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

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

doi:10.1136/bmjgh-2021-004959

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

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

Microbiology, Immunology, and Molecular Genetics

Research output: Contribution to journal › Article › peer-review

66 Scopus citations

Abstract

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. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de São Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.

Original language	English
Article number	e004959
Journal	BMJ Global Health
Volume	6
Issue number	4
DOIs	https://doi.org/10.1136/bmjgh-2021-004959
State	Published - Apr 29 2021

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Funding

SLL is supported by the Oxford Martin Programme on Pandemic Genomics and the Canadian Social Sciences and Humanities Research Council (SSHRC) Doctoral Fellowship. CAPJ is supported by Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - Brasil (CAPES) - Financial Code 001, Funda??o Faculdade de Medicina (FFM), and the S?o Paulo Research Foundation (FAPESP 2019/21858-0). AEZ is supported by the Oxford Martin Programme on Pandemic Genomics. WMS is supported by the S?o Paulo Research Foundation (FAPESP 2017/13981-0 and 2019/24251-9). VHN is supported by the Brazilian National Council for Scientific and Technological Development (CNPq: 304714/2018-6). NRF is supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z). This project was supported by a Medical Research Council-S?o Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) (http://caddecentre.org/). Funding SLL is supported by the Oxford Martin Programme on Pandemic Genomics and the Canadian Social Sciences and Humanities Research Council (SSHRC) Doctoral Fellowship. CAPJ is supported by Coordena\u00E7\u00E3o de Aperfei\u00E7oamento de Pessoal de N\u00EDvel Superior - Brasil (CAPES) - Financial Code 001, Funda\u00E7\u00E3o Faculdade de Medicina (FFM), and the S\u00E3o Paulo Research Foundation (FAPESP 2019/21858-0). AEZ is supported by the Oxford Martin Programme on Pandemic Genomics. WMS is supported by the S\u00E3o Paulo Research Foundation (FAPESP 2017/13981-0 and 2019/24251-9). VHN is supported by the Brazilian National Council for Scientific and Technological Development (CNPq: 304714/2018-6). NRF is supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z). This project was supported by a Medical Research Council-S\u00E3o Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) (http://caddecentre.org/).

Funders	Funder number
Faculdade Regional de Medicina
Fundação Universitaria do ABC, Faculdade de Medicina do ABC
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Medical Research Council-São Paulo Research Foundation
FFM
Social Sciences and Humanities Research Council of Canada
Aperfei?oamento de Pessoal de N?vel Superior
Wellcome Trust	204311
Fundação de Amparo à Pesquisa do Estado de São Paulo	18/14389-0, 2017/13981-0, 2019/24251-9, MR/S0195/1, 2019/21858-0
Royal Society Sir Henry Dale Fellowship	204311/Z/16/Z
Conselho Nacional de Desenvolvimento Científico e Tecnológico	304714/2018-6

Keywords

cross-sectional survey
epidemiology
geographic information systems
mathematical modelling
public health

ASJC Scopus subject areas

Health Policy
Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bmjgh-2021-004959

Cite this

Li, S. L., Pereira, R. H. M., Prete, C. A., Zarebski, A. E., Emanuel, L., Alves, P. J. H., Peixoto, P. S., Braga, C. K. V., de Souza Santos, A. A., de Souza, W. M., Barbosa, R. J., Buss, L. F., Mendrone, A., de Almeida-Neto, C., Ferreira, S. C., Salles, N. A., Marcilio, I., Wu, C. H., Gouveia, N., ... Messina, J. 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), Article e004959. https://doi.org/10.1136/bmjgh-2021-004959

@article{a51a0085c9d54b24a4ab1dde24262a8e,

title = "Higher risk of death from COVID-19 in low-income and non-White populations of S{\~a}o Paulo, Brazil",

abstract = "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 S{\~a}o Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de S{\~a}o Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.",

keywords = "cross-sectional survey, epidemiology, geographic information systems, mathematical modelling, public health",

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

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.",

year = "2021",

month = apr,

day = "29",

doi = "10.1136/bmjgh-2021-004959",

language = "English",

volume = "6",

journal = "BMJ Global Health",

publisher = "BMJ Publishing Group",

number = "4",

}

Li, SL, Pereira, RHM, Prete, CA, Zarebski, AE, Emanuel, L, Alves, PJH, Peixoto, PS, Braga, CKV, de Souza Santos, AA, de Souza, WM, Barbosa, RJ, Buss, LF, Mendrone, A, de Almeida-Neto, C, Ferreira, SC, Salles, NA, Marcilio, I, Wu, CH, Gouveia, N, Nascimento, VH, Sabino, EC, Faria, NR & Messina, JP 2021, 'Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil', BMJ Global Health, vol. 6, no. 4, e004959. https://doi.org/10.1136/bmjgh-2021-004959

TY - JOUR

T1 - Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil

AU - Li, Sabrina L.

AU - Pereira, Rafael H.M.

AU - Prete, Carlos A.

AU - Zarebski, Alexander E.

AU - Emanuel, Lucas

AU - Alves, Pedro J.H.

AU - Peixoto, Pedro S.

AU - Braga, Carlos K.V.

AU - de Souza Santos, Andreza Aruska

AU - de Souza, William M.

AU - Barbosa, Rogerio J.

AU - Buss, Lewis F.

AU - Mendrone, Alfredo

AU - de Almeida-Neto, Cesar

AU - Ferreira, Suzete C.

AU - Salles, Nanci A.

AU - Marcilio, Izabel

AU - Wu, Chieh Hsi

AU - Gouveia, Nelson

AU - Nascimento, Vitor H.

AU - Sabino, Ester C.

AU - Faria, Nuno R.

AU - Messina, Jane P.

PY - 2021/4/29

Y1 - 2021/4/29

N2 - 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. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de São Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.

AB - 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. We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in theSistema de Monitoramento Inteligente de São Paulodatabase. 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. 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 andPardoindividuals 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). Low-income and Black andPardocommunities 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.

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KW - epidemiology

KW - geographic information systems

KW - mathematical modelling

KW - public health

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JO - BMJ Global Health

JF - BMJ Global Health

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ER -

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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