High Socioeconomic Vulnerability Research Articles

Integrating social, climate and environmental changes to confront accelerating global aging

IntroductionThe global increase in the aging population presents critical challenges for healthcare systems, social security, and economic stability worldwide. Although the studies of the global rate of aging have increased more than four times in the past two decades, few studies have integrated the potential combined effects of socio-economic, climatic, and environmental factors.MethodsWe calculated the geographic heterogeneity of aging population growth rates from 218 countries between 1960 and 2022. Public databases were then integrated to assess the impacts of seven global stressors: socio-economic vulnerability, temperature, drought, seasonality, climate extremes, air pollution, and greening vulnerability on growth rates of aging population (a totally 156 countries). Linear regression models were primarily used to test the statistically significant effects of these stressors on the rate of aging, and multiple model inference was then used to test whether the number of stressors exceeding specific thresholds (e.g., > 25, 50, and 75%) was consistently significant in the best models. The importance of stressors and the number of stressors exceeding thresholds was verified using random forest models for countries experiencing different population aging rates.ResultsOur analysis identified significant heterogeneity in growth rates of aging population globally, with many African countries exhibiting significantly lower aging rates compared with Europe. High socio-economic vulnerability, increased climate risks (such as high temperature and intensive extreme climate), and decreased environmental quality were found to significantly increase growth rates of the aging population (P < 0.05). The positive combined impacts of these stressors were diminished at medium–high levels of stressors (i.e., relative to their maximum levels observed in nature). The number of global stressors exceeding the 25% threshold emerged as an important predictor of global aging rates. Demographic changes in regions with relatively rapid aging (e.g., Africa and Asia) are more sensitive to climate change (e.g., extreme climate and drought) and the number of global stressors, and regions with low to medium rates of aging (e.g., Europe and the Americas) are more sensitive to socio-economic vulnerability and environmental stability (e.g., drought, green fragility and air pollution).ConclusionsOur findings underscore that policy tools or methods must be developed that consider the holistic dimension of the global factor. Further investigations are essential to understand the complex interactions between multiple stressors and their combined effects on global aging.

Towards a global impact-based forecasting model for tropical cyclones

Abstract. Tropical cyclones (TCs) produce strong winds and heavy rains accompanied by consecutive events such as landslides and storm surges, resulting in losses of lives and livelihoods, particularly in regions with high socioeconomic vulnerability. To proactively mitigate the impacts of TCs, humanitarian actors implement anticipatory action. In this work, we build upon such an existing anticipatory action for the Philippines, which uses an impact-based forecasting model for housing damage based on eXtreme Gradient Boosting (XGBoost) to release funding and trigger early action. We improve it in three ways. First, we perform a correlation and selection analysis to understand if Philippines-specific features can be left out or replaced with features from open global data sources. Secondly, we transform the target variable (percentage of completely damaged houses) and not yet grid-based global features to a 0.1∘ grid resolution by de-aggregation using Google Open Buildings data. Thirdly, we evaluate XGBoost regression models using different combinations of global and local features at grid and municipality spatial levels. We first introduce a two-stage model to predict if the damage is above 10 % and then use a regression model trained on all or only high-damage data. All experiments use data from 39 typhoons that impacted the Philippines between 2006–2020. Due to the scarcity and skewness of the training data, specific attention is paid to data stratification, sampling, and validation techniques. We demonstrate that employing only the global features does not significantly influence model performance. Despite excluding local data on physical vulnerability and storm surge susceptibility, the two-stage model improves upon the municipality-based model with local features. When applied to anticipatory action, our two-stage model would show a higher true-positive rate, a lower false-negative rate, and an improved false-positive rate, implying that fewer resources would be wasted in anticipatory action. We conclude that relying on globally available data sources and working at the grid level holds the potential to render a machine-learning-based impact model generalizable and transferable to locations outside of the Philippines impacted by TCs. Also, a grid-based model increases the resolution of the predictions, which may allow for a more targeted implementation of anticipatory action. However, it should be noted that an impact-based forecasting model can only be as good as the forecast skill of the TC forecast that goes into it. Future research will focus on replicating and testing the approach in other TC-prone countries. Ultimately, a transferable model will facilitate the scaling up of anticipatory action for TCs.

Performance of two rapid antigen tests against SARS-CoV-2 in neighborhoods of socioeconomic vulnerability from a middle-income country.

