COVID-19's intra-urban inequalities and social vulnerability in a medium-sized city

Nogueira, Mário Círio; Leite, Isabel Cristina Gonçalves; Teixeira, Maria Teresa Bustamante; Vieira, Marcel de Toledo; Colugnati, Fernando Antonio Basile

doi:10.1590/0037-8682-0445-2021

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Revista da Sociedade Brasileira de Medicina Tropical

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Major Article • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0445-2021 copy

COVID-19's intra-urban inequalities and social vulnerability in a medium-sized city

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Social conditions are related to the impact of epidemics on human populations. This study aimed to investigate the spatial distribution of cases, hospitalizations, and deaths from COVID-19 and its association with social vulnerability.

Methods:

An ecological study was conducted in 81 urban regions (UR) of Juiz de Fora from March to November 2020. Exposure was measured using the Health Vulnerability Index (HVI), a synthetic indicator that combines socioeconomic and environmental variables from the Demographic Census 2010. Regression models were estimated for counting data with overdispersion (negative binomial generalized linear model) using Bayesian methods, with observed frequencies as the outcome, expected frequencies as the offset variable, and HVI as the explanatory variable. Unstructured random-effects (to capture the effect of unmeasured factors) and spatially structured effects (to capture the spatial correlation between observations) were included in the models. The models were estimated for the entire period and quarter.

Results:

There were 30,071 suspected cases, 8,063 confirmed cases, 1,186 hospitalizations, and 376 COVID-19 deaths. In the second quarter of the epidemic, compared to the low vulnerability URs, the high vulnerability URs had a lower risk of confirmed cases (RR=0.61; CI95% 0.49-0.76) and a higher risk of hospitalizations (RR=1.65; CI95% 1.23-2.22) and deaths (RR=1.73; CI95% 1.08-2.75).

Conclusions:

The lower risk of confirmed cases in the most vulnerable UR probably reflected lower access to confirmatory tests, while the higher risk of hospitalizations and deaths must have been related to the greater severity of the epidemic in the city’s poorest regions.

Keywords:
COVID-19; Spatial analysis; Social inequality; Urban health

	Suspected		Confirmed		Admissions		Deaths
Variables	N	%	N	%	N	%	N	%
TOTAL	30071	100.00	8063	100.00	1186	100.00	376	100.00
Sex
Female	17181	57.13	4213	52.25	539	45.45	174	46.28
Male	12881	42.84	3845	47.69	647	54.55	202	53.72
Ignored	9	0.03	5	0.06	0	0.00	0	0.00
Age group
0 to 9 years	1539	5.12	188	2.33	17	1.43	1	0.27
10 to 19 years	1371	4.56	250	3.10	8	0.67	0	0.00
20 to 39 years old	14215	47.27	3694	45.81	114	9.61	10	2.66
40 to 59 years old	9391	31.23	2824	35.02	355	29.93	65	17.29
60 years and older	3555	11.82	1107	13.73	692	58.35	300	79.79
Race/color
White	6927	23.04	1091	13.53	563	47.47	180	47.87
Brown	2542	8.45	250	3.10	186	15.68	64	17.02
Black	2253	7.49	211	2.62	155	13.07	56	14.89
Yellow	170	0.57	32	0.40	15	1.26	2	0.53
Indigenous	11	0.04	2	0.02	0	0.00	0	0.00
Ignored	18168	60.42	6477	80.33	267	22.51	74	19.68
Pregnant
No	29788	99.06	8022	99.49	1183	99.75	376	100.00
yes	283	0.94	41	0.51	3	0.25	0	0.00
Risk
Usual	16205	53.89	4005	49.67	247	20.83	35	9.31
High	6829	22.71	1577	19.56	939	79.17	341	90.69
Ignored	7037	23.40	2481	30.77	0	0.00	0	0.00
Vulnerability of the Urban Region of residence
Low	9777	32.51	3178	39.41	354	29.85	121	32.18
Medium	12832	42.67	3256	40.38	519	43.76	156	41.49
High	7462	24.81	1629	20.20	313	26.39	99	26.33
Administrative Region of residence
Central	7352	24.45	2204	27.33	214	18.04	67	17.82
East	4435	14.75	1146	14.21	238	20.07	79	21.01
Northeast	2658	8.84	770	9.55	125	10.54	45	11.97
North	6945	23.10	1631	20.23	258	21.75	74	19.68
West	2530	8.41	738	9.15	89	7.50	28	7.45
Southeast	3065	10.19	632	7.84	126	10.62	40	10.64
South	3086	10.26	942	11.68	136	11.47	43	11.44
Location of notification
Hospital	13803	45.90	2467	30.60	-	-	-	-
Basic Health Units	6270	20.85	376	4.66	-	-	-	-
Emergency Service	2405	8.00	277	3.44	-	-	-	-
Other	7593	25.25	4943	61.30	-	-	-	-

