In-Hospital Mortality in Patients With COVID-19 Associated with the Spread of SARS-CoV-2 Variant of Concern P.1 (Gamma) in Belo Horizonte and Metropolitan Region: A Non-Concurrent Cohort Study

Abstract

Background: Little has been published about the burden of VOC Gamma introduction and spread at regional levels in Brazil, how it evolved, and patient- and community-level risk factors for mortality.Methods: A historical cohort study was conducted to analyze the course of covid-19 in BH-RM between 03/13/2020 and 09/09/2021, split into three distinct surges. Risk factors for in-hospital mortality were assessed at the patient and municipality levels.Findings: Crude in-hospital mortality rates were 31%, 32·1% and 35·3% in first, second, and third surge (from 02/15/2021 onwards), respectively. Third surge had a higher proportion of patients of brown race, male, aged Interpretation: In BH-RM, spread of VOC Gamma in early/mid 2021 caused a sudden rise in covid-19 cases associated with increased adjusted hospital mortality, mainly in nonelderly patients, together with a clinical and demographic shift. Hospital mortality was driven by patient factors, and by disparities in ecological (municipality-level) features, and access to healthcare.Funding Information: There was no funding for this study.Declaration of Interests: All authors are employees of Unimed-Belo Horizonte, which is the sole medical cooperative that administers hospitals in Belo Horizonte and Metropolitan Region.Ethics Approval Statement: Because all data sources used in this research are publicly available databases with unidentified data at the individual level, and following Brazilian legislation about the subject,18 this research did not involve assessment by an independent research ethics review board.