Adults at high-risk of severe coronavirus disease-2019 (Covid-19) in Brazil

Rezende, Leandro F. M.; Thome, Beatriz; Schveitzer, Mariana Cabral; Souza-Júnior, Paulo Roberto Borges de; Szwarcwald, Célia Landmann

doi:10.11606/s1518-8787.2020054002596

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002596 copy

Adults at high-risk of severe coronavirus disease-2019 (Covid-19) in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate the proportion and total number of the general adult population who may be at higher risk of severe Covid-19 in Brazil.

METHODS

We included 51,770 participants from a nationally representative, household-based health survey (PNS) conducted in Brazil. We estimated the proportion and number of adults (≥ 18 years) at risk of severe Covid-19 by sex, educational level, race/ethnicity, and state based on the presence of one or more of the following risk factors: age ≥ 65 years or medical diagnosis of cardiovascular disease, diabetes, hypertension, chronic respiratory disease, cancer, stroke, chronic kidney disease and moderate to severe asthma, smoking status, and obesity.

RESULTS

Adults at risk of severe Covid-19 in Brazil varied from 34.0% (53 million) to 54.5% (86 million) nationwide. Less-educated adults present a 2-fold higher prevalence of risk factors compared to university graduated. We found no differences by sex and race/ethnicity. São Paulo, Rio de Janeiro, Minas Gerais, and Rio Grande do Sul were the most vulnerable states in absolute and relative terms of adults at risk.

CONCLUSIONS

Proportion and total number of adults at risk of severe Covid-19 are high in Brazil, with wide variation across states and adult subgroups. These findings should be considered while designing and implementing prevention measures in Brazil. We argue that these results support broad social isolation measures, particularly when testing capacity for SARS-CoV-2 is limited.

Risk Groups; Coronavirus Infections, epidemiology; Socioeconomic Factors; Patient Care Planning

Risk factors	Definition	Presence of risk factor for severe Covid-19

		Criterion 1	Criterion 2
Age	in years	≥ 65 years	≥ 65 years
Cardiovascular disease	Has a doctor ever diagnosed you with a heart disease such as infarction, angina, heart failure or other?	Yes	Yes
Diabetes	Has a doctor ever diagnosed you with diabetes?	Yes	Yes
Hypertension	Has a doctor ever diagnosed you with hypertension (high blood pressure)?	Yes	Yes
Chronic respiratory disease	Has a doctor already diagnosed you with any lung disease such as pulmonary emphysema, chronic bronchitis, or COPD (Obstructive Pulmonary Disease Chronic)?	Yes	Yes
Cancer	Has any doctor ever diagnosed you with cancer (excluding skin cancer)?	Yes	Yes
Cancer	How many years ago since your cancer diagnosis?	< 5 years	< 5 years
Stroke	Has any doctor ever diagnosed you with stroke?	Yes	Yes
Obesity	Measured body mass index	No	≥ 30 kg/m²
Smoking	Current smoker	No	Yes (daily or less than daily)
Chronic kidney disease	Has any doctor ever diagnosed you with chronic kidney disease?	No	Yes
Chronic kidney disease	What do you currently do or have done because of the chronic kidney disease?	No	Hemodialysis, peritoneal dialysis, took medication, underwent a kidney transplant
Moderate to severe asthma	Has any doctor ever diagnosed you with asthma (or asthmatic bronchitis)?	No	Yes
Moderate to severe asthma	What do you currently do because of asthma?	No	Use of inhalers, aerosol or tablets

Characteristics	Age groups		Total

	< 65 years	≥ 65 years
Number of participants	23.838	27.932	51.770
Mean age, years (se)	39.7 (11.4)	73.5 (14.1)	44.3 (15.0)
Sex (%)
Men	45.4	42.9	45.0
Education (%)
None or incomplete primary education	15.1	67.0	22.2
Complete primary or incomplete secondary education	27.2	14.0	25.4
Complete secondary education or incomplete undergraduate course	42.7	10.3	38.3
University Graduate	15.0	8.7	14.1
Race/ethnicity (%)
White	48.3	55.9	49.4
Non-white	51.7	44.1	50.6
Risk factors for Severe Covid-19 (%)
Cardiovascular disease	3.4	13.0	4.7
Diabetes	5.1	20.7	7.2
Chronic respiratory disease	1.5	4.4	1.9
Hypertension	18.8	55.3	23.7
Cancer	0.6	2.2	0.8
Stroke	1.0	6.1	1.7
Obesity (BMI ≥30 kg/m²)	22.0	22.7	22.1
Smoking	14.6	9.6	13.9
Chronic kidney disease	0.7	2.0	0.9
Moderate to severe asthma	1.5	1.7	1.5
*Number of risk factors for severe Covid-19 (%)**
None	52.7	24.1	48.8
1	30.9	35.1	31.5
2	12.0	25.2	13.8
3+	4.4	15.6	5.9

Characteristics	Prevalence of one or more risk factors for severe Covid-19

	Criterion 1 (n = 52,511)		Criterion 2 (n = 51,770)

	Prevalence (%)	95%CI	Prevalence (%)	95%CI
Total	34.0	33.2–34.7	54.4	53.6–55.2
Sex
Men	31.6	30.5–32.8	53.3	52.1–54.5
Women	35.9	34.9–36.8	55.4	54.3–56.4
Education
None or incomplete primary education	66.3	64.7–67.9	80.2	78.9–81.4
Complete primary or incomplete secondary education	30.5	29.2–31.9	55.0	53.5–56.5
Complete secondary education or incomplete undergraduate course	20.4	19.4–21.4	42.2	40.9–43.6
University Graduate	27.0	25.1–29.1	46.1	44.1–48.3
Race/ethnicity
White	34.9	33.8–36.0	55.0	53.9–56.2
Non-white	33.1	21.1–34.0	53.9	52.8–54.9

