P. O. Baqui|Ioana Bica|Valerio Marra|Ari Ercole|Mihaela van der Schaar
Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study
Universidade Federal do Espírito Santo|The Alan Turing Institute|University of Oxford|Universidade Federal do Espírito Santo|University of Cambridge|University of California, Los Angeles|University of Cambridge|The Alan Turing Institute
brazil ranks second worldwide total number covid19 cases deaths understanding possible socioeconomic ethnic health inequities particularly important given diverse population fragile political economic situation aimed characterise covid19 pandemic brazil assess variations mortality according region ethnicity comorbidities symptomswe conducted crosssectional observational study covid19 hospital mortality using data sivepgripe sistema de informao de vigilncia epidemiolgica da gripe dataset characterise covid19 pandemic brazil study included hospitalised patients positive rtpcr test severe acute respiratory syndrome coronavirus 2 ethnicity information dataset ethnicity participants classified according five categories used brazilian institute geography statistics branco white preto black amarelo east asian indgeno indigenous pardo mixed ethnicity assessed regional variations patients covid19 admitted hospital state two socioeconomically grouped regions north centralsouth used mixedeffects cox regression survival analysis estimate effects ethnicity comorbidity individual level context regional variationof 99 557 patients sivepgripe dataset included 11 321 patients study 9278 820 patients centralsouth region 2043 180 north region compared white brazilians pardo black brazilians covid19 admitted hospital significantly higher risk mortality hazard ratio hr 145 95 ci 133158 pardo brazilians 132 115152 black brazilians pardo ethnicity second important risk factor age death comorbidities common brazilians admitted hospital north region centralsouth similar proportions various ethnic groups states north higher hrs compared centralsouth except rio de janeiro much higher hr centralsouth stateswe found evidence two distinct associated effects increased mortality north region regional effect pardo black populations ethnicity effect speculate regional effect driven increasing comorbidity burden regions lower levels socioeconomic development ethnicity effect might related differences susceptibility covid19 access health care including intensive care across ethnicities analysis supports urgent effort part brazilian authorities consider national response covid19 better protect pardo black brazilians well population poorer states higher risk dying covid19none