Social and racial inequalities in COVID-19 risk of hospitalisation and death across São Paulo state, Brazil

  1. Sabrina L Li
  2. Rafael H M Pereira
  3. Carlos A Prete
  4. Alexander E Zarebski
  5. Lucas Emanuel
  6. Pedro JH Alves
  7. Pedro S Peixoto
  8. Carlos KV Braga
  9. Andreza A de Souza Santos
  10. William M de Souza
  11. Rogerio J Barbosa
  12. Lewis F Buss
  13. Alfredo Mendrone
  14. Cesar de Almeida-Neto
  15. Suzete C Ferreira
  16. Nanci A Salles
  17. Izabel Marcilio
  18. Chieh-Hsi Wu
  19. Nelson Gouveia
  20. Vitor H Nascimento
  21. Ester C Sabino
  22. Nuno R Faria
  23. Jane P Messina
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Abstract

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 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 (SARI) notified from March to August 2020, in the Sistema de Monitoramento Inteligente de São 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.

Funding

This project was supported by a Medical Research Council-São Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0) ( <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://caddecentre.org/">http://caddecentre.org/</ext-link> ). This work received funding from the U.K. Medical Research Council under a concordat with the U.K. Department for International Development.

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