As new and improved antigen-detecting rapid diagnostic tests for SARS-CoV-2 infection (Ag-RDT) continue to be developed, assessing their diagnostic performance is necessary to increase test options with accurate and rapid diagnostic capacity especially in resource-constrained settings. This study aimed to assess the performance of two Ag-RDTs in a population-based study. We conducted a diagnostic accuracy study in neighborhoods with high socioeconomic vulnerability in Salvador-Brazil, including individuals aged ≥12 years old who attended primary health services, between July and December 2022, with COVID-19 symptoms or who had been in contact with a confirmed case. Two Ag-RDTs were compared in parallel using reverse transcription polymerase chain reaction (RT-PCR) as reference standard, the PanbioTM COVID-19 Ag test (Abbott®) and Immuno-Rapid COVID-19 Ag (WAMA Diagnostic®). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. For the Abbott test the sensitivity was 52.7% (95% CI: 44.3% - 61.0%), specificity 100% (95% CI: 98.7% - 100%), PPV 100% (95% CI: 95.4% - 100%) and NPV 80.4% (95% CI: 75.9% - 84.4%). For the WAMA test, the sensitivity was 53.4% (95% CI: 45.0% - 61.6%), specificity 100% (95% CI: 98.7% - 100%), PPV 100% (95% CI: 95.4% - 100%) and NPV 80.7% (95% CI: 76.2% - 84.6%). Sensitivity for the group with Cycle Threshold (CT) <24 was 82.3% (95%CI: 72.1-90.0, n = 83) for PanbioTM COVID-19 Ag test and 87.3% (95%CI: 77.9-93.8, n = 83) for Immuno-Rapid COVID-19 Ag test. Sensitivity for both Ag-RDT was lower than reported by manufacturers. In the stratified analysis, sensitivity was higher among those with lower CT values <24. Specificity was high for both rapid antigen tests. Both Ag-RDT showed to be useful for rapid diagnostic of potential cases of COVID-19. Negative results must be assessed carefully according to clinical and epidemiological information.

Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes.

To investigate the impact of neighborhood-level social vulnerability on pediatric tonsillectomy outcomes. This single-center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two-sided Pearson chi-square tests were used, whereas for continuous variables, paired t-tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post-T&A complications and readmissions. The study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128-22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270-28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275-31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293-79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089-29.396). Social vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community-based interventions. Because of the increased risk, it may have implications for preoperative decision-making, treatment plans, and clinic follow-ups. Laryngoscope, 134:954-962, 2024.

High land surface temperatures (LSTs) disproportionately affect vulnerable socioeconomic groups in Barranquilla, Colombia

Temperatures in urban areas usually exhibit distinct spatial patterns and disproportionately affect lower-income communities as they are frequently located in warmer neighborhoods. Our study focuses on the urban area of the metropolitan area of Barranquilla on the Caribbean Coast of Colombia. We examined heat disparities at the block level and used, 2018 census data to test whether population groups with high socioeconomic vulnerability were also exposed to higher land surface temperatures (LST). Specifically, we defined populations with high and low socioeconomic vulnerability based on their socioeconomic level, educational attainment, age, population density and percentage of migrant population. We tested whether those groups had differences in LST and other temperature-related variables, including NDVI (normalized difference vegetation index), NDBI (normalized difference built-up index) and distance to water. Finally, we generated a heat risk map based on socioeconomic vulnerability and heat exposure. Our results showed that high and low-vulnerability groups had significant differences in LST and distance to water compared to marginal differences in NDVI and NDBI. Spatially, due to historical urban development patterns, areas at higher heat risk were found to the south of the study region, where there is a combination of low socioeconomic level, higher population density and high LST.

Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study

ObjectivesThis pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. MethodThis interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals’ knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. ResultsTraining was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. ConclusionFollowing the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.

