Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020

Sanhueza-Sanzana, Carlos; Aguiar, Italo Wesley Oliveira; Almeida, Rosa Lívia Freitas; Kendall, Carl; Mendes, Aminata; Kerr, Ligia Regina Franco Sansigolo

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (3) • 2021 • https://doi.org/10.1590/S1679-49742021000300022 copy

Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020^* * Article derived from the project entitled ‘Social inequalities during the COVID-19 pandemic in a metropolis of northeastern Brazil: an ecological study’, conceived by the ‘Grupo Cearense de Pesquisa em Doenças Infecciosas (GCPDI)’ of the Postgraduate Program in Public Health of the Federal University of Ceará in 2020.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the association among social and health inequalities, socioeconomic status, spatial segregation and Case Fatality Rate (CFR) due to COVID-19 in Fortaleza, the state capital of Ceará, Brazil.

Methods

This was an ecological study of confirmed cases and deaths due to COVID-19. The 119 neighborhoods of Fortaleza were used as units of analysis. Incidence, mortality and apparent CFR indicators due to COVID-19 were calculated between January 1 and June 8, 2020. Socioeconomic indicators were obtained from the 2010 Brazilian Demographic Census. Spatial analysis was performed and local and global Moran's indexes were calculated.

Results

There were 22,830 confirmed cases, 2,333 deaths and the apparent CFR was 12.7% (95% CI 11.6;13.9). Significant spatial autocorrelations between apparent CFR (I=0.35) and extreme poverty (I=0.51), overlapping in several neighborhoods of the city, were found.

Conclusion

The apparent CFR due to COVID-19 is associated with the worst socioeconomic and health status, which shows the relationship between social inequalities and health outcomes in times of pandemic.

Keywords:
SARS-CoV-2; Socioeconomic Factors; Social Inequity; Case Fatality Rate; Mortality; Spatial analysis

Variables	Cases (n)	Cases (%)	Deaths (n)	Deaths (%)
Variables	N=22,830	Cases (%)	N=2,333	Deaths (%)
Sex
Female	12,334	54.0	1,046	42.5
Male	10,493	45.9	1,411	57.4
Age group (years)
<1	19	0.1	3	0.1
1-9	194	0.9	3	0.1
10-19	342	1.5	6	0.3
20-29	2,474	10.8	27	1.2
30-39	4,999	21.9	76	3.3
40-59	8,008	35.1	462	19.8
60-69	2,865	12.5	440	18.8
≥70	3,584	15.7	1,308	56.1
Not informed	345	1.5	8	0.3
Comorbidities
Cardiovascular	1,230	5.3	815	34.9
Diabetes mellitus	1,089	4.7	799	31.9
Obesity	69	0.3	40	1.7
Kidney disease	161	0.7	105	4.5
Pulmonary disease	80	0.3	54	2.3
Neurological	147	0.6	117	5.2
Immunodeficiency	93	0.4	45	1.3
Postpartum	25	0.1	4	0.2
Asthma	69	0.3	39	1.7
Hematological	24	0.1	19	0.8

Variables	Average	95%IC		Median	IQR	Standard deviation	p-value^a
Variables	Average	LL	UL	Median	IQR	Standard deviation	p-value^a
Incidence rate	66.4	59.2	73.6	57.5	40.3	39.6	<0.01
Mortality rate	7.6	6.8	8.5	6.7	5.9	4.4	<0.01
Apparent case fatality rate	12.7	11.6	13.9	12.5	8.1	6.1	0.550
Deaths	16,1	13,4	18,6	12,0	18,0	14,3	<0.01
Cases	125.5	106.9	146.1	109.0	18.0	14.3	<0.01

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence
Carlos Sanhueza-Sanzana - Universidade Federal do Ceará, Faculdade de Medicina, Programa de Pos-Graduação em Saúde Pública, Rua Professor Costa Mendes, Nº 1608, 5° andar, Rodolfo Teófilo, Fortaleza, CE, Brazil. CEP: 60430-140. E-mail: carlosanhueza.san@gmail.com