The University of Southampton
University of Southampton Institutional Repository

Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil

Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil
Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil

INTRODUCTION: Little 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 São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities.

METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.

RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).

CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.

Adult, Aged, Aged, 80 and over, Brazil/epidemiology, COVID-19/ethnology, Cross-Sectional Studies, Ethnic Groups/statistics & numerical data, Female, Health Status Disparities, Hospital Mortality/ethnology, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral/epidemiology, Poverty Areas, Residence Characteristics/statistics & numerical data, SARS-CoV-2, Seroepidemiologic Studies, Socioeconomic Factors
2059-7908
Li, Sabrina L.
62a3df1d-57e6-4335-8394-e432f4366a99
Pereira, Rafael H.M.
706c79b9-0228-4ca3-90e2-0d904dd7de8a
Prete, Carlos A.
41bc411d-67f3-480e-b7d6-108359394dd4
Zarebski, Alexander E.
8baab934-9c89-49df-b849-41e49625946d
Emanuel, Lucas
4228d606-4c7f-4ea4-b1aa-5a167dfdc384
Alves, Pedro J.H.
3aa85634-5533-4703-97ad-57eb1c99a5ce
Peixoto, Pedro S.
bdc28fe6-2268-4f2f-aa4f-f800c8523683
Braga, Carlos K.V.
7dbcbb1b-85f4-40c1-b67b-fb25572dc63a
de Souza Santos, Andreza Aruska
d9705550-e1d5-4e66-85eb-d46e4ff11791
de Souza, William M.
3cc9cfcb-ad2c-47ff-ae24-73d94fa9471b
Barbosa, Rogerio J.
af7f92cd-070e-4d13-be77-65b7665e052f
Buss, Lewis F.
53ab8102-943b-4b6f-a976-1b7100c41266
Mendrone, Alfredo
13813647-f978-4ed6-99ef-79ea709a6090
de Almeida-Neto, Cesar
86142422-fb5e-4ab4-998e-c6beafa88bd3
Ferreira, Suzete C.
3d8a15cf-307d-4a37-96aa-b63ea24700dd
Salles, Nanci A.
c1d4a860-7811-466f-8e07-abbcff08ef50
Marcilio, Izabel
ebb77142-e2ee-4270-9f01-27d7b5f1c4a8
Wu, Chieh Hsi
ace630c6-2095-4ade-b657-241692f6b4d3
Gouveia, Nelson
46991301-2f4d-490b-b72f-548642621f5b
Nascimento, Vitor H.
27677720-a741-4837-b663-9154f6ad2e97
Sabino, Ester C.
36d8182b-1c56-4071-abd6-33bdd931fdb7
Faria, Nuno R.
cc78a30a-2b32-4b9b-9d46-5c7bd842da37
Messina, Jane P.
d7056ef3-752d-48df-8907-2161e498b47c
Li, Sabrina L.
62a3df1d-57e6-4335-8394-e432f4366a99
Pereira, Rafael H.M.
706c79b9-0228-4ca3-90e2-0d904dd7de8a
Prete, Carlos A.
41bc411d-67f3-480e-b7d6-108359394dd4
Zarebski, Alexander E.
8baab934-9c89-49df-b849-41e49625946d
Emanuel, Lucas
4228d606-4c7f-4ea4-b1aa-5a167dfdc384
Alves, Pedro J.H.
3aa85634-5533-4703-97ad-57eb1c99a5ce
Peixoto, Pedro S.
bdc28fe6-2268-4f2f-aa4f-f800c8523683
Braga, Carlos K.V.
7dbcbb1b-85f4-40c1-b67b-fb25572dc63a
de Souza Santos, Andreza Aruska
d9705550-e1d5-4e66-85eb-d46e4ff11791
de Souza, William M.
3cc9cfcb-ad2c-47ff-ae24-73d94fa9471b
Barbosa, Rogerio J.
af7f92cd-070e-4d13-be77-65b7665e052f
Buss, Lewis F.
53ab8102-943b-4b6f-a976-1b7100c41266
Mendrone, Alfredo
13813647-f978-4ed6-99ef-79ea709a6090
de Almeida-Neto, Cesar
86142422-fb5e-4ab4-998e-c6beafa88bd3
Ferreira, Suzete C.
3d8a15cf-307d-4a37-96aa-b63ea24700dd
Salles, Nanci A.
c1d4a860-7811-466f-8e07-abbcff08ef50
Marcilio, Izabel
ebb77142-e2ee-4270-9f01-27d7b5f1c4a8
Wu, Chieh Hsi
ace630c6-2095-4ade-b657-241692f6b4d3
Gouveia, Nelson
46991301-2f4d-490b-b72f-548642621f5b
Nascimento, Vitor H.
27677720-a741-4837-b663-9154f6ad2e97
Sabino, Ester C.
36d8182b-1c56-4071-abd6-33bdd931fdb7
Faria, Nuno R.
cc78a30a-2b32-4b9b-9d46-5c7bd842da37
Messina, Jane P.
d7056ef3-752d-48df-8907-2161e498b47c

