RT Journal Article
SR Electronic
T1 Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e004959
DO 10.1136/bmjgh-2021-004959
VO 6
IS 4
A1 Sabrina L Li
A1 Rafael H M Pereira
A1 Carlos A Prete Jr
A1 Alexander E Zarebski
A1 Lucas Emanuel
A1 Pedro J H Alves
A1 Pedro S Peixoto
A1 Carlos K V Braga
A1 Andreza Aruska de Souza Santos
A1 William M de Souza
A1 Rogerio J Barbosa
A1 Lewis F Buss
A1 Alfredo Mendrone
A1 Cesar de Almeida-Neto
A1 Suzete C Ferreira
A1 Nanci A Salles
A1 Izabel Marcilio
A1 Chieh-Hsi Wu
A1 Nelson Gouveia
A1 Vitor H Nascimento
A1 Ester C Sabino
A1 Nuno R Faria
A1 Jane P Messina
YR 2021
UL http://gh.bmj.com/content/6/4/e004959.abstract
AB 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.Data are available upon request. The data sets used and/or analysed during the current study are available from the corresponding authors on reasonable request.