretationThis study provides real-world evidence of the effectiveness of COVID-19 vaccination in Brazil, including during the Omicron wave, demonstrating protection even after waning effectiveness. Comparisons of the effectiveness among different vaccines require caution due to potential bias effects related to age groups, periods in the pandemic, and eventual behavioural changes.FundingFundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Pan American Health Organization (PAHO), Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde do Brasil (DECIT/SCTIE/MS).

Project description:Objective: To estimate the incidence, mortality and lethality rates of COVID-19 among Indigenous Peoples in the Brazilian Amazon. Additionally, to analyze how external threats can contribute to spread the disease in Indigenous Lands (IL). Methods: The Brazilian Amazon is home to nearly half a million Indigenous persons, representing more than 170 ethnic groups. As a pioneer in heading Indigenous community-based surveillance (I-CBS) in Brazil, the Coordination of the Indigenous Organizations of the Brazilian Amazon (COIAB) started to monitor Indigenous COVID-19 cases in March of 2020. Brazil's Ministry of Health (MOH) was the main source of data regarding non-Indigenous cases and deaths; to contrast the government's tally, we used the information collected by I-CBS covering 25 Special Indigenous Sanitary Districts (DSEI) in the Brazilian Amazon. The incidence and mortality rates of COVID-19 were calculated using the total number of new cases and deaths accumulated between the 9th and 40th epidemiological weeks. We studied (a) the availability of health care facilities to attend to Indigenous Peoples; (b) illegal mines, land grabbing, and deforestation to perform a geospatial analysis to assess how external threats affect Indigenous incidence and mortality rates. We used the Generalized Linear Model (GLM) with Poisson regression to show the results. Results: MOH registered 22,127 cases and 330 deaths, while COIAB's survey recorded 25,356 confirmed cases and 670 deaths, indicating an under-reporting of 14 and 103%, respectively. Likewise, the incidence and mortality rates were 136 and 110% higher among Indigenous when compared with the national average. In terms of mortality, the most critical DSEIs were Alto Rio Solimões, Cuiabá, Xavante, Vilhena and Kaiapó do Pará. The GLM model reveals a direct correlation between deforestation, land grabbing and mining, and the incidence of cases among the Indigenous. Conclusion: Through this investigation it was possible to verify that not only the incidence and mortality rates due to COVID-19 among Indigenous Peoples are higher than those observed in the general population, but also that the data presented by the federal government are underreported. Additionally, it was evident that the presence of illegal economic activities increased the risk of spreading COVID-19 in ILs.

Dataset Information

Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.

Publications

Area-level inequalities in Covid-19 outcomes in Brazil in 2020 and 2021: An analysis of 1,894,165 severe Covid-19 cases.

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