Li, Sabrina L., Pereira, Rafael H.M., Prete, Carlos A., Zarebski, Alexander E., Emanuel, Lucas, Alves, Pedro J.H., Peixoto, Pedro S., Braga, Carlos K.V., de Souza Santos, Andreza Aruska, de Souza, William M., Barbosa, Rogerio J., Buss, Lewis F., Mendrone, Alfredo, de Almeida-Neto, Cesar, Ferreira, Suzete C., Salles, Nanci A., Marcilio, Izabel, Wu, Chieh Hsi, Gouveia, Nelson, Nascimento, Vitor H., Sabino, Ester C., Faria, Nuno R. and Messina, Jane P. (2021) Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil. BMJ Global Health, 6 (4), [e004959]. (doi:10.1136/bmjgh-2021-004959).

Record type: Article

Abstract

INTRODUCTION: Little 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 São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities.

METHODS: We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.

RESULTS: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).

CONCLUSIONS: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.

This record has no associated files available for download.

More information

Published date: 29 April 2021
Keywords: Adult, Aged, Aged, 80 and over, Brazil/epidemiology, COVID-19/ethnology, Cross-Sectional Studies, Ethnic Groups/statistics & numerical data, Female, Health Status Disparities, Hospital Mortality/ethnology, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral/epidemiology, Poverty Areas, Residence Characteristics/statistics & numerical data, SARS-CoV-2, Seroepidemiologic Studies, Socioeconomic Factors

Identifiers

Local EPrints ID: 450964
URI: http://eprints.soton.ac.uk/id/eprint/450964
ISSN: 2059-7908
PURE UUID: 6d4f0326-d63b-472a-96ae-89cbfe1c2256
ORCID for Chieh Hsi Wu: ORCID iD orcid.org/0000-0001-9386-725X

Catalogue record

Date deposited: 27 Aug 2021 16:30
Last modified: 18 Mar 2024 03:55

Export record

Altmetrics

Contributors

Author: Sabrina L. Li
Author: Rafael H.M. Pereira
Author: Carlos A. Prete
Author: Alexander E. Zarebski
Author: Lucas Emanuel
Author: Pedro J.H. Alves
Author: Pedro S. Peixoto
Author: Carlos K.V. Braga
Author: Andreza Aruska de Souza Santos
Author: William M. de Souza
Author: Rogerio J. Barbosa
Author: Lewis F. Buss
Author: Alfredo Mendrone
Author: Cesar de Almeida-Neto
Author: Suzete C. Ferreira
Author: Nanci A. Salles
Author: Izabel Marcilio
Author: Chieh Hsi Wu ORCID iD
Author: Nelson Gouveia
Author: Vitor H. Nascimento
Author: Ester C. Sabino
Author: Nuno R. Faria
Author: Jane P. Messina

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×