Dissemination of COVID-19 in inland cities of Northeastern Brazil

Assis, Sanderson José Costa de; Lopes, Johnnatas Mikael; Filho, Bartolomeu Fagundes de Lima; Sanchis, Gerônimo José Bouzas; Guedes, Thais Sousa Rodrigues; Cavalcanti, Rafael Limeira; Araújo, Daline Fernandes de Souza; Sarmento, António; Guedes, Marcello Barbosa Otoni Gonçalves; Oliveira, Ângelo Giuseppe Roncalli da Costa

doi:10.1371/journal.pone.0253171

Cited by 3 publications

(2 citation statements)

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“…In addition, an Italian study encompassing 20 Italian regions in an ecological study and a study containing 189 countries reported a positive correlation between HDI and the COVID-19 death rate [22,44]. Previous Brazilian studies reported the HDI to be significantly associated with cumulative COVID-19 cases and faster dissemination of the virus; that is, the higher the HDI, the more cases were reported and in a shorter period [8,45]. Interestingly, one Brazilian study, which evaluated the cities from the Ceará state, also observed a positive correlation between HDI and the incidence of COVID-19, which is maybe related to worse sanitary conditions and the fact that Fortaleza, the capital of Ceará state, is a hub that attracts tourism, mainly from Europe, which could, ultimately, have enhanced the dissemination of SARS-CoV-2 [14,46].…”

Section: Discussionmentioning

confidence: 94%

“…Although one of the most important sociodemographic indexes, the HDI, solely, cannot deeply analyze a country's response to COVID-19 due to its simplicity. Thus, jointly analyzing other socio, economic, and demographic indexes, such as the GINI index and the number of intensive care units (ICU) beds, which were already linked to COVID-19 in previous studies [8,9], is essential. Living conditions can also play a key role as a risk factor for COVID-19 since poor infrastructure and overcrowding, such as that observed in slums, can enhance SARS-CoV-2 dissemination [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Human Development Index Is Associated with COVID-19 Case Fatality Rate in Brazil: An Ecological Study

Palamim

Boschiero

Valencise

et al. 2022

IJERPH

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The Human Development Index measures a region’s development and is a step for development debate beyond the traditional, economic perspective. It can also determine the success of a country’s response to the COVID-19 pandemic, mainly affecting the case fatality rate among severe cases of SARS-CoV-2 infection. We aimed to associate the Human Development Index with the case fatality rate due to COVID-19 in each Brazilian state and the Federal District, taking into account comorbidities and the need for invasive mechanical ventilation. We also evaluated the influence of the GINI index, number of intensive care unit beds, and occupied households in subnormal clusters on the case fatality rate. We performed an ecological study including two populations: COVID-19 individuals that did not require the mechanical ventilation protocol; and COVID-19 individuals under invasive mechanical ventilation. We performed a Pearson correlation test and a univariate linear regression analysis on the relationship between Human Development Index, Human Development Index—Education Level, Human Development Index—Life Expectancy, and Human Development Index—Gross National Income per capita and COVID-19 deaths. The same analyses were performed using the other markers. We grouped the patients with COVID-19 according to comorbidities and the need for invasive mechanical ventilation. Alpha = 0.05. We included 848,501 COVID-19 individuals, out of which 153,710 needed invasive mechanical ventilation and 314,164 died, and 280,533 COVID-19 individuals without comorbidity, out of which 33,312 needed invasive mechanical ventilation and 73,723 died. We observed a low negative Pearson correlation between the Human Development Index and death and a moderate negative Pearson correlation between the Human Development Index and deaths of individuals on invasive mechanical ventilation, with or without comorbidity. The univariate linear analysis showed the case fatality rate depends on at least 20–40% of the Human Development Index. In Brazil, regions with a low Human Development Index demonstrated a higher case fatality rate due to COVID-19, mainly in individuals who needed invasive mechanical ventilation, than regions with a higher Human Development Index. Although other indexes studied, such as intensive care unit beds and GINI, were also associated with the COVID-19 case fatality rate, they were not as relevant as the Human Development Index. Brazil is a vast territory comprising cultural, social, and economic diversity, which mirrors the diversity of the Human Development Index. Brazil is a model nation for the study of the Human Development Index’s influence on aspects of the COVID-19 pandemic, such as its impact on the case fatality rate.

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