COVID-19 hospitalization and death and relationship with social determinants of health and morbidities in Espírito Santo State, Brazil: a cross-sectional study

Mascarello, Keila Cristina; Vieira, Anne Caroline Barbosa Cerqueira; Souza, Ana Sara Semeão de; Marcarini, Wena Dantas; Barauna, Valério Garrone; Maciel, Ethel Leonor Noia

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Brasil

Epidemiologia e Serviços de Saúde

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Brasil

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Sumário

Original Article • Epidemiol. Serv. Saúde 30 (3) • 2021 • https://doi.org/10.1590/S1679-49742021000300004 copy

COVID-19 hospitalization and death and relationship with social determinants of health and morbidities in Espírito Santo State, Brazil: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the association between social determinants and morbidities for the outcomes of hospitalization, intensive care unit admission and death by COVID-19 in Espírito Santo State, Brazil.

Methods

Cross-sectional study with secondary data from confirmed cases of COVID-19, reported in the Notifiable Diseases Information System. Poisson regression was used to estimate the prevalence ratios.

Results

104,384 cases reported between February 28^th and September 1^st, 2020 were studied. The outcomes under study were more frequent among male, elderly, yellow, followed by black, uneducated and with multimorbidity. There was a higher risk of death among people over the age of 60 (PR=56.31 - 95%CI 34.24;92.61), multimorbidities (PR=3.63 - 95%CI 3.16;4.17), kidney disease (PR=3.42 - 95%CI 2.81;4.15) and neoplasms (PR=3.15 - 95%CI 2.41;4.13).

Conclusion

The effect of social determinants and morbidities on hospitalization and deaths by COVID-19 is evident.

Keywords:
Coronavirus Infections; Hospitalization; Mortality; Social Determinants of Health; Cross-Sectional Studies

Exposure variable	N	%	Hospitalization n (%)^a	ICU^c n (%)^a	Death n (%)^a
			Yes	Yes	Yes
			p<0.001^b	p<0.001^b	p<0.001^b
Sex (104,359)
Female	55,401	53.09	2,794 (7.10)	1,292 (4.14)	1,363 (2.63)
Male	48,958	46.91	3,476 (9.93)	1,653 (5.87)	1,764 (3.85)
Race/skin color (81,338)
White	34,366	42.25	1,972 (7.59)	909 (4.53)	1,106 (3.44)
Black	6,253	7.69	468 (9.79)	231 (5.91)	251 (4.27)
Yellow	7,018	8.63	553 (10.32)	310 (7.31)	324 (4.88)
Brown	33,536	41.23	2,127 (8.58)	995 (4.99)	1,094 (3.55)
Indigenous	165	0.20	7 (5.56)	2 (1.85)	3 (2.00)
Age (years) (104,384)
18-29	19,603	18.78	222 (1.60)	55 (0.94)	27 (0.37)
30-39	27,566	26.41	527 (2.75)	143 (1.55)	71 (0.60)
40-49	22,885	21.92	842 (5.14)	250 (3.07)	144 (1.45)
50-69	16,514	15.82	1,086 (9.22)	380 (6.42)	267 (3.67)
≥60	17,816	17.07	3,595 (27.35)	1,309 (18.37)	1,575 (19.17)
Schooling (68,152)
No schooling	13,127	19.26	1,395 (13.39)	650 (7.75)	893 (7.34)
Elementary education	9,642	14.15	562 (7.51)	244 (4.17)	308 (3.44)
High school education	30,298	44.46	910 (3.88)	353 (1.93)	300 (1.06)
Higher education	15,085	22.13	394 (3.33)	142 (1.59)	82 (0.58)
Morbidity (103,136)
None	75,661	73.36	2,155 (4.17)	858 (2.12)	790 (1.12)
One morbidity	18,741	18.17	1,978 (12.99)	926 (7.47)	988 (5.65)
Multimorbidity	8,734	8.47	2,053 (28.32)	1,121 (18.18)	1,295 (15.79)

