Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study
Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study
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DOI：
10.1016/s2214-109x(20)30285-0
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发表时间：
2020-08-01
影响因子：
34.3
通讯作者：
van der Schaar, Mihaela
中科院分区：
文献类型：
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作者：
Baqui, Pedro;Bica, Ioana;van der Schaar, Mihaela
巴西在COVID-19病例和死亡总数方面居全球第二位。鉴于人口多样性和脆弱的政治和经济局势，了解可能存在的社会经济和族裔卫生不平等尤为重要。我们的目的是在巴西的COVID-19大流行和评估死亡率的变化，根据地区，种族，合并症，和symptoms.Methods我们进行了一项横断面观察研究的COVID-19医院死亡率使用SIVEP-Gripe（Sistema de Informacao de Vigilancia Epidemiologica da Gripe）数据集，以确定COVID-19在巴西的大流行。在这项研究中，我们纳入了严重急性呼吸综合征冠状病毒2型RT-PCR检测阳性且数据集中有种族信息的住院患者。根据巴西地理和统计研究所使用的五个类别对参与者的种族进行了分类：布兰科（白色）、普雷托（黑人）、阿马雷洛（东亚）、印第安人（土著）或帕尔多（混合种族）。我们评估了各州和两个社会经济分组地区（北部和中南部）收治的COVID-19患者的地区差异。我们采用混合效应考克斯回归生存分析，估计种族和合并症的影响，在个人水平的背景下，区域variation.Findings的SIVEP-Gripe数据集的99 557例患者，我们包括11 321例患者在我们的研究。这些患者中有9278例（82个中心点0%）来自中南部地区，2043例（18个中心点0%）来自北部地区。与白色巴西人相比，因COVID-19而入院的巴西帕尔多人和黑人的死亡风险显著更高（风险比[HR] 1中心点45，95% CI 1中心点33-1中心点58，巴西帕尔多人; 1中心点32，1中心点15-1中心点52，巴西黑人）。Pardo种族是死亡的第二大风险因素（仅次于年龄）。共病在北部地区住院的巴西人中比在中南地区更常见，各族裔群体之间的比例相似。在北部的国家有较高的HRs相比，中南地区，除了里约热内卢，其中有一个高得多的HR比其他中南states.Interpretation我们发现了两个不同的证据，但相关的影响：增加死亡率在北部地区（区域效应），并在帕尔多和黑人人口（种族效应）。我们推测，区域效应是由社会经济发展水平较低地区的共同负担增加所驱动的。种族效应可能与不同种族对COVID-19的易感性和获得医疗保健（包括重症监护）的差异有关。我们的分析支持巴西当局的紧急努力，即考虑国家对COVID-19的应对措施如何更好地保护帕尔多和黑人巴西人以及较贫穷州的人口，使其免于死于COVID-19的风险。版权所有（c）2020作者。由Elsevier Ltd.发布，这是CC BY 4.0许可下的开放获取文章。
Background Brazil ranks second worldwide in total number of COVID-19 cases and deaths. Understanding the possible socioeconomic and ethnic health inequities is particularly important given the diverse population and fragile political and economic situation. We aimed to characterise the COVID-19 pandemic in Brazil and assess variations in mortality according to region, ethnicity, comorbidities, and symptoms.Methods We conducted a cross-sectional observational study of COVID-19 hospital mortality using data from the SIVEP-Gripe (Sistema de Informacao de Vigilancia Epidemiologica da Gripe) dataset to characterise the COVID-19 pandemic in Brazil. In the study, we included hospitalised patients who had a positive RT-PCR test for severe acute respiratory syndrome coronavirus 2 and who had ethnicity information in the dataset. Ethnicity of participants was classified according to the five categories used by the Brazilian Institute of Geography and Statistics: Branco (White), Preto (Black), Amarelo (East Asian), Indigeno (Indigenous), or Pardo (mixed ethnicity). We assessed regional variations in patients with COVID-19 admitted to hospital by state and by two socioeconomically grouped regions (north and central-south). We used mixed-effects Cox regression survival analysis to estimate the effects of ethnicity and comorbidity at an individual level in the context of regional variation.Findings Of 99 557 patients in the SIVEP-Gripe dataset, we included 11 321 patients in our study. 9278 (82 center dot 0%) of these patients were from the central-south region, and 2043 (18 center dot 0%) were from the north region. Compared with White Brazilians, Pardo and Black Brazilians with COVID-19 who were admitted to hospital had significantly higher risk of mortality (hazard ratio [HR] 1 center dot 45, 95% CI 1 center dot 33-1 center dot 58 for Pardo Brazilians; 1 center dot 32, 1 center dot 15-1 center dot 52 for Black Brazilians). Pardo ethnicity was the second most important risk factor (after age) for death. Comorbidities were more common in Brazilians admitted to hospital in the north region than in the central-south, with similar proportions between the various ethnic groups. States in the north had higher HRs compared with those of the central-south, except for Rio de Janeiro, which had a much higher HR than that of the other central-south states.Interpretation We found evidence of two distinct but associated effects: increased mortality in the north region (regional effect) and in the Pardo and Black populations (ethnicity effect). We speculate that the regional effect is driven by increasing comorbidity burden in regions with lower levels of socioeconomic development. The ethnicity effect might be related to differences in susceptibility to COVID-19 and access to health care (including intensive care) across ethnicities. Our analysis supports an urgent effort on the part of Brazilian authorities to consider how the national response to COVID-19 can better protect Pardo and Black Brazilians, as well as the population of poorer states, from their higher risk of dying of COVID-19. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.