Social determinants of health and COVID-19 infection in Brazil: an analysis of the pandemic.

Figueiredo, Alexandre Medeiros de; Figueiredo, Daniela Cristina Moreira Marculino de; Gomes, Luciano Bezerra; Massuda, Adriano; Gil-García, Eugenia; Vianna, Rodrigo Pinheiro de Toledo; Daponte, Antonio

OBJECTIVE To analyze the influence of socioeconomic, demographic, epidemiological factors, and the health system structure in the evolution of the COVID-19 pandemic in Brazil. METHODS Ecological study with variables extracted from databases, having the incidence and mortality by COVID-19 until August 23, 2020, in Brazilian states, as response variables. The magnitude of the associations was estimated using Spearman's correlation coefficient and multiple regression analysis. RESULTS In the Brazilian states, 59.8% of variation in the incidence of COVID-19 was justified by income inequality, significant home densification, and higher mortality. In the case of mortality, those same variables explained 57.9% of the country's variations in federal units. CONCLUSION Our results indicate that socioeconomic factors influenced the evolution and impact of COVID-19 in Brazil. Thus, we suggest comprehensive actions to ensure economic conditions and strengthening of health networks for populations with socioeconomic vulnerability.