Abstract
We investigated the predictors of delay in the diagnosis and mortality of patients with COVID-19 in Rio de Janeiro, Brazil. A cohort of 3,656 patients were evaluated (Feb-Apr 2020) and patients' sociodemographic characteristics, and social development index (SDI) were used as determinant factors of diagnosis delays and mortality. Kaplan-Meier survival analyses, time-dependent Cox regression models, and multivariate logistic regression analyses were conducted. The median time from symptoms onset to diagnosis was eight days (interquartile range [IQR] 7.23-8.99 days). Half of the patients recovered during the evaluated period, and 8.3% died. Mortality rates were higher in men. Delays in diagnosis were associated with male gender (p = 0.015) and patients living in low SDI areas (p < 0.001). The age groups statistically associated with death were: 70-79 years, 80-89 years, and 90-99 years. Delays to diagnosis greater than eight days were also risk factors for death. Delays in diagnosis and risk factors for death from COVID-19 were associated with male gender, age under 60 years, and patients living in regions with lower SDI. Delays superior to eight days to diagnosis increased mortality rates.
Highlights
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China at the end of 2019 has caused a sizeable global outbreak
Considering the current pandemic situation worldwide with an important emphasis on underdeveloped regions, our aim was to investigate the risk factors associated of delay in the diagnosis and mortality of patients with COVID-19 in Rio de Janeiro, Brazil
Young patients aged 10-19 years (18.3 days [interquartile range (IQR), 15.6-20.9]), 20-29 years (13.5 days [IQR, 11.2-15.8]), 30-39 years (12.3 days [IQR, 10.6-14.0]), had longer median times until diagnosis than patients of advanced age between 40-49 years (7.0 days [IQR, 6.0-7.9]), 50-59 years (6.0 days [IQR, 4.9-4.9]), 60-69 years old (6.0 days [95% confidence interval (CI), 4.9-7.0]), 70-79 years old (6.0 days [IQR, 4.8-7.1]), 80-89 years (4.0 days [IQR, 1.4-6.5]) and 90-99 years (2.0 days [IQR, 1.0-5.2])
Summary
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China at the end of 2019 has caused a sizeable global outbreak It is a major public health issue responsible for more than 603,697 deaths and more than five million infected people worldwide[1]. The first case of this disease, called COVID-19, in South America, was from a 61-year-old Brazilian diagnosed at the Albert Einstein Hospital in São Paulo (Brazil) after returning from a trip to northern Italy in February 20202,3 Since this episode, more than 2,098,389 cases and 79,488 deaths have been confirmed in Brazil, framing the country in a public health state of emergency of international interest, according to the World Health Organization (WHO)[1]. Studies demonstrated that the virus is detectable for some time on smooth surfaces, aerosols, and feces[4]
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