Spatiotemporal Pattern of COVID-19–Related Mortality during the First Year of the Pandemic in Brazil: A Population-based Study in a Region of High Social Vulnerability

Abstract

Currently, the world is facing a severe pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although the WHO has recommended preventive measures to limit its spread, Brazil has neglected most of these recommendations, and consequently, our country has the second largest number of deaths from COVID-19 worldwide. In addition, recent studies have shown the relationship between socioeconomic inequalities and the risk of severe COVID-19 infection. Herein, we aimed to assess the spatiotemporal distribution of mortality and lethality rates of COVID-19 in a region of high social vulnerability in Brazil (Northeast region) during the first year of the pandemic. A segmented log-linear regression model was applied to assess temporal trends of mortality and case fatality rate (CFR) and according to the social vulnerability index (SVI). The Local Empirical Bayesian Estimator and Global Moran Index were used for spatial analysis. We conducted a retrospective space–time scan to map clusters at high risk of death from COVID-19. A total of 66,358 COVID-19–related deaths were reported during this period. The mortality rate was 116.2/100,000 inhabitants, and the CFR was 2.3%. Nevertheless, CFR was > 7.5% in 27 municipalities (1.5%). We observed an increasing trend of deaths in this region (AMCP = 18.2; P = 0.001). Also, increasing trends were observed in municipalities with high (N = 859) and very high SVI (N = 587). We identified two significant spatiotemporal clusters of deaths by COVID-19 in this Brazilian region (P = 0.001), and most high-risk municipalities were on the coastal strip of the region. Taken together, our analyses demonstrate that the pandemic has been responsible for several deaths in Northeast Brazil, with clusters at high risk of mortality mainly in municipalities on the coastline and those with high SVI.

COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities

“…91% (86 of 95) of the studies 20 , 21 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , ...…”

“…In Brazil, positive associations were found between social disadvantage and COVID-19 mortality rates in all 12 studies conducted at different timepoints. 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 126 For example, de Souza and colleagues 97 (up to May 6, 2020) and Silva and Ribeiro-Alves 101 (up to May 23, 2020) found that people living in high-income areas were more at risk of COVID-19 infection, but those living in more deprived areas had higher death rates. Studies from Chile, 104 Columbia, 105 and Mexico 106 , 107 all observed positive associations between indicators of social disadvantage and COVID-19 mortality rates.…”

The COVID-19 Mortality Rate Is Associated with Illiteracy, Age, and Air Pollution in Urban Neighborhoods: A Spatiotemporal Cross-Sectional Analysis

“…Similar temporal groupings during that era have been observed in previous studies, for example, in Brazil [ 102 ]. Iran has previously dealt with a variety of diseases, but COVID-19 stunned the system with its severity, rapid spread, and pathological consequences [ 103 ]. COVID-19 vaccination did not begin until late February 2021.…”

Factors associated with deaths from COVID-19 in a region of northeastern Brazil

“…Regarding the study's limitations, it was not possible to investigate the association between some variables such as education and main associated symptoms and the outcome of death from COVID-19 due to the unavailability of some information in the database used in our study. Another relevant limitation is the possibility of underreported cases and deaths, an issue reported in prior studies in Brazil [4,66], the European continent, and South Africa [67]. Mortality information is crucial in understanding the spread of COVID-19.…”