Characteristics	Risk factors for severe Covid-19

	Criterion 1 (n = 52,511)				Criterion 2 (n = 51,770)

	Older age defined as ≥ 60 years		Older age defined as ≥ 70 years		Older age defined as ≥ 60 years		Older age defined as ≥ 70 years

	Prevalence (%)	95%CI	Prevalence (%)	95%CI	Prevalence (%)	95%CI	Prevalence (%)	95%CI
Total	36.7	36.0–37.5	32.3	31.6–33.0	56.2	55.3–57.0	53.3	52.5–54.0
Sex
Men	34.5	33.3–35.6	30.0	28.9–31.1	54.9	53.7–56.1	52.2	51.0–53.4
Women	38.6	37.6–39.5	34.2	33.3–35.1	57.2	56.1–58.2	54.2	53.2–55.2
Education
None or incomplete primary	72.0	70.4–73.4	62.2	60.5–63.8	83.4	82.3–84.6	77.5	76.2–78.8
Complete primary or incomplete secondary	32.2	30.9–33.6	29.3	28.0–30.6	56.2	54.6–57.7	54.1	52.5–55.6
Complete secondary or incomplete university	22.1	21.1–23.2	19.8	18.8–20.8	43.4	42.0–44.7	41.8	40.4–43.2
University Graduate	30.0	28.0–32.1	25.6	23.7–27.5	48.1	45.9–50.2	45.1	43.0–47.2
Race/ethnicity
White	38.0	36.9–39.2	33.1	32.0–34.2	57.0	55.8–58.2	53.8	52.6–54.9
Non-white	35.5	34.5–36.5	31.6	30.6–32.5	55.3	54.3–56.3	52.8	51.8–53.9

Brazilian States	Adult population (≥ 18 years)	Prevalence of one or more risk factors for severe Covid-19, %

		Criterion 1 (n = 52,511)			Criterion 2 (n = 51,770)

		Prevalence (%)	95%CI	N at risk	Prevalence (%)	95%CI	N at risk
Brazil	158,255,554	34.0	33.2–34.7	53,806,888	54.4	53.6–55.2	86,091,021
Brazilian States
Rondônia	1,296,218	29.6	26.7–32.7	383,681	50.3	47.3–53.2	651,998
Acre	581,754	28.1	25.3–31.0	163,473	50.0	46.8–53.2	290,877
Amazonas	2,769,201	25.1	22.6–27.8	695,069	48.7	45.7–51.7	1,348,601
Roraima	430,939	25.0	22.3–27.9	107,735	48.6	45.0–52.2	209,436
Pará	5,971,477	26.2	23.2–29.3	1,564,527	45.2	41.8–48.7	2,699,108
Amapá	570,298	23.4	20.2–26.9	133,450	45.9	41.6–50.3	261,767
Tocantins	1,125,023	33.1	29.0–37.6	372,383	52.2	48.7–55.7	587,262
Maranhão	4,873,279	30.0	26.3–34.0	1,461,984	48.5	43.9–53.0	2,363,540
Piauí	2,383,425	32.7	29.4–36.1	779,380	53.0	49.6–56.3	1,263,215
Ceará	6,788,403	33.8	31.0–36.7	2,294,480	53.7	50.8–56.6	3,645,372
Rio Grande do Norte	2,632,403	33.2	30.2–36.3	873,958	52.9	49.7–56.1	1,392,541
Paraiba	2,984,647	33.4	30.6–36.3	996,872	49.0	46.0–51.9	1,462,477
Pernambuco	7,035,040	33.2	30.7–35.8	2,335,633	53.4	50.8–55.9	3,756,711
Alagoas	2,377,983	31.7	28.6–35.0	753,821	53.5	49.7–57.3	1,272,221
Sergipe	1,688,955	30.8	28.0–33.8	520,198	50.0	46.7–53.2	844,478
Bahia	11,044,986	30.3	26.8–34.1	3,346,631	48.9	44.8–53.0	5,400,998
Minas Gerais	16,425,183	35.6	33.1–38.2	5,847,365	55.1	52.0–58.2	9,050,276
Espírito Santo	3,047,439	31.5	27.6–35.6	959,943	48.1	43.6–52.7	1,465,818
Rio de Janeiro	13,419,464	36.0	33.8–38.1	4,831,007	55.8	53.6–58.0	7,488,061
São Paulo	35,414,776	35.6	33.7–37.4	12,607,660	58.2	56.2–60.2	20,611,400
Paraná	8,736,014	34.9	31.7–38.2	3,048,869	57.1	53.3–60.9	4,988,264
Santa Catarina	5,578,842	34.1	30.2–38.2	1,902,385	55.9	51.6–60.1	3,118,573
Rio Grande do Sul	8,902,263	39.5	36.8–42.3	3,516,394	58.4	55.6–61.1	5,198,922
Mato Grosso do Sul	2,045,881	34.7	31.6–37.8	709,921	57.6	54.5–60.7	1,178,427
Mato Grosso	2,543,642	31.9	28.9–35.1	811,422	54.8	51.9–57.6	1,393,916
Goiás	5,277,383	34.4	31.5–37.4	1,815,420	52.0	49.1–54.9	2,744,239
Distrito Federal	2,310,636	29.9	27.3–32.5	690,880	49.2	46.3–52.1	1,136,833

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[1] Correspondence: Leandro F. M. Rezende Universidade Federal de São Paulo. Escola Paulista de Medicina. Departamento de Medicina Preventiva Rua Botucatu, 740, 4º Andar sala 457 04023-062 São Paulo, SP, Brasil E-mail: leandro.rezende@unifesp.br