Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey.
Structural factors associated with SARS-CoV-2 infection risk in an urban slum setting in Salvador, Brazil: A cross-sectional survey.
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DOI：
10.1371/journal.pmed.1004093
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发表时间：
2022-09
期刊：
影响因子：
15.8
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中科院分区：
文献类型：
--
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城市贫民窟的结构环境，包括自然、人口和社会经济属性，使居民更容易受到严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的感染。然而，人们对导致这些社区内高传播率的具体决定因素知之甚少。因此，我们的目标是调查巴西一个城市贫民窟的SARS-CoV-2血清阳性率。我们在巴西2019年冠状病毒病(新冠肺炎)第一波大流行之后和第二波大流行期间，于2020年11月至2021年2月期间，对来自巴西萨尔瓦多的2,041名城市贫民窟居民进行了横断面血清调查。这一人群的平均年龄为29岁(四分位数范围[IQR]16到44)；大多数参与者报告他们的种族是黑人(51.5%)或棕色(41.7%)，58.5%是女性。参与的家庭规模中位数为3个(IQR 2至4)，人均收入中位数为2.32(IQR 0.33-5.15)美元。主要观察指标为抗SARS-CoV-2刺突蛋白的免疫球蛋白。我们对每个家庭实施了随机截距的多水平模型，以估计血清阳性率和相关的风险因素，调整了检测的敏感性和特异性，以及我们研究人群的年龄和性别分布。我们发现高血清阳性率(47.9%，95%可信区间[CI]44.2%至52.1%)，特别是在女性居民中(50.3%[95%可信区间46.3%至54.8%]与男性居民44.6%[95%可信区间40.1%至49.4%]。儿童中为54.4%[95%可信区间为49.6%至59.3%]，成人为45.4%[95%可信区间为41.5%至49.7%]，P<；0.01)。居住在有孩子的家庭中的成年人更有可能是血清阳性(48.6%[95%可信区间44.8%至52.3%]比40.7%[95%CI 37.2%至44.3%]，p<；0.01)。与相同就业和收入状况的男性相比，失业和生活在贫困线以下(家庭人均日收入1.25美元)的女性更有可能出现血清阳性(53.9%[95%可信区间47.0%至60.6%]比32.9%[95%可信区间23.2%至44.3%]，p<；0.01)。参与这项研究是自愿的，这可能会限制我们研究结果的概括性。在第二波新冠肺炎疫情达到高峰之前，通过血清学评估，巴西城市贫民窟人口的累积发病率接近50%。与工业化国家的观察结果不同，SARS-CoV-2在儿童以及生活在极端贫困中的妇女中的发病率最高。这些调查结果强调，需要有针对性的干预措施，为儿童提供安全的环境，减轻拥挤和贫穷给城市贫民窟最脆弱的居民带来的结构性风险。玛丽亚姆·O·福法纳和他的同事在巴西的一个城市贫民窟调查了SARS-CoV-2血清阳性率。在目前的大流行期间，非正式住区或城市贫民窟的居民感染严重急性呼吸综合征冠状病毒2型的风险增加，但关于在这些高传播环境中的人群所经历的风险的异质性的证据有限。了解影响贫民窟人口风险的因素可以为边缘化和资源不足社区的公共卫生预防战略提供依据。我们希望确定影响城市贫民窟居民感染SARS-CoV-2风险的社会人口因素，如年龄和性别。我们收集了社会人口学数据，并测量了2020年11月至2021年2月巴西萨尔瓦多第一次大流行后2,041名城市贫民窟居民的血清样本中SARS-CoV-2抗S抗体的水平。总体而言，48%的居民抗体水平为阳性，这反映了以前感染过SARS-CoV-2。我们发现，妇女和儿童更有可能感染SARS-CoV-2。在巴西最初的疫情浪潮中，这个城市贫民窟的居民经历了感染SARS-CoV-2的高风险。即使在城市贫民窟的高危环境中，也存在叠加的风险梯度，使妇女和儿童特别容易感染2019年冠状病毒病(新冠肺炎)。
The structural environment of urban slums, including physical, demographic, and socioeconomic attributes, renders inhabitants more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Yet, little is known about the specific determinants that contribute to high transmission within these communities. We therefore aimed to investigate SARS-CoV-2 seroprevalence in an urban slum in Brazil. We performed a cross-sectional serosurvey of an established cohort of 2,041 urban slum residents from the city of Salvador, Brazil between November 2020 and February 2021, following the first Coronavirus Disease 2019 (COVID-19) pandemic wave in the country and during the onset of the second wave. The median age in this population was 29 years (interquartile range [IQR] 16 to 44); most participants reported their ethnicity as Black (51.5%) or Brown (41.7%), and 58.5% were female. The median size of participating households was 3 (IQR 2 to 4), with a median daily per capita income of 2.32 (IQR 0.33–5.15) US Dollars. The main outcome measure was presence of IgG against the SARS-CoV-2 spike protein. We implemented multilevel models with random intercepts for each household to estimate seroprevalence and associated risk factors, adjusting for the sensitivity and specificity of the assay, and the age and gender distribution