Social and racial inequalities in COVID-19 risk of hospitalisation and death across Sao Paulo state, Brazil
Sabrina L. Li,
Rafael H. M. Pereira,
Carlos A. Prete,
Alexander E. Zarebski,
Pedro J. H. Alves,
Pedro S Peixoto,
Carlos K. V. Braga,
Andreza Aruska de Souza Santos,
William Marciel Souza,
Rogerio J. Barbosa,
Lewis F Buss,
Cesar de Almeida-Neto,
Suzete C Ferreira,
Nanci A Salles,
Vitor H. Nascimento,
Ester C. Sabino,
Nuno R. Faria,
Jane P. Messina
Posted 12 Dec 2020
medRxiv DOI: 10.1101/2020.12.09.20246207
Posted 12 Dec 2020
Background: 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 Sao 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 (SARI) notified from March to August 2020, in the Sistema de Monitoramento Inteligente de Sao Paulo (SIMI-SP) database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple datasets for individual-level and spatio-temporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour, and comorbidities. Findings: Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared to patients living in the 5% wealthiest areas (OR: 1.60, 95% CI: 1.48 - 1.74) and were more likely to be hospitalised between April and July, 2020 (OR: 1.08, 95% CI: 1.04 - 1.12). Black and Pardo individuals were more likely to be hospitalised when compared to White individuals (OR: 1.37, 95% CI: 1.32 - 1.41; OR: 1.23, 95% CI: 1.21 - 1.25, respectively), and were more likely to die (OR: 1.14, 95% CI: 1.07 - 1.21; 1.09, 95% CI: 1.05 - 1.13, respectively). Interpretation: Low-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to healthcare, adherence to social distancing, and the higher prevalence of comorbidities.
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