COVID-19 testing experience among users of primary health care in communities with high socioeconomic vulnerability in northeast brazil

COVID-19 testing experience among users of primary health care in communities with high socioeconomic vulnerability in northeast brazil

Multivariate framework for integrated drought vulnerability assessment – An application to India

Drought is one of the intricate hazards with multifaceted impacts that distress the social well-being of a country. Due to climate change, the Indian monsoon is becoming aberrant with an anomalous spatiotemporal pattern of rainfall; hence, along with mismanagement of water resources, India faces increased vulnerability to drought. Such vulnerability is contingent on multiple factors that comprise water availability, socioeconomic conditions, and existing policies for mitigation and adaptation to drought. Limited literature is available on studies that focus upon either the spatiotemporal dynamics of drought vulnerability from a science-policy perspective or an integrated approach to all four types of droughts, namely, meteorological, agricultural, hydrological and socioeconomic. Hence, this study proposes an indicator-based framework to assess integrated drought vulnerability that considers all these droughts. The various statistical methods used to construct vulnerability indices include the variance inflation factor (VIF), Shannon entropy weightage, and principal component analysis (PCA). The proposed framework is demonstrated for India to classify its states and union territories based on vulnerability to drought. Results of the study indicate that the central regions of India show high meteorological drought hazard. States of Jharkhand, Telangana, Odisha, West Bengal, and Himachal Pradesh are highly vulnerable to agricultural drought. Rajasthan, Jharkhand, and Haryana have lower reservoir storage, indicating high vulnerability to hydrological drought. Chhattisgarh, Madhya Pradesh, Bihar, Odisha, and northeast states show high socioeconomic drought vulnerability. Hence, this study on integrated drought vulnerability assessment can support science-informed policy formulation and model development for drought management.

An index-based approach to assess the vulnerability of socio-ecological systems to aridity and drought in the Danube Delta, Romania

Delta regions are compound socio-ecological systems increasingly exposed to various multi-hazards (e.g., drought, flooding). The Danube Delta, one of the most complex wetland areas in Europe, and one of the most vulnerable regions when it comes to drought, defined by its key vulnerable categories: women, children, the elderly population, the unemployed etc. In addition to the demographic aspects, there is also the infrastructure that puts a damper on the development of certain sectors of the economy, be they technical (water, gas, electricity), or social (schools, medicine, medical facilities). The current paper aims to apply a multi-criteria regional-level aridity and drought vulnerability assessment relying on both quantitative and qualitative methods in attaining a two-fold objective: (1) developing a comprehensive socio-economic aridity and drought vulnerability index in order to (2) identifying aridity and drought-vulnerable areas based on the finest indicators available for quantifying socio-economic vulnerability. The main research findings point to a general high and very high socio-economic vulnerability in the central and northern parts of the Danube Delta (36.3% of the total population) because of the high values of the elderly population, of households not connected to the water supply and sewage network, of the economic dependency rate, the high distance from the polarizing centres and the small numbers of emergency situation units. The low and very low vulnerability is registered in the West and in Sulina town (19.4% of the total population) where the accessibility to infrastructure and services makes up for the overall high drought exposure (dry/arid and semiarid climate). The research findings will improve the general understanding of drought vulnerability in a deltaic area, thus providing valuable information to be used by policymakers for drought management.

A multi-step hazard assessment for debris-flow prone areas influenced by hydroclimatic events

Hazard assessment studies are fundamental to identifying disaster-prone areas, especially in locations with high environmental and socioeconomic vulnerability. This study proposes a multi-step debris-flow hazard assessment, based on the combination of Logistic Regression (LR) analysis, numerical simulation and rainfall back-analysis. A landslide-prone area of 84 km2 is chosen as test-site, including 20 river catchments and one of the largest petrochemical plants in Latin America. Rainfall is the main influencing factor in debris-flow initiation, as highlighted by the LR analysis, followed by soil cover and slope. The analysis also indicated the catchments more susceptible to debris flows and the simulation results show that the average runout distance in these catchments is 470 m, with an average peak flow height of 5 m and a peak velocity of 23 m s−1. Debris flows are triggered by short duration (<48 h), high-intensity (>200 mm) precipitation, with return periods that vary from 3 to 10 years. Five levels of hazard (very low to very high) are, then, proposed for the study site, based mainly on 48-h accumulated rainfall and flow properties. Industrial and residential areas in the projected debris-flow route generally exhibit the highest overall hazard levels, as many were developed in the depositional area of debris flows and near fluvial courses, where associated floods and flash floods may occur. As pointed out by recent studies, an increase in the frequency of extreme precipitation events is projected in the Serra do Mar region and when the general short return period of the debris-flow triggering rainfall is considered (<10 years), large magnitude (>105 m3) debris flows are likely to occur in the near future.

