School of Geography and the Environment, University of Oxford, Oxford, UK
Institute of Applied Economic Research, Brasília, Brazil
BMJ Glob Health. 2021 Apr;6(4). doi: 10.1136/bmjgh-2021-004959.
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.
We conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.
Throughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).
Low-income and Black and communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.
关于 COVID-19 对弱势人群的健康影响的差异，证据有限。在这里，我们描述了巴西圣保罗州住院和死亡的差异风险，并展示了 COVID-19 的脆弱性是如何由社会经济不平等造成的。
我们使用 2020 年 3 月至 8 月期间从数据库中报告的住院严重急性呼吸道感染，进行了一项横断面研究。我们使用个人层面和时空分析的多个数据集，检查了种族和社会经济地位与住院和死亡风险之间的关系。我们根据移动电话数据、远程工作行为和合并症解释了这些不平等现象。
在整个研究期间，与居住在最富有 5%地区的患者相比，居住在最贫困 40%地区的患者死亡的可能性更高（OR：1.60，95%CI 1.48 至 1.74），并且在 2020 年 4 月至 7 月期间更有可能住院（OR：1.08，95%CI 1.04 至 1.12）。与白人相比，黑人（OR：1.41，95%CI 1.37 至 1.46）和 （OR：1.26，95%CI 1.23 至 1.28）更有可能住院，并且在 2020 年 4 月至 7 月期间更有可能死亡（OR：1.13，95%CI 1.07 至 1.19；1.07，95%CI 1.04 至 1.10）。一旦住院，与在私立医院接受治疗的患者相比，在公立医院接受治疗的患者更有可能死亡（OR：1.40%，95%CI 1.34% 至 1.46%）。黑人以及受教育程度较低的人更有可能患有一种或多种合并症（OR：1.29，95%CI 1.19 至 1.39；1.36，95%CI 1.27 至 1.45）。
低收入、黑人和 社区更有可能死于 COVID-19。这与获得优质医疗保健的机会、自我隔离的能力以及合并症的更高患病率有关。
