Article
Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil
Registro en:
PERES, I. T. et al. Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil. Public Health, v. 192, p. 15-20, 2021.
0033-3506
10.1016/j.puhe.2021.01.005
Autor
Peres, I. T.
Bastos, L. S. L.
Gelli, J. G. M.
Marchesi, J. F.
Dantas, L. F.
Antunes, B. B. P.
Maçaira, P. M.
Baião, F. A.
Hamacher, S.
Bozza, Fernando A.
Resumen
Objectives: The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to
healthcare systems, increasing racial disparities and worsening health outcomes in these populations.
This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital
mortality in Brazil.
Study design: A retrospective analysis was conducted on quantitative reverse transcription polymerase
chain reactioneconfirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database
(SIVEP-Gripe) between February 16 and August 8, 2020.
Methods: Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of
hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital
mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic
regression model.
Results: During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths.
The study population included 228,196 COVID-19epositive adult in-hospital patients with a defined
outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and
35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/
Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were
admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more
invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%,
respectively). Black/Brown race was independently associated with high in-hospital mortality after
adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio ¼ 1.15; 95%
confidence interval ¼ 1.09e1.22).
Conclusions: Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher
in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions
than White patients. Racial disparities in health outcomes and access to health care highlight the need to
actively implement strategies to reduce inequities caused by the wider health determinants, ultimately
leading to a sustainable change in the health system.