Flood disaster risk and socioeconomy in the Yellow River Basin, China

Study regionthe Yellow River Basin (YRB) in China. Study focusGlobal warming potentially accentuates risks of extreme precipitation and floods that afflict regional socioeconomy. However, spatiotemporally-coupled relations between flood risk and socioeconomic development in the YRB are not properly understood. Here we used the Coupled Coordination Degree Model (CCDM) to evaluate the coupled relationship between flood risk and socioeconomic development in the YRB, China. New hydrological insights for the regionThe regions with flood hazard along the mainstream of the YRB and decreasing flood hazard in the direction from southeast to northwest of the YRB, high hazard and higher hazard areas accounted for 10.39%. Meanwhile, overall flood exposure and vulnerability are decreasing from southeast to northwest YRB. Higher socioeconomic restorability highly alleviates the risk of flood disasters in central and northern Shandong, northern Henan, central Shaanxi, southern Shanxi provinces, and parts of Inner Mongolia. Relations between socioeconomic development and flood disaster risk are varying across the YRB. The lower YRB is dominated by developed socioeconomy but higher flood disaster risk. The high socioeconomic exposure and vulnerability of the lower YRB will increase the risk of flood disasters. The “transitional” zone in the middle YRB needs to properly handle the contradiction between economy and flood risk to avoid increased risk. Overall, socioeconomic development has a weak relation with flood disaster risk in the upper YRB.

County-Level COVID-19 Vaccination Rates, Non-Communicable Diseases, and Socioeconomic Inequities: Applying Syndemic Theory to Vaccines.

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected certain high-risk populations, including those with underlying chronic illnesses and those who are socioeconomically disadvantaged. Our study evaluated county-level rates of fully vaccinated populations after classifying counties based on rates of non-communicable diseases (NCDs) and socioeconomic inequities below the 25th percentile of overall distribution of counties for each measure as low, counties above the 75th percentile as high, and all other counties as medium. Counties with higher rates of non-communicable diseases and socioeconomic disparities had lower COVID-19 vaccination coverage than did counties with lower rates of non-communicable diseases and socioeconomic disparities. Co-occurrence of high NCD and high socioeconomic vulnerability among counties in the lower half of vaccination coverage was also found for some counties. These findings demonstrate the co-occurrence of low rates of vaccine coverage, high rates of NCDs, and high rates of socioeconomic disparities as a syndemic.

Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California

IntroductionArea-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions. MethodsThis retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1–2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015–2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery. ResultsAmong 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.02–2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03–2.98). ConclusionNeighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention.

Internalizing Problems and Resilience in Primary School Students in Low and High Socioeconomic Vulnerability Establishments in Chile.

The processes involved in this study were 2-fold. First, we analyzed the levels of resilience and internalized problems (defined as group of emotional symptoms) in children aged 9 to 12 years. Second, we examined whether the relationship between them varies according to the low or high vulnerability of school communities. About 1460 students from schools in northern Chile participated. A total of 52.6% were girls, and 47.4% were boys. The scales of internalizing problems of the System of Evaluation of Children and Adolescents (SENA) and the short scale of resilience (CYRM-12) were applied. Correlations in each group and differences between groups were analyzed using a MANOVA. A 2-level path analysis was also performed. Resilience was higher in the context of low vulnerability while depression, social anxiety, and posttraumatic stress symptomatology were greater in the context of high vulnerability. A 2-level path analysis showed that the slope of gender, anxiety, and depression symptomatology varies between schools and an interaction effect between vulnerability and anxiety symptomatology. There are differences in the relationship between internalized problems and resilience according to whether the students belong to low or high vulnerability establishments. This study contributes to a better understanding of the relationship between internalizing problems and resilience.

526. Implementation of Use of Monoclonal Antibody Therapy in a Large Academic Center for the Outpatient Treatment of Covid-19: Impact on 30 Day Hospitalization Rates, ED Visits and Death

