Human development, social vulnerability and COVID-19 in Brazil: a study of the social determinants of health

Carlos Dornels Freire De Souza,Rodrigo Feliciano Do Carmo,Michael Ferreira Machado

doi:10.1186/s40249-020-00743-x

Carlos Dornels Freire De Souza, Rodrigo Feliciano Do Carmo + Show 1 more

Open Access

https://doi.org/10.1186/s40249-020-00743-x

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Abstract

BackgroundCoronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. Since then, the disease has spread throughout the country, reaching the poorest areas. This study analyzes the relationship between COVID-19 and the population’s living conditions. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020.MethodsThis is an ecological study evaluating the relationship between COVID-19 incidence, mortality, and case fatality rates and 49 social indicators of human development and social vulnerability. For the analysis, bivariate spatial correlation and multivariate and spatial regression models (spatial lag model and spatial error models) were used, considering a 95% confidence interval and a significance level of 5%.ResultsA total of 44.8% of municipalities registered confirmed cases of COVID-19 and 14.7% had deaths. We observed that 56.2% of municipalities with confirmed cases had very low human development (COVID-19 incidence rate: 59.00/100 000; mortality rate: 36.75/1 000 000), and 52.8% had very high vulnerability (COVID-19 incidence rate: 41.68/100 000; mortality rate: 27.46/1 000 000). The regression model showed 17 indicators associated with transmission of COVID-19 in Brazil.ConclusionsAlthough COVID-19 first arrived in the most developed and least vulnerable municipalities in Brazil, it has already reached locations that are farther from large urban centers, whose populations are exposed to a context of intense social vulnerability. Based on these findings, it is necessary to adopt measures that take local social aspects into account in order to contain the pandemic.

Highlights

Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020
In Brazil, the first case of COVID-19 was confirmed on February 26, 2020, and the first death was confirmed on March 17, in São Paulo, the country’s most populous metropolis, with approximately 12 million inhabitants
Municipalities are classified into the following five strata of vulnerability: very low (SVI 0 to 0.200), low (SVI 0.201 to 3.00), medium (SVI 0.301 to 0.400), high (SVI 0.401 to 0.500) and very High (SVI > 0.501) [9]. Based on this and on the need to understand the relationship between COVID-19 and the population’s living conditions, this study aimed to identify the social determinants of health (SDH) related to the incidence, mortality, and case fatality rates of COVID-19 in Brazil, in 2020

Summary

Introduction

Coronavirus disease 2019 (COVID-19) was confirmed in Brazil in February 2020. We aimed to identify social determinants related to the incidence, mortality, and case fatality rate of COVID-19 in Brazil, in 2020. As of April 11, 2020, there were more than 4.1 million cases and 284 000 deaths due to the disease worldwide [3]. The countries with the highest number of cases are the USA (1 300 000), Spain (224 000), and the United Kingdom (224 000). The USA (79 000), the United Kingdom (32 000), and Italy (30 000) have the highest numbers [3]. In Brazil, the first case of COVID-19 was confirmed on February 26, 2020, and the first death was confirmed on March 17, in São Paulo, the country’s most populous metropolis, with approximately 12 million inhabitants

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