Examining socio-economic factors to understand the hospital case fatality rates of COVID-19 in the city of Sao Paulo, Brazil.
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ABSTRACT: Background
Understanding differences in hospital case fatality rates (HCFRs) of coronavirus disease 2019 (COVID-19) may help evaluate its severity and the capacity of the healthcare system to reduce mortality.Methods
We examined the variability in HCFRs of COVID-19 in relation to spatial inequalities in socio-economic factors, hospital health sector and patient medical condition across the city of São Paulo, Brazil. We obtained the standardized hospital case fatality ratio adjusted indirectly by age and sex, which is the ratio between the HCFR of a specific spatial unit and the HCFR for the entire study area. We modelled it using a generalized linear mixed model with spatial random effects in a Bayesian context.Results
We found that HCFRs were higher for men and for individuals ≥60 y of age. Our models identified per capita income as a significant factor that is negatively associated with the HCFRs of COVID-19, even after adjusting for age, sex and presence of risk factors.Conclusions
Spatial analyses of the implementation of these methods and of disparities in COVID-19 outcomes may help in the development of policies for at-risk populations in geographically defined areas.
SUBMITTER: Lorenz C
PROVIDER: S-EPMC8499984 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundHeterogeneity in COVID-19 morbidity and mortality is often associated with a country's health-services structure and social inequality. This study aimed to characterize social inequalities in COVID-19 mortality in São Paulo, the most populous city in Brazil and Latin America.MethodsWe conducted a population-based study, including COVID-19 deaths among São Paulo residents from March to September 2020. Age-standardized mortality rates and unadjusted rate ratios (RRs) [with corresponding 95% confidence intervals (CIs)] were estimated by race, sex, age group, district of residence, household crowding, educational attainment, income level and percentage of households in subnormal areas in each district. Time trends in mortality were assessed using the Joinpoint model.ResultsMales presented an 84% increase in COVID-19 mortality compared with females (RR = 1.84, 95% CI 1.79-1.90). Higher mortality rates were observed for Blacks (RR = 1.77, 95% CI 1.67-1.88) and mixed (RR = 1.42, 95% CI 1.37-1.47) compared with Whites, whereas lower mortality was noted for Asians (RR = 0.63, 95% CI 0.58-0.68). A positive gradient was found for all socio-economic indicators, i.e. increases in disparities denoted by less education, more household crowding, lower income and a higher concentration of subnormal areas were associated with higher mortality rates. A decrease in mortality over time was observed in all racial groups, but it started earlier among Whites and Asians.ConclusionOur results reveal striking social inequalities in COVID-19 mortality in São Paulo, exposing structural inequities in Brazilian society that were not addressed by the governmental response to COVID-19. Without an equitable response, COVID-19 will further exacerbate current social inequalities in São Paulo.
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Project description:BACKGROUND: Over the last century the incidence of cutaneous melanoma has increased worldwide, a trend that has also been observed in Brazil. The identified risk factors for melanoma include the pattern of sun exposure, family history, and certain phenotypic features. In addition, the incidence of melanoma might be influenced by ethnicity. Like many countries, Brazil has high immigration rates and consequently a heterogeneous population. However, Brazil is unique among such countries in that the ethnic heterogeneity of its population is primarily attributable to admixture. This study aimed to evaluate the contribution of European ethnicity to the risk of cutaneous melanoma in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: We carried out a hospital-based case-control study in the metropolitan area of Sao Paulo, Brazil. We evaluated 424 hospitalized patients (202 melanoma patients and 222 control patients) regarding phenotypic features, sun exposure, and number of grandparents born in Europe. Through multivariate logistic regression analysis, we found the following variables to be independently associated with melanoma: grandparents born in Europe-Spain (OR = 3.01, 95% CI: 1.03-8.77), Italy (OR = 3.47, 95% CI: 1.41-8.57), a Germanic/Slavic country (OR = 3.06, 95% CI: 1.05-8.93), or ≥ 2 European countries (OR = 2.82, 95% CI: 1.06-7.47); eye color-light brown (OR = 1.99, 95% CI: 1.14-3.84) and green/blue (OR = 4.62; 95% CI 2.22-9.58); pigmented lesion removal (OR = 3.78; 95% CI: 2.21-6.49); no lifetime sunscreen use (OR = 3.08; 95% CI: 1.03-9.22); and lifetime severe sunburn (OR = 1.81; 95% CI: 1.03-3.19). CONCLUSIONS: Our results indicate that European ancestry is a risk factor for cutaneous melanoma. Such risk appears to be related not only to skin type, eye color, and tanning capacity but also to others specific characteristics of European populations introduced in the New World by European immigrants.