BackgroundMonoclonal Antibody Therapy (MAbs) has been shown to reduce rates of ED visits and hospitalizations in patients at risk for severe Covid-19 infection in clinical trials. Since November, three Mabs received emergency use authorization: Bamlanivimab (Bam), Bamlanivimab/Etesevimab (Bam/Ete) and Casirivimab/Imdevimab (Casi/imdevi). We describe here the real-world effectiveness of implementing early MAb therapy in the outpatient setting for individuals with Covid-19 at high risk of progression. MethodsWe examined the records of 808 UCLA Health patients with a confirmed positive SARS-CoV2 PCR test who were either referred for outpatient Mab therapy or received Mab treatment in the emergency department (ED) between December 10, 2020, and May 3, 2021. The primary outcome of our analysis was the combined 30-day incidence of emergency department visits, hospitalizations, or death following the date of referral. SARS-CoV2 isolates of hospitalized patients who had received Mabs were sequenced to determine the presence of variants.ResultsOf 808 patients, 383 were referred for treatment but did not receive treatment, 109 received Mabs in the ED and 316 patients were treated in an outpatient setting. Composite 30-day mortality, ED visits and hospital admissions were significantly reduced in the combination therapy group (Bam/Ete or Cas/Imd) compared with monotherapy (Bam alone) or no treatment groups (aHR 0.16, 95% CI .038, .67). Significant factors associated with the composite outcome included: history of lung disease (HR 4.46, 95% CI 2.89-6.90), cardiovascular disease (HR 1.87, 95% CI 1.12-3.12), kidney disease (HR 2.04, 95% CI 1.27-3.25), and immunocompromised state (HR 3.24, 95% CI 1.02-10.26) as well as high social vulnerability index (HR 1.87, 95% CI 1.13-3.10). Over one-third of hospitalized patients who had received Mabs were confirmed to have the California variant (B.1.427/29) (Figure 1). Figure 1. Covid-19 MAB Treatment Failure LineagesConclusionOur data show that in a real-world setting, combination monoclonal antibody therapy, not monotherapy, significantly reduced ED visits and hospital admissions, likely due to the presence of the California variants. High socioeconomic vulnerability and certain medical conditions increased risk of treatment failure.Disclosures Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator)

COVID-19 pandemic hazard–risk–vulnerability analysis: a framework for an effective Pan-India response

This study evaluated the COVID-19 risk considering positive cases (as a hazard) and the demographic structure (as a socio-economic vulnerability) at districts scale across India using fuzzy analytical hierarchical process and geospatial modelling. Despite the fact that the high and very high COVID-19 hazard was observed in a limited area (14.2%, 233 districts), the proportion of high to very high COVID-19 risk was evident in larger regions (42.5%, 575 districts). A moderate to very high socio-economic vulnerability was recorded in major parts of the country (60.0%, 557 districts), while the districts with megacities had been severely affected due to the more complex urban and social systems. The study highlights the zones under high COVID-19 hazard and its possible linkages with vulnerability and risk at district scales in India that may effectively support emergency preparedness and response mechanisms during the different waves of the pandemic.

Mortality due to breast cancer in a region of high socioeconomic vulnerability in Brazil: Analysis of the effect of age-period and cohort.

IntroductionBreast cancer is an important public health problem worldwide, with important disparities in incidence, mortality, and survival rates between developed and developing countries due to inequalities regarding access to measures for the prevention and treatment of the disease. In Brazil, there are higher rates of incidence and a downward trend in mortality in regions of greater socioeconomic development.ObjectiveTo evaluate the effect of age, period, and birth cohort on breast cancer mortality in women aged 20 years and older in the states of the Northeast Region of Brazil, an area of high socioeconomic vulnerability, from 1980 to 2019.MethodsThe death records were extracted from the DATASUS Mortality Information System website (Department of National Health Informatics) from the Ministry of Health of Brazil. Estimable functions were used to estimate the age-period and cohort models (APC) using the Epi library from the R statistical software version 6.4.1.ResultsThe average breast cancer mortality rate for the period was 20.45 deaths per 100,000 women. The highest coefficients per 100,000 women were observed in the states of Pernambuco (21.09 deaths) and Ceará (20.85 deaths), and the lowest in Maranhão (13.58 deaths) and Piauí (15.43 deaths). In all of the locations, there was a progressive increase in mortality rates in individuals over 40 years of age, with higher rates in the last five-year period (2015–2019). There was an increase in the risk of death for the five-year period of the 2000s in relation to the reference period (1995–1999) in the Northeast region and in the states of Alagoas, Bahia, Maranhão, Paraíba, and Piauí. In addition, there was an increased risk of death for women born after the 1950s in all locations.ConclusionThe highest mortality rates in all five-year periods analyzed were observed in states with greater socioeconomic development, with an increase in mortality rates in the 2000s, and a higher risk of death in the younger cohorts.

Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis

BackgroundCOVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease).MethodsFrom several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities.FindingsThe initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs.InterpretationIn Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.FundingNone.TranslationFor the Portuguese translation of the abstract see Supplementary Materials section.

