Brazilian Older People Hospitalized by COVID-19: Characteristics and Prognostic Factors in a Retrospective Cohort Study

Abstract

Objective: Analyzing the survival of older people hospitalized due to COVID-19 in Brazil and identifying its main predictive factors for death. Method: This is a retrospective, multicenter cohort study, based on 20,831 records of hospitalizations of older people due to SARS-CoV-2 in Brazil. The observation period was from February 28 to May 18, 2020. Results: There was a reduced overall survival time of 47.70% (95% confidence interval [CI] = [46.72%, 48.67%]) in 10 days. The variables age, race, education, intensive care unit (ICU), region, day of hospitalization, time elapsed between the first symptom and hospitalization, and the municipality that provided assistance showed increased risk of death using the multiple Cox proportional-hazards model. Conclusion: These results emphasize the relevance of inequality and access to health services as determinants for the death of older people with COVID-19.

Risk assessment and rationalization of health resource allocation: Lessons from the Brazilian COVID-19 cohort in 2020

“…A similar pattern also manifested itself among the older patients, but less pronouncedly, possibly due to the prevalent accumulation of comorbidities among individuals in these strata. Our results confirmed the association of aging with the demand for healthcare resources and COVID-19-related deaths reported in different Brazilian states, ( Sousa et al, 2020 , Macedo et al, 2020 , Cobre et al, 2020 , Escosteguy et al, 2020 , Moura et al, 2020 , Leal et al, 2021 , Policarpo et al, 2021 , Bastos et al, 2020 ) in population restricted to a clinical condition or not, or even in national population studies, ( Santos et al, 2021 , de Souza et al, 2020 , Nascimento et al, 2020 , Marcolino et al, 2021 , Castro et al, 2021 ) but also reported in studies in Latin America, ( Escalera-Antezana et al, 2020 , Araujo et al, 2020 , Elizondo et al, 2021 , Galindo et al, 2021 , Yacobitti et al, 2021 , Ortiz-Prado et al, 2021 ) and in international cohorts ( Pepe et al, 2021 ). Overall, frailty and the high prevalence of comorbidities made the elderly more susceptible to severe infection by COVID-19.…”

“…Pneumopathy increased risk to a lesser extent than non-respiratory comorbidities, and only among older people, while asthma not only did not increase risk but was, for some combinations of age strata and symptom groups, unexpectedly a risk-carrying factor. Other authors also found asthma associated with lower ICU admission, COVID-19-related death, or both ( Santos et al, 2021 , Castro et al, 2021 , Álvarez-Maldonado et al, 2021 ). Conversely, smoking increased risks for all outcomes evaluated, as expected.…”

“…Finally, we found evidence of inequality in the distribution of health resources and COVID-19-related death in the year 2020. Individuals who self-declared black/brown and/or had lower education simultaneously had a higher risk of death and lower demand for health resources when compared to self-declared white and highly educated individuals; a frequent finding in population studies with Brazilians ( Santos et al, 2021 , de Andrade et al, 2020 ). Either this shows racism in the health system, which prioritizes resources in the care of white individuals to the detriment of black individuals or, because an imbalance of resources between the private and public health networks.…”

Assessing COVID-19 Vaccine Effectiveness in Frail Long-Term Care Facilities Residents in a Middle-Income Country

“…Inequality was shown as a determinant agent of disparate outcomes in the COVID-19 pandemic. [11][12][13] The suboptimal healthcare provisioning, prevalent in low and middle-income countries, invariably contribute to a heightened prevalence of frail older adults, with a high number and gravity of chronic ailments. 14,15 In this study, we aimed to evaluate the effectiveness of COVID-19 vaccines among frail and socially vulnerable LTCF residents, in a middle-income country.…”

Nanotechnology meets immunology towards a rapid diagnosis solution: the COVID-19 outbreak challenge

“…4,5 In this scenario, Brazil was considered particularly highly vulnerable to the COVID-19 pandemic because all government levels were not integrated, and they have not promptly adopted strict public health restrictions, which was aggravated by its continental dimension and the enormous socioeconomic asymmetry. [6][7][8] Since the very beginning of the SARS-CoV-2 reported cases, it was almost a consensus among health professionals, public authorities, and society that the strategy to ght the pandemic would require different crucial fronts, including (i) social distancing and sanitary actions combined with rapid and early diagnosis of infected individuals to minimize or ideally to avoid the virus dissemination; (ii) intensive research for developing new vaccines preventing the infection through massive vaccination, and (iii) dramatic search for effective treatments for the infected patients to reduce hospitalization and mortality. [9][10][11][12][13][14] In this view, from the strategic diagnosis front against COVID-19, most health facilities rely on polymerase chain reaction (PCR)-based tests based on the amplication of genetic material (i.e., RNA) to detect the virus.…”