Covid lethality is 30% higher in poorer municipalities, study shows

Poorer Brazilian municipalities had a 30% higher lethality during the Covid-19 pandemic compared to richer cities, with higher GDP per capita (42.6% versus 31.8%, respectively).

This is what a study reveals that analyzed about 3 million cases of SARS (Severe Acute Respiratory Syndrome) of people who were hospitalized and who died between 2020 and 2021 – of these, 1.9 million with a confirmed diagnosis of Covid. The work was published in the journal Preventive Medicine.

Other research had already detected socioeconomic inequalities in the distribution of Covid deaths in some municipalities at the beginning of the pandemic, but the work is the first to assess two years of the health crisis, with all deaths occurring in the period in the 5,570 municipalities.

By investigating these deaths according to the GDP (Gross Domestic Product) per capita of each municipality, researchers from UFSC (Federal University of Santa Catarina), Harvard and two universities in São Paulo (Santa Casa and Unesp) also identified inequalities in carrying out diagnostic tests and hospital care.

For example, the poorest municipalities had a three times greater proportion of patients with SARS without collection of biological material for the diagnosis of Covid compared to the richest municipalities (8.8% versus 2.9%). They also had less access to computed tomography to assess pulmonary involvement (2.4% versus 1%).

According to epidemiologist Antonio Fernando Boing, lead author of the study and professor at UFSC, one of the explanations for the socioeconomic disparities in deaths from Covid was the lack of access, at the right time, to quality health services.

He explains that wealthier municipalities tend to have, on average, more health professionals hired and a more structured service network, with patient flows established at all levels of care (primary, secondary and high complexity hospitals)

“There are studies showing that lethality tends to be higher in hospitals where new teams have been formed. Municipalities that had to seek out professionals to build their networks, in addition to taking longer, did not have teams with as much experience.”

In addition, Boing points out that the lower purchasing capacity of the poorest municipalities, such as supplies and hiring personnel, also had an impact on testing for Covid.

“Having a test in a timely manner allows you to provide more planned assistance and that the municipality’s surveillance can also act to prevent further spread of the virus.”

For him, the absence of national coordination and, in many cases, state coordination, which did not help in the organization of assistance in the municipalities, also generated disparities. “Each one had to make do. And then whoever had the greatest purchasing power and lobbying did better.”

According to the researcher, the burden of chronic diseases also tends to be greater in the populations of poorer municipalities, which contributes to a worse outcome of cases.

In general, in these municipalities, housing conditions are more precarious, with a greater agglomeration of people per household, which facilitates the transmission of the virus, in addition to the fact that many of the residents were unable to work remotely.

According to the researcher, the country cannot continue to ignore inequalities that were already present long before the Covid pandemic. “You cannot arrive after two years, as this study did, and verify: how unequal we are! How lethality was worse in the most fragile municipalities!”

For the epidemiologist, it is necessary to implement in routine surveillance services a monitoring of inequalities between population groups and between regions not only to reduce deaths from Covid but from any other preventable cause.

“Our homework is to monitor in order to act. Such injustice is avoidable. There should have been no excess mortality in the most vulnerable groups. Many lives could have been saved if we had been monitoring inequalities.”

These disparities are also being discussed in other countries. Analyzes carried out in the United States, Europe, Asia and Africa between 2020 and 2021 confirmed the existence of strong inequality, with worse outcomes from Covid-19 among populations with poor socioeconomic indicators.

Some studies characterize Covid-19 as a syndemic, that is, a product of the interaction between pre-existing clinical conditions and social, economic and political factors.

How is municipal GDP per capita calculated?

Brazil is divided into 27 federative units and 5,570 municipalities. For each of them, IBGE (Brazilian Institute of Geography and Statistics) calculated the GDP and resident population for 2018 in partnership with state statistical agencies, state government departments and the Superintendence of the Manaus Free Trade Zone.

The values, estimated in reais, were divided into deciles (from 1 to 10) according to their distribution. Sivep-Gripe records the patients’ municipalities of residence using the same codes, standardized by the IBGE for the entire national territory, allowing the linking of the databases.