Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Brazil.
Faculty of Economics (PPGE)-Federal University of Bahia, Salvador, Brazil.
PLoS One. 2022 Nov 15;17(11):e0277441. doi: 10.1371/journal.pone.0277441. eCollection 2022.
Socioeconomic factors have exacerbated the impact of COVID-19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID-19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID-19 mortality in large urban centers in Brazil. We compiled weekly COVID-19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID-19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID-19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID-19, as supported by the observed associations in this study.
社会经济因素加剧了 COVID-19 在全球的影响。巴西已经存在显著的经济不平等，是受影响最严重的国家之一，死亡率也位居世界前列。了解不平等和收入隔离如何导致巴西城市 COVID-19 死亡率过高，对于制定减轻疾病影响的公共卫生政策至关重要。本文旨在通过分析收入不平等和收入隔离对巴西大城市 COVID-19 死亡率的影响来填补这一空白。我们采用纵向生态学设计，从 2020 年 3 月至 2021 年 2 月每周汇总 COVID-19 死亡率数据，将数据汇总到巴西 152 个城市的市级水平。使用混合线性模型比较了不同周、城市和州的 COVID-19 死亡率。我们使用混合负二项模型，包括市级和周级随机截距，估计了 COVID-19 死亡率与收入不平等和收入隔离之间的关联。我们使用 2010 年巴西人口普查数据衡量收入不平等的基尼指数和收入隔离的不相似指数。我们发现，88.2%的 COVID-19 死亡率变化发生在不同的周之间，8.5%发生在不同的城市之间，3.3%发生在不同的州之间。在考虑了所有调整因素后，收入不平等和收入隔离值越高，COVID-19 死亡率越高。在我们的主要调整模型中，收入不平等和收入隔离每增加 1 个标准差，死亡率的比率（RR）分别增加 17%（95%CI 9%至 26%）和 11%（95%CI 4%至 19%）。收入不平等和收入隔离是巴西大城市的长期特征。与社会经济背景相关的风险因素影响了该国大流行的进程，并导致了高死亡率。本研究观察到的关联表明，先前存在的社会脆弱性是 COVID-19 恶化的关键因素。