Commoning of territorial heritage and tools of participated sustainability for the production and enhancement of agro-environmental public goods

The purpose of this paper is to analyze how the commoning heritage processes find application for the production of agro-environmental public goods in contexts of high socio-economic marginality and environmental vulnerability, characterized by abandonment and from the consumption of agricultural land for food use. The purpose is to understand how these processes are able to influence, at local level, the governance processes for the implementation of environmental protection strategies. The survey made it possible to verify how the commoning processes aimed at the production of agro-environmental goods generate territorial resilience, understood as a community competence able to structure specific forms of social learning based on priorities identified and defined by the communities. The followed theoretical framework and the methodological approach have allowed on the one hand to draw up a taxonomy of the different territorial dynamics and on the other to identify a mixed indicator system, applicable and replicable also in other contexts, able to describe its dimensions analytically. The assessment of the cognitive elements related to the territorial fabric carried out through the proposed approach has allowed to demonstrate how the knowledge of the territorial capital contributes to the activation of forms of collective intelligence necessary for decision-making processes.

Social vulnerability and fragmentation of postoperative surgical care among patients undergoing hepatopancreatic surgery

Presenter: Djhenne M Dalmacy MS | The Ohio State University Background: Regionalization of hepatopancreatic (HP) surgery to high-volume hospitals has been associated with fragmentation of post-discharge surgical care and, in turn, inferior outcomes. The objective of the current study was to assess whether patient social vulnerability was associated with the chance of fragmented postoperative care following HP surgery. Methods: Medicare beneficiaries who underwent HP surgery and had at least one readmission within 90 days were identified using Medicare 100% Standard Analytical Files from 2013 to 2017. Patients were categorized into four groups based on their social vulnerability level (i.e. low, low-moderate, moderate-high, and high). Fragmented postoperative care was defined as readmission at a hospital other than the index institution where the initial surgery was performed. The association of social vulnerability index (SVI) and the individual components comprising SVI [Socioeconomic, Household Composition & Disability (HC & Disability), Minority Status & Language (MS & Language), Housing Type & Transportation (HT & Transportation)] with fragmentation of postoperative care was examined using multivariable logistic regression analysis. Results: Among 11,142 patients who met the inclusion criteria, 8,053 (72.3%) had undergone pancreatectomy, while 3,089 (27.7%) had undergone hepatectomy. The overall incidence of fragmented care was 32.9% (n = 3,667). Patients who had fragmented care were older (fragmented: 73 years [IQR: 69-77] vs. 72 years [IQR: 68-77]) and had a higher comorbidity score (fragmented: 4 [IQR: 2-8] vs. non-fragmented: 3 [IQR: 2-8]) (both p<0.001). Median overall SVI was higher among patients who received fragmented care (fragmented: 52.5 [IQR: 29.3 – 70.4] vs. non-fragmented: 51.3 [IQR: 27.9 – 69.4], p = 0.03). When examining each of the components comprising SVI, patients who received fragmented care had higher socioeconomic index (fragmented: 52.5[IQR: 29.3-70.4] vs. non-fragmented: 51.3 [IQR: 27.9-69.4]), higher HC & disability index (fragmented: 41 [IQR: 22.1-59.8] vs. non-fragmented: 39.3 [IQR: 19.4-57.4]) and lower MS & language index (fragmented: 76.3 [IQR: 54.5-90.3] vs. non-fragmented: 78.4 [IQR: 58.6-91.4]) (all p<0.05). On multivariable analysis, odds of receiving fragmented care were higher among patients with high socioeconomic vulnerability (referent low; OR: 1.24; 95% CI: 1.11 – 1.39), high HC & Disability (OR: 1.30; 95% CI: 1.16 – 1.46; p<0.001), whereas high MS & Language vulnerability was inversely associated with receipt of fragmented postoperative care (OR: 0.84; 95% CI: 0.75 – 0.94; p = 0.002) (Figure 1a). The possibility of fragmented care increased with increasing overall SVI (high vs low SVI; OR: 1.12; 95% CI: 1.01 – 1.26; p = 0.04) (Figure 1b). Conclusion: Approximately one-third of Medicare beneficiaries had fragmented postoperative surgical care following HP surgery. Social vulnerability was strongly associated with the chance of receiving fragmented postoperative care. Social determinants of health including social vulnerability should be considered when assessing patient risk of fragmented care after HP surgery.