Regional heterogeneity of in-hospital mortality of COVID-19 in Brazil

查看全文 作　　者：Yuan [1]Liu;Kexin [1]Wang;Lin [2]Yang;Daihai [1]He

机构地区：[1]Department of Applied Mathematics,Hong Kong Polytechnic University,Hong Kong,China;[2]School of Nursing,Hong Kong Polytechnic University,Hong Kong,China

出　　处：《Infectious Disease Modelling》索引2022年第7卷第3期,共10页

基　　金：The work described in this paper was partially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region,China(HKU C7123-20G). 摘　　要：Background The ongoing Coronavirus disease of 2019(COVID-19)pandemic has hit Brazil hard in period of different dominant variants.Different COIVD-19 variants have swept through the region,resulting that the total number of cases in Brazil is the third highest in the world.This study is aimed at investigating the regional heterogeneity of in-hospital mortality of COVID-19 in Brazil and the effects of vaccination and social inequality.Methods We fitted a multivariate mixed-effects Cox model to a national database of inpatient data in Brazil who were admitted for COVID-19 from February 27,2020 to March 15,2022.The in-hospital mortality risks of vaccinated and unvaccinated patients were compared,with adjustment for age,state,ethnicity,education and comorbidities.And the effects of variables to in-hospital mortality were also compared.Stratified analysis was conducted across different age groups and vaccine types.Results By fitting the multivariate mixed-effects Cox model,we concluded that age was the most important risk factor for death.With regards to educational level,illiterate patients(hazard ratio:1.63,95%CI:1.56–1.70)had a higher risk than those with a university or college degree.Some common comorbidities were more dangerous for hospitalized patients,such as liver disease(HR:1.46,95%CI:1.34–1.59)and immunosuppression(HR:1.32,95%CI:1.26–1.40).In addition,the states involving Sergipe(HR:1.75,95%CI:1.46–2.11),Roraima(HR:1.65,95%CI:1.43–1.92),Maranhão(HR:1.57,95%CI:1.38–1.79),Acre(HR:1.44,95%CI:1.12–1.86),and Rondônia(HR:1.26,95%CI:1.10–1.44)in the north and the northeast region tended to have higher hazard ratios than other area.In terms of vaccine protection,vaccination did not significantly reduce mortality among hospitalized patients.Sinovac and AstraZeneca offered different protection in different regions,and no vaccine provided high protection in all regions.Conclusion The study revealed the regional heterogeneity of in-hospital mortality of Covid-19 in Brazil and the effects of vaccination and social inequality.We found that ethnic concentrations were consistent with higher proportion of death cases relative to population size.White Brazilians had more frequent international travel opportunities.As race revealed the intersection of social connections,we speculated that uneven interactions with residential communities partially contribute to the spread of the epidemic.Additionally,the vaccine showed different protection in different regions.In the northern and northeastern regions,AstraZeneca was much more protective than Sinovac,while Sinovac was more protective for hospitalized patients with varying numbers of comorbidities in the Central-west,Southeast and South regions. 关键词：COVID-19 In-hospital mortality VACCINE Brazil

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Regional heterogeneity of in-hospital mortality of COVID-19 in Brazil

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