Variable	Crude analysis			Adjusted analysis
Variable	Hospitalization PR (95%CI)	ICU admission PR (95%CI)	Death PR (95%CI)	Hospitalization PR (95%CI)	ICU admission PR (95%CI)	Death PR (95%CI)
Morbidity^a
None	1.00	1.00	1.00	1.00	1.00	1.00
One morbidity	3.11 (2.93;3.29)	3.53 (3.22;3.86)	5.06 (4.62;5.55)	1.49 (1.36;1.64)	1.65 (1.42;1.92)	1.78 (1.54;2.05)
Multimorbidity	6.78 (6.42;7.16)	8.59 (7.89;9.35)	14.15 (12.99;15.41)	2.66 (2.43;2.93)	3.09 (2.65 - 3.60)	3.63 (3.16;4.17)
Chi-square trend	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
Sex^b
Male	1.00	1.00	1.00	1.00	1.00	1.00
Female	0.71 (0.68;0.75)	0.70 (0.65;0.75)	0.68 (0.63;0.73)	0.67 (0.62;0.71)	0.62 (0.56;0.69)	0.63 (0.57;0.70)
Race/skin color^c
White	1.00	1.00	1.00	1.00	1.00	1.00
Black	1.28 (1.17;1.41)	1.35 (1.13;1.50)	1.24 (1.08;1.42)	1.28 (1.13;1.44)	1.34 (1.11;1.62)	1.22 (1.03;1.45)
Yellow	1.35 (1.24;1.48)	1.61 (1.42;1.82)	1.42 (1.25;1.60)	1.35 (1.19;1.52)	1.81 (1.52;2.16)	1.27 (1.08;1.50)
Brown	1.12 (1.06;1.19)	1.10 (1.01;1.20)	1.03 (0.95;1.12)	1.17 (1.08;1.26)	1.21 (1.07;1.37)	1.11 (0.99;1.23)
Indigenous	0.73 (0.35;1.50)	0.40 (0.10;1.61)	0.58 (0.18;1.78)	0.52 (0.17;1.59)	0.76 (0.19;2.95)	0.80 (0.20;3.12)
Schooling^d
Higher education	1.00	1.00	1.00	1.00	1.00	1.00
High school education	1.16 (1.03;1.30)	1.21 (1.00;1.47)	1.84 (1.44;2.34)	1.19 (1.06;1.35)	1.28 (1.04;1.59)	1.71 (1.33;2.20)
Elementary education	2.25 (1.99;2.55)	2.63 (2.14;3.22)	5.95 (4.67;7.59)	1.51 (1.31;1.73)	1.74 (1.38;2.18)	2.76 (2.14;3.56)
No schooling	4.02 (3.60;4.48)	4.88 (4.08;5.84)	12.72 (10.16;15.93)	1.78 (1.58;2.02)	2.08 (1.69;2.56)	3.35 (2.63;4.26
Chi-square trend	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
Age (years)^e
18-29	1.00	1.00	1.00	1.00	1.00	1.00
30-39	1.71 (1.47;2.00)	1.65 (1.27;2.13)	1.98 (1.32;2.97)	1.64 (1.34;2.02)	1.72 (1.20;2.46)	2.07 (1.16;3.67)
40-49	3.31 (2.77;3.72)	3.16 (2.48;4.02)	5.78 (3.99;8.38)	2.89 (2.38;3.51)	2.69 (1.91;3.78)	5.39 (3.18;9.11)
50-59	5.76 (5.00;6.64)	6.99 (5.54;8.80)	14.60 (10.19;20.92)	4.38 (3.61;5.30)	4.23 (3.88;7.49)	11.39 (6.83;18.99)
≥60	17.10 (14.96;19.54)	21.33 (17.12;26.57)	83.49 (58.94;118.26)	11.39 (9.49;13.68)	10.70 (10.34;19.48)	56.31 (34.24;92.61)
Chi-square trend	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Morbidity	N (%)	Crude analysis			Adjusted analysis^a
Morbidity	N (%)	Hospitalization PR (95%CI)	ICU admission PR (95%CI)	Death PR (95%CI)	Hospitalization PR (95%CI)	ICU admission PR (95%CI)	Death PR (95%CI)
Lung disease
No	100,093 (96.87)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	3,235 (3.13)	2.28 (2.10;2.48)	2.47 (2.19;2.79)	3.13 (2.79;3.52)	1.86 (1.65;2.09)	2.02 (1.68;2.43)	2.01 (1.70;2.36)
Neoplasms
No	102,966 (99.65)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	363 (0.35)	5.29 (4.85;5.78)	3.49 (2.93;4.17)	8.89 (7.88;10.04)	2.76 (2.23;3.41)	1.72 (1.10;2.68)	3.15 (2.41;4.13)
Cardiovascular disease
No	83,249 (80.55)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	20,100 (19.45)	3.56 (3.40;3.73)	4.37 (4.07;4.69)	5.92 (5.52;6.35)	1.16 (1.07;1.26)	1.34 (1.18;1.52)	1.36 (1.21;1.52)
Kidney disease
No	102,555 (99.23)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	793 (0.77)	5.85 (5.38;6.36)	6.45 (5.67;7.34)	9.46 (8.38;10.67)	2.81 (2.41;3.27)	2.90 (2.28;3.69)	3.42 (2.81;4.15)
Diabetes mellitus
No	95,523 (92.44)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	7,810 (7.56)	3.82 (3.63;4.02)	4.65 (4.33;5.00)	6.02 (5.61;6.47)	1.73 (1.60;1.88)	2.04 (1.81;2.30)	2.07 (1.86;2.30)
Tobacco smoking
No	101,424 (98.16)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	1,905 (1.84)	2.68 (2.44;2.96)	3.13 (2.74;3.58)	3.40 (2.95;3.91)	1.72 (1.50;1.97)	1.94 (1.59;2.38)	1.72 (1.42;2.08)
Obesity
No	99,268 (96.18)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	3,940 (3.82)	2.00 (1.85;2.18)	1.96 (1.73;2.22)	2.48 (2.20;2.79)	1.81 (1.62;2.02)	1.72 (1.44;2.06)	2.03 (1.74; 2.36)
HIV infection
No	103,126 (99.80)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	209 (0.20)	3.39 (2.66;4.32)	3.44 (2.39;4.97)	2.93 (1.88;4.56)	3.18 (2.28;4.43)	3.34 (1.98;5.62)	2.40 (1.26;4.57)
Neurological diseases
No	102,495 (99.19)	1.00	1.00	1.00	1.00	1.00	1.00
Yes	839 (0.81)	4.44 (4.01;4.92)	4.15 (3.52;4.89)	7.50 (6.57;8.57)	1.96 (1.64;2.34)	1.41 (1.02;1.96)	2.38 (1.92;2.94)

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
Keila Cristina Mascarello - Universidade Federal do Espírito Santo, Centro Universitário Norte do Espírito Santo, Centro de Ciências da Saúde, BR-101, km 60, Litorâneo, São Mateus, ES, Brasil. Postcode: 29932-540. E-mail: keila.mascarello@ufes.br