Ethnoracial disparity among patients with dementia during COVID-19 pandemic

We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.

Keywords:
Ethnicity; Dementia; COVID-19

	Overall			White			Black			Mixed
	2019	2020	% *	2019	2020	% *	2019	2020	% *	2019	2020	% *
Hospitalization rate **
Region
North	0.28 ***	0.18	-35.7	0.09	0.12	33.3	N/A ^#	-	-	0.20	0.12	-40.0
Northeast	0.47 ***	0.41	-12.8	0.22	0.14	-36.4	0.28	0.24	-14.3	0.33	0.36	9.1
Southeast	1.52	1.03	-32.2	1.32	1.03	-22.0	1.18	0.71	-39.8	0.91	0.05	-94.5
South	1.42	1.61	13.4	1.37	1.64	19.7	0.79	1.65	108.9	0.52	0.39	-25.0
Central-West	1.17	0.98	-16.2	0.48	0.63	31.3	0.33	0.33	0.0	0.59	0.53	-10.2
Mean inpatient spending (BRL 1,000)
Region
North	0.56 ^##	0.63 ^##	12.5	0.41	0.23	-43.9	N/A ^#	-	-	0.93	1.04	11.8
Northeast	1.75 ^##	2.08 ^##	18.9	2.09	2.46	17.7	4.45	6.20	39.3	1.62	1.84	13.6
Southeast	5.86	7.85	34.0	6.60	7.67	16.2	8.21	11.53	40.4	7.84	14.40	83.7
South	0.88 ^##	0.94 ^##	6.8	0.94	0.97	3.2	1.87	1.03	-44.9	0.34	1.22	258.8
Central-West	2.56	3.36 ^##	31.3	2.27	2.81	23.8	4.20	4.63	10.2	5.80	6.74	16.2
Inpatient mortality rate
Region
North ^###	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Northeast	9.10 ^##	21.30	134.1	9.70	15.80	62.9	5.30	31.30	490.6	12.70	27.80	118.9
Southeast	15.20	18.20 ^##	19.7	18.30	20.70	13.1	20.20	24.20	19.8	12.80	18.01	40.7
South	9.80 ^##	9.40 ^##	-4.1	10.30	8.33	-19.1	9.10	17.40	91.2	2.90	8.00	175.9
Central-West	36.80	33.30	-9.5	50.00	36.10	-27.8	40.00	60.00	50.0	21.60	42.50	96.8

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[1] Correspondence
N. Feter Universidade Federal de Pelotas. Rua Luís de Camões 625, Pelotas, RS 96055-630, Brasil. natanfeter@hotmail.com