Spatial-temporal distribution of incidence, mortality, and case-fatality ratios of coronavirus disease 2019 and its social determinants in Brazilian municipalities

Abstract

The COVID-19 pandemic caused impact on public health worldwide. Brazil gained prominence during the pandemic due to the magnitude of disease. This study aimed to evaluate the spatial-temporal dynamics of incidence, mortality, and case fatality of COVID-19 and its associations with social determinants in Brazilian municipalities and epidemiological week. We modelled incidence, mortality, and case fatality rates using spatial-temporal Bayesian model. The rates were standardised using the indirect method. “Bolsa Família Programme” (BOLSAFAM) and “proportional mortality ratio” (PMR) were inversely associated with the standardised incidence ratio (SIR), while “health insurance coverage” (HEALTHINSUR) and “Gini index” were directly associated with the SIR. BOLSAFAM and PMR were inversely associated with the standardised mortality ratio (SMR) and standardised case fatality ratio (SCFR), while HEALTHINSUR and “proportion of black and pardo population” were directly associated with the SMR and SCFR. The highest proportion of excess risk for SIR and the SMR started in the North, expanding to the Midwest, Southeast, and South regions. However, this excess risk was detected predominantly in the North region in all periods. The highest proportion of excess risk for the SCFR outcome was observed in some municipalities in the North region and in the other Brazilian regions. The COVID-19 incidence and mortality in municipalities that most benefited from the cash transfer programme and with better social development decreased. The municipalities with a higher proportion of non-white people were at greater risk of having their population becoming ill and dying from the disease.