Department of Epidemiology, Institute of Social Medicine, Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil.
Department of Physical Education and Sports, Naval School, Marinha do Brasil - Rio de Janeiro (RJ), Brazil.
Rev Bras Epidemiol. 2021 Dec 1;24:e210056. doi: 10.1590/1980-549720210056. eCollection 2021 Sep 1.
The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services.
Hospitalization data for severe acute respiratory syndrome (SARS) were obtained using the SIVEP-Gripe Database. All hospitalized adults who were diagnosed as COVID-19 or unspecified SARS, between January and December 2020, were included in the analysis. Logistic regression models were fitted to evaluate the risk of death between Rio de Janeiro and São Paulo, adjusted for age, sex, and comorbidities.
A total of 388,657 hospital registers for Rio de Janeiro and São Paulo (91,532 and 297,125, respectively) were analyzed. Missing data are frequent in the database and it was greater in Rio de Janeiro, at the state and capital levels. Adjusting for confounders, the odds ratio of dying by COVID-19, comparing the state of Rio de Janeiro with São Paulo, was 2.51 in the private hospitals and 2.29 in the public ones. For the capitals, the scenario is worse. The lethality among hospitalized patients with COVID-19 is at least twice in Rio de Janeiro than São Paulo, both at the states and capitals. The public or private services showed important differences, with odds ratios of 2.74 and 3.46, respectively.
It appears that the worst governance in the health sector in Rio de Janeiro, more than lack of resources, explains the excess mortality of hospitalized COVID-19 patients in Rio de Janeiro.
本研究旨在比较 COVID-19 住院病例在圣保罗和里约热内卢的死亡率，按私立和公立服务分层。
使用 SIVEP-Gripe 数据库获取严重急性呼吸综合征（SARS）住院数据。所有在 2020 年 1 月至 12 月期间被诊断为 COVID-19 或未特指 SARS 的成年住院患者均纳入分析。使用逻辑回归模型评估里约热内卢和圣保罗之间的死亡风险，调整年龄、性别和合并症。
共分析了来自里约热内卢和圣保罗的 388657 例住院记录（分别为 91532 例和 297125 例）。数据库中经常存在缺失数据，里约热内卢州和首都的缺失数据更多。在调整混杂因素后，与圣保罗相比，私立医院和公立医院 COVID-19 死亡的优势比分别为 2.51 和 2.29。对于首府来说，情况更糟。里约热内卢住院 COVID-19 患者的死亡率至少是圣保罗的两倍，无论是在州还是首府。公共或私人服务显示出重要差异，优势比分别为 2.74 和 3.46。
似乎是里约热内卢卫生部门的治理不善，而不是缺乏资源，导致了里约热内卢 COVID-19 住院患者的超额死亡。
