Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil

Peres, Igor Tona; Bastos, Leonardo dos Santos Lourenço; Mayrinck Gelli, João Gabriel; Marchesi, Janaina Figueira; Dantas, Leila Figueiredo; Antunes, Bianca Brandão de Paula; Maçaira, Paula Medina; Baião, Fernanda Araújo; Hamacher, Silvio; Bozza, Fernando Augusto

Objectives – The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial/ethnic disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. Study design – A retrospective analysis was conducted of COVID-19 quantitative reverse transcription polymerase chain reaction (RT-qPCR)-confirmed adult hospitalised patients with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between 16 February and 8 August 2020. Methods – Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of COVID-19 adult hospitalised patients, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities using a logistic regression model, was evaluated. Results – During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. Total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less-frequently to the intensive care unit (ICU) [32% vs 36%] and used more invasive mechanical ventilation (21% vs 19%), especially outside the ICU (17% vs 11%). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio 1.15; 95% confidence interval 1.09–1.22). Conclusions – In Brazilian COVID-19 hospitalised adults, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial/ethnic disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.