Mortality Predictors for 221,414 COVID-19 Cases: The Role of Socio-Demographic Factors, Symptoms, and Comorbidities in a Brazilian State-Wide Landscape

Abstract

Background: Brazil is facing a surge in COVID-19 infection, with heterogeneous regional spread associated with varying infection and death rates across the country’s states. This study aimed to thoroughly analyze the association of death with demographic characteristics, symptoms, and comorbidities at three levels of COVID-19 severity—in non-hospitalized, non-ICU-ward, and ICU-ward patients—in a state-wide context in South Brazil.Methods: We selected 221,414 cases in the state of Paraná diagnosed by positive RT-PCR tests, defining outcome based on electronic medical records including demographic characteristics (sex, age, HDI), description of symptoms (114,025 cases with at least one symptom—SY group), and comorbidities (116,229 cases with at least one comorbidity—CM group). Logistic regression was performed to test the association between deaths with demographic characteristics and categorical variables in three levels of medical intervention within the SY and CM groups.Findings: Registered ICU deaths ranged between 68·62% (SY) and 69·6% (CM). Males presented increased mortality among non-hospitalized patients (SY: OR=1·81, 95% CI=1·51–2·17; CM: OR=1.97, 95% CI=1·66–2·34) and non-ICU patients (SY: OR=1·24, 95% CI=1·07–1·45; CM: OR=1·35, 95% CI=1·15–1·57). Lower human development index (HDI) was associated with increased mortality in non-hospitalized patients (SY: OR=0·01, 95% CI=0·02–0·08, CM: OR=0·02, 95% CI=0·01– 0·11). A higher mortality rate occurred in patients older than 40 years (non-hospitalized OR=25·65, 95% CI=8·17–155·36, non-ICU OR=5·05, 95% CI=1·87–20·75, and ICU OR=3·91, 95% CI=1·27–14·58), with strong association in elderly SY and CM adults. The main symptoms associated with increased mortality were dyspnoea in non-hospitalized (OR=3·71, 95% CI=3·10–4·44), non-ICU (OR=2·47, 95% CI=2·11–2·90), and ICU patients (OR=1·43, 95% CI=1·16–1·77). In all patients, diabetes, heart, neurological, and kidney diseases were associated with death (e.g., in non-hospitalized patients: OR=2·12, 95% CI=1·72–2·60; OR=1·84, 95% CI=1·47–2·29; OR=2·18, 95% CI=1·46–3·17 OR=2·00, 95% CI=1·20–3·19, respectively).Interpretation: The demographic characteristics “male sex” and “age > 40 years” were unequivocally associated with death and with lower HDI in non-hospitalized patients. Other categorical variables—dyspnoea, diabetes, heart disease, neurological disease, and kidney disease—were associated with most patients’ mortality. Our study highlights the importance of these predictors for the implementation of public healthcare policy in response to the pandemic.Funding: Araucária Foundation – FAAP-PR, State Secretariat of Science, Technology and Higher Education – SETI –PR. ABWB currently receives a research productivity scholarship from CNPq (314288/2018-0).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The study received the ethical approval number CAAE 39108020.0.0000.0107, registered on the Plataforma Brasil – Comissão Nacional de Ética em Pesquisa database (https://plataformabrasil.saude.gov.br).