of our study population. We identified high seroprevalence (47.9%, 95% confidence interval [CI] 44.2% to 52.1%), particularly among female residents (50.3% [95% CI 46.3% to 54.8%] versus 44.6% [95% CI 40.1% to 49.4%] among male residents, p < 0.01) and among children (54.4% [95% CI 49.6% to 59.3%] versus 45.4% [95% CI 41.5% to 49.7%] among adults, p < 0.01). Adults residing in households with children were more likely to be seropositive (48.6% [95% CI 44.8% to 52.3%] versus 40.7% [95% CI 37.2% to 44.3%], p < 0.01). Women who were unemployed and living below the poverty threshold (daily per capita household income <$1.25) were more likely to be seropositive compared to men with the same employment and income status (53.9% [95% CI 47.0% to 60.6%] versus 32.9% [95% CI 23.2% to 44.3%], p < 0.01). Participation in the study was voluntary, which may limit the generalizability of our findings. Prior to the peak of the second wave of the COVID-19 pandemic, cumulative incidence as assessed by serology approached 50% in a Brazilian urban slum population. In contrast to observations from industrialized countries, SARS-CoV-2 incidence was highest among children, as well as women living in extreme poverty. These findings emphasize the need for targeted interventions that provide safe environments for children and mitigate the structural risks posed by crowding and poverty for the most vulnerable residents of urban slum communities. Mariam O. Fofana and colleagues investigate SARS-CoV-2 seroprevalence in an urban slum in Brazil. Inhabitants of informal settlements or urban slums are at increased risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection during the ongoing pandemic, yet there is limited evidence on the heterogeneities in risk experienced by populations in these high-transmission settings. Understanding the factors that influence risk within slum populations can inform public health prevention strategies in marginalized and under-resourced communities. We wanted to identify sociodemographic factors, such as age and gender, that influence SARS-CoV-2 infection risk among residents of urban slum communities. We collected sociodemographic data and measured levels of SARS-CoV-2 anti-S IgG in serum samples from 2,041 urban slum residents from Salvador, Brazil after the first pandemic wave, from November 2020 to February 2021. Overall, 48% of residents had positive antibody levels, reflecting prior SARS-CoV-2 infection. We found that women and children were more likely to have experienced a SARS-CoV-2 infection. Residents of this urban slum community experienced a high risk of SARS-CoV-2 infection during the initial wave of the epidemic in Brazil. Even within the high-risk environment of urban slums, there are superimposed gradients of risk that make women and children particularly vulnerable to Coronavirus Disease 2019 (COVID-19).
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影响因子：
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作者：
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通讯作者：
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DOI：
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DOI：
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期刊：
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