Variables	Average	DP	Min	Q1	Q2	Q3	Max	I*
Population	6579.62	5621.57	180	2833	5074	8118	24516	0.07
HVI	0.32	0.14	0.08	0.20	0.32	0.42	0.79	0.47*
Suspected
Total	371.25	312.40	4	173	276	471	1788	0.06
Period 1	50.27	41.52	1	22	42	67	210	0.04
Period 2	141.78	124.52	2	63	105	182	708	0.07
Period 3	179.20	151.18	1	81	137	243	880	0.07
Confirmed
Total	99.54	89.82	0	40	72	129	494	0.08
Period 1	6.35	6.89	0	2	4	8	37	0.14*
Period 2	42.35	38.53	0	17	30	53	215	0.06
Period 3	50.85	46.85	0	21	39	60	253	0.10
Hospitalizations
Total	14.64	13.05	0	6	11	21	66	0.03
Period 1	1.79	2.43	0	0	1	2	13	-0.07
Period 2	5.65	5.46	0	2	4	8	30	0.07
Period 3	7.20	6.66	0	2	5	10	32	0.05
Deaths
Total	4.64	5.11	0	1	3	7	27	0.02
Period 1	0.56	0.97	0	0	0	1	5	-0.10
Period 2	1.80	2.12	0	0	1	3	9	0.02
Period 3	2.28	2.71	0	0	1	3	13	0.04
Suspected rate
Total	6308.02	4092.20	1840.18	4222.65	5399.49	6796.95	31040.74	0.22*
Period 1	876.12	588.51	83.11	575.06	733.85	936.21	4418.58	0.31*
Period 2	2340.85	1508.19	629.34	1634.97	2035.22	2506.24	12023.41	0.22*
Period 3	3091.05	2160.89	792.72	2085.09	2564.02	3383.26	14598.75	0.18*
Confirmed rate
Total	1620.46	1188.01	0	1090.01	1288.09	1664.96	7970.24	0.27*
Period 1	113.93	154.27	0	46.26	72.99	122.01	961.73	0.26*
Period 2	671.63	536.83	0	439.86	549.07	724.62	4207.92	0.19*
Period 3	834.89	667.78	0	517.44	628.7	947.23	5210.34	0.19*
Hospitalization rate
Total	168.14	86.25	0	124.59	163.74	199.82	410.77	0.05
Period 1	25.67	49.08	0	0	16.57	27.73	396.36	0.04
Period 2	64.53	44.07	0	35.46	64.24	82.03	208.62	-0.04
Period 3	77.94	53.32	0	49.05	68.33	104.43	350.13	-0.10
Mortality rate
Total	45.01	38.91	0	10.88	40.37	68.99	198.62	-0.14*
Period 1	5.63	11.55	0	0	0	7.22	63.19	-0.11
Period 2	16.76	17.58	0	0	14.91	27.27	90.85	0.02
Period 3	22.62	27.67	0	0	15.52	32.91	156.95	-0.15*

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[1] Corresponding author: Dr. Mário Círio Nogueira. e-mail:mario.cirio.nogueira@gmail.com