巴西儿童和青少年中COVID-19死亡的空间聚集、健康的社会决定因素及风险：一项基于全国人口的生态学研究。
Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: A nationwide population-based ecological study.
作者信息
Santos Victor Santana, Siqueira Thayane Santos, Atienzar Ana I Cubas, Santos Maria Augusta Ricardo da Rocha, Vieira Sarah Cristina Fontes, Lopes Aline de Siqueira Alves, Silva José Rodrigo Santos, Martins-Filho Paulo Ricardo, Cuevas Luis Eduardo, Gurgel Ricardo Queiroz
机构信息
Department of Medicine, Federal University of Sergipe, Lagarto, Brazil.
Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil.
出版信息
Lancet Reg Health Am. 2022 Sep;13:100311. doi: 10.1016/j.lana.2022.100311. Epub 2022 Jun 29.
BACKGROUND
Data regarding the geographical distribution of cases and risk factors for COVID-19 death in children and adolescents are scarce. We describe the spatial distribution of COVID-19 cases and deaths in paediatric population and their association with social determinants of health in Brazil.
METHODS
This is a population-based ecological study with a spatial analysis of all cases and deaths due to COVID-19 in Brazil among children and adolescents aged 0-19 years from March 2020 to October 2021. The units of analysis were the 5570 municipalities. Data on COVID-19 cases and deaths, social vulnerability, health inequities, and health system capacity were obtained from publicly available databases. Municipalities were stratified from low to very high COVID-19 incidence and mortality using K-means clustering procedures, and spatial clusters and relative risks were estimated using spatial statistics with Poisson probability models. The relationship between COVID-19 estimates and social determinants of health was explored by using multivariate Beta regression techniques.
FINDINGS
A total of 33,991 COVID-19 cases and 2424 deaths among children and adolescents aged 0-19 years were recorded from March 2020 to October 2021. There was a spatial dependence for the crude mortality coefficient per 100,000 population in the paediatric population aged 0-19 years (I Moran 0·10; < 0·001). Forty municipalities had higher mortality rates, of which 20 were in states from the Northeast region. Seven spatial clusters were identified for COVID-19 mortality, with four clusters in the Northeast region and three in the North region. Municipalities with higher social inequality and vulnerability had higher COVID-19 mortality in the paediatric population.
INTERPRETATION
The main clusters of risk for mortality among children and adolescents were identified in municipalities in the North and Northeast regions, which are the regions with the worst socioeconomic indicators and greatest health disparities in the country. Our findings confirmed the higher burden of COVID-19 for Brazilian paediatric population in municipalities with higher social inequality and vulnerability and worse socioeconomic indicators. To reduce the burden of COVID-19 on children, mass immunisation is necessary.
FUNDING
None.
背景
关于儿童和青少年中新冠病毒病（COVID-19）病例的地理分布及死亡风险因素的数据稀缺。我们描述了巴西儿科人群中COVID-19病例和死亡的空间分布及其与健康社会决定因素的关联。
方法
这是一项基于人群的生态学研究，对2020年3月至2021年10月期间巴西0至19岁儿童和青少年中所有因COVID-19导致的病例和死亡进行空间分析。分析单位为5570个市。COVID-19病例和死亡、社会脆弱性、健康不平等及卫生系统能力的数据均取自公开可用数据库。使用K均值聚类程序将各市按COVID-19发病率和死亡率从低到极高进行分层，并使用泊松概率模型的空间统计方法估计空间聚类和相对风险。采用多变量贝塔回归技术探讨COVID-19估计值与健康社会决定因素之间的关系。
结果
2020年3月至2021年10月期间，共记录了33991例0至19岁儿童和青少年的COVID-19病例及2424例死亡。0至19岁儿科人群中每10万人口的粗死亡率系数存在空间依赖性（I莫兰指数0·10；<0·001）。40个市的死亡率较高，其中20个位于东北地区的州。确定了7个COVID-19死亡的空间聚类，其中4个在东北地区，3个在北部地区。社会不平等和脆弱性较高的市，儿科人群中的COVID-19死亡率也较高。
解读
在北部和东北地区的市确定了儿童和青少年死亡的主要风险聚类，这些地区是该国社会经济指标最差且健康差距最大的地区。我们的研究结果证实，在社会不平等和脆弱性较高且社会经济指标较差的市，巴西儿科人群的COVID-19负担更重。为减轻COVID-19对儿童的负担，大规模免疫接种是必要的。
资金来源
无。
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