Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 9;50(3):732-742.
doi: 10.1093/ije/dyab022.

Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil

Karina Braga Ribeiro  1 , Ana Freitas Ribeiro  2   3 , Maria Amélia de Sousa Mascena Veras  1 , Marcia Caldas de Castro  4
Affiliations

Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil

Karina Braga Ribeiro et al. Int J Epidemiol. .

Abstract

Background: Heterogeneity in COVID-19 morbidity and mortality is often associated with a country's health-services structure and social inequality. This study aimed to characterize social inequalities in COVID-19 mortality in São Paulo, the most populous city in Brazil and Latin America.

Methods: We conducted a population-based study, including COVID-19 deaths among São Paulo residents from March to September 2020. Age-standardized mortality rates and unadjusted rate ratios (RRs) [with corresponding 95% confidence intervals (CIs)] were estimated by race, sex, age group, district of residence, household crowding, educational attainment, income level and percentage of households in subnormal areas in each district. Time trends in mortality were assessed using the Joinpoint model.

Results: Males presented an 84% increase in COVID-19 mortality compared with females (RR = 1.84, 95% CI 1.79-1.90). Higher mortality rates were observed for Blacks (RR = 1.77, 95% CI 1.67-1.88) and mixed (RR = 1.42, 95% CI 1.37-1.47) compared with Whites, whereas lower mortality was noted for Asians (RR = 0.63, 95% CI 0.58-0.68). A positive gradient was found for all socio-economic indicators, i.e. increases in disparities denoted by less education, more household crowding, lower income and a higher concentration of subnormal areas were associated with higher mortality rates. A decrease in mortality over time was observed in all racial groups, but it started earlier among Whites and Asians.

Conclusion: Our results reveal striking social inequalities in COVID-19 mortality in São Paulo, exposing structural inequities in Brazilian society that were not addressed by the governmental response to COVID-19. Without an equitable response, COVID-19 will further exacerbate current social inequalities in São Paulo.

Keywords: COVID-19; mortality; race factors; social determinants of health.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trends in COVID-19 mortality according to epidemiological week and race, São Paulo city, March–July 2020
See this image and copyright information in PMC

References

    1. Zhu N, Zhang D, Wang W et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–33. - PMC - PubMed
    1. World Health Organization. Coronavirus Disease 2019 (COVID-19)—Situation Report 51. Geneva: World Health Organization.
    1. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/ (12 October 2020, date last accessed).
    1. Ministério da Saúde. COVID-19 NO BRASIL. https://covid.saude.gov.br/ (14 October 2020, date last accessed).
    1. Baqui P, Bica I, Marra V, Ercole A, van der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Glob Health 2020;8:e1018–26. - PMC - PubMed

Publication types