Villar Jéssica, Maçaira Paula, Baião Fernanda A
Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
PLoS One. 2025 May 30;20(5):e0324171. doi: 10.1371/journal.pone.0324171. eCollection 2025.
In the 21st century, the world has faced the devastating impacts of three acute respiratory diseases: Middle East respiratory Syndrome (MERS), Severe Acute respiratory Syndrome (SARS), and COVID-19, which evolved into a pandemic. These diseases have not only caused a large number of deaths but have also damaged the economies of the affected regions. Particularly, countries in the Latin American and Caribbean (LAC) region have faced additional challenges due to more significant social inequalities, limited access to Healthcare services, and precarious living conditions, and it is not clear how these challenges impacted the effects of the mitigation actions adopted by each country. However, this understanding is crucial to guide measures to mitigate Health and socioeconomic impacts if (or when) new acute respiratory diseases emerge, especially in these countries. A retrospective study was conducted to model the dynamics of variation in COVID-19 mortality in LAC countries and to analyze its association with vaccination strategies, containment measures, mobility restrictions, and socioeconomic factors. The study methodology applied clustering techniques that revealed two distinct clusters based on sociodemographic characteristics, followed by the application of XGBoost to model the dynamics of variation in deaths in the countries of each cluster over time. Finally, the SHAP Values technique was applied to understand the associations between mortality and factors such as vaccination, containment measures, and mobility restrictions. The study provides evidence that economic support and the completion of the vaccination scheme were especially relevant in reducing COVID-19 mortality. Two distinct groups of countries were detected, one characterized by a greater vulnerability. The most important interventions for understanding COVID-19 mortality varied between pre- and post-vaccination periods. In the pre-vaccination period, containment measures were the most important interventions for mortality in the less vulnerable countries, while population mobility was more important in the more vulnerable countries. In the post-vaccination period, vaccination coverage was the most important intervention for mortality in the less vulnerable countries, while containment measures impacted the more vulnerable countries.
在21世纪，世界面临了三种急性呼吸道疾病的毁灭性影响：中东呼吸综合征（MERS）、严重急性呼吸综合征（SARS）以及演变成全球大流行的2019冠状病毒病（COVID-19）。这些疾病不仅造成了大量死亡，还损害了受影响地区的经济。特别是拉丁美洲和加勒比（LAC）地区的国家，由于社会不平等现象更为严重、获得医疗服务的机会有限以及生活条件不稳定，面临着额外的挑战，而且尚不清楚这些挑战如何影响了每个国家所采取的缓解措施的效果。然而，这种理解对于指导减轻健康和社会经济影响的措施至关重要，如果（或当）新的急性呼吸道疾病出现时，尤其是在这些国家。开展了一项回顾性研究，以模拟拉丁美洲和加勒比地区国家COVID-19死亡率的变化动态，并分析其与疫苗接种策略、防控措施、流动限制和社会经济因素的关联。该研究方法应用了聚类技术，根据社会人口特征揭示了两个不同的集群，随后应用极端梯度提升（XGBoost）来模拟每个集群国家随时间推移的死亡变化动态。最后，应用SHAP值技术来理解死亡率与疫苗接种、防控措施和流动限制等因素之间的关联。该研究提供了证据表明经济支持和疫苗接种计划的完成对于降低COVID-19死亡率尤为重要。检测到了两组不同的国家，其中一组具有更大的脆弱性。对于理解COVID-19死亡率而言，最重要的干预措施在疫苗接种前后有所不同。在疫苗接种前阶段，防控措施是较不脆弱国家降低死亡率的最重要干预措施，而人口流动在较脆弱国家更为重要。在疫苗接种后阶段，疫苗接种覆盖率是较不脆弱国家降低死亡率的最重要干预措施，而防控措施对较脆弱国家有影响。