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Project description:Seroprevalence of Toxoplasma gondii has been extensively studied in a variety of different human populations. However, no study has focused on homeless populations. Accordingly, the present study aimed to assess the seroprevalence of anti-T. gondii antibodies and the risk factors associated in homeless persons from homeless shelter of São Paulo city, southeastern Brazil. In addition, anti-HIV antibodies and associated risk of T. gondii and HIV coinfection have been evaluated. Anti-T. gondii antibodies were detected by indirect fluorescent antibody test. In addition, anti-HIV levels were tested by chemiluminescence enzyme immunoassay, with positive samples confirmed by rapid immunoblot assay. Overall, IgG anti-T. gondii seropositivity was found in 43/120 (35.8%) homeless persons, with endpoint titers varying from 16 to 1,024. The only two pregnant women tested were negative for IgM by chemiluminescence enzyme immunoassay, with normal parturition and clinically healthy newborns in both cases. There were no statistical differences in the risk factors for anti-T. gondii serology (p > 0.05). Anti-HIV seropositivity was found in 2/120 (1.7%) homeless persons, confirmed as HIV-1. One HIV seropositive individual was also sero-reactive to IgG anti-T. gondii, and both were negative to IgM anti-T. gondii. This is the first study that reports the serosurvey of T. gondii in homeless persons worldwide. Despite the limited sample size available in the present study, our findings have shown that the prevalence of anti-T. gondii antibodies in homeless persons herein was lower than the general population, probably due to homeless diet habit of eating mainly processed food intake. No statistical differences were found regarding risk factors for anti-T. gondii exposure in homeless persons. Future studies should be conducted to fully establish risk factors for anti-T. gondii exposure in homeless persons.
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Project description:Reinfection by the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) has been reported in many countries, suggesting that the virus may continue to circulate among humans despite the possibility of local herd immunity due to massive previous infections. The emergence of variants of concern (VOC) that are more transmissible than the previous circulating ones has raised particular concerns on the vaccines effectiveness and reinfection rates. The P.1 lineage was first identified in December 2020 in Manaus city and is now globally spread. We report the first case of reinfection of SARS-CoV-2 caused by the P.1 variant outside of Manaus. The potential of these new variants to escape naturally and vaccine- induced immunity highlights the need for a global vigilance.
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Project description:This paper presents the characterization of municipal solid waste (MSW) randomly collected from two material recovery facilities in São Paulo city, before (input - recyclables) and after (output - rejects) the sorting processes. Geo-environmental and geotechnical tests were performed on shredded samples and a digestion method was applied to detect the metals As, Cd, Cr, Cu, Fe, Mn, Ni, Pb, and Zn concentrations using an ICP OES. The objective was to assist future activities of integrated solid waste management and soil pollution. Results showed different particle sizes comparing the input (44.6%) and the output MSW (75.1%) passing through the 100-mm sieve. Organic matter and ash contents indicated the influence of inorganic carbon due to the plastics' presence, with values varying between 6 and 13%. The pH values obtained were neutral and the electrical conductivity of the MSW rejects suggested a higher amount of ions, with values above 1000 µS/cm. Metals analyses show that Cd, Cu, Ni, Pb, and Zn are present in high concentrations, depending on the types of the materials. Standard Proctor compaction curves yielded maximum dry unit weight varying from 6.6 to 10.0 kN/m3 and optimum moisture contents from 20 to 42%. Cohesion ranged from 1.3 to 31.3 kPa and friction angle from 3.2 to 42.9°. The results are comparable with those obtained for other countries using different MSW treatments and contribute to the data basis for MSW from the selective collection, aiming the integrated solid waste management, serving for other countries that adopt MSW sorting and recycling.
| S-EPMC8794613 | biostudies-literature
Project description:BackgroundTo investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic.MethodsEcological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method.ResultsCOVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years.ConclusionThere was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.
| S-EPMC8184000 | biostudies-literature