Assessing Predictive Factors of COVID-19 Outcomes: A Retrospective Cohort Study in the Metropolitan Region of São Paulo (Brazil).

Juliana Neide Amato,Luciano José Pereira,Paula Midori Castelo,Ferla Maria Simas Bastos Cirino,Fernando Capela E Silva,Guilherme Meyer,Natália Simões Aderaldo,Luís Cláudio Sartori

doi:10.3390/medicina57101068

Abstract

Background and Objectives: The aim of this retrospective cohort study was to search individual, sociodemographic and environmental predictors of COVID-19 outcomes. Materials and Methods: A convenience sample of 1036 COVID-19 confirmed patients (3–99 years, mean 59 years; 482 females) who sought treatment at the emergency units of the public health system of Diadema (Brazil; March–October 2020) was included. Primary data were collected from medical records: sex, age, occupation/education, onset of symptoms, presence of chronic diseases/treatment and outcome (death and non-death). Secondary socioeconomic and environmental data were provided by the Department of Health. Results: The mean time spent between COVID-19 symptom onset and admission to the health system was 7.4 days. Principal component analysis summarized secondary sociodemographic data, and a Poisson regression model showed that the time between symptom onset and health system admission was higher for younger people and those from the least advantaged regions (availability of electricity, a sewage network, a water supply and garbage collection). A multiple logistic regression model showed an association of age (OR = 1.08; 1.05–1.1), diabetes (OR = 1.9; 1.1–3.4) and obesity (OR = 2.9; 1.1–7.6) with death outcome, while hypertension and sex showed no significant association. Conclusion: The identification of vulnerable groups may help the development of health strategies for the prevention and treatment of COVID-19.

Highlights

At the end of 2019, the highly transmittable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China [1]
The virus spread rapidly across the planet, and to date (27 July 2021), the Johns Hopkins Coronavirus Resource Center has reported more than 195,199,879 confirmed cases and 4,175,769 deaths all over the world
The results show that the time between symptom onset and admission to the health system was higher for younger people and those from the least advantaged regions; in addition, a greater likelihood of dying from COVID-19 among older individuals and those with obesity and diabetes was observed

Summary

Introduction

At the end of 2019, the highly transmittable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in Wuhan, China [1]. People from lower socioeconomic groups live in crowded houses, perform work activities that do not allow working from home (increasing contact with co-workers), use public transportation and may not have access to adequate personal protective equipment [8] These people are more susceptible to stress situations at work, burnout syndrome and unemployment, which may reduce immune function and disrupt inflammatory responses [4]. In this context, a simplistic analysis of clinical conditions at the individual level is insufficient to explain health problem outcomes, since social contexts create stratification, differential exposure to harmful conditions and differential vulnerability [9].

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Discussion

Conclusion