Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil

Fabrin, Caroline; Boing, Alexandra Crispim; Garcia, Leandro Pereira; Boing, Antonio Fernando

doi:10.1590/1980-549720230015

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Revista Brasileira de Epidemiologia

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Sumário

Original Article • Rev. bras. Epidemiol. 26 • 2023 • https://doi.org/10.1590/1980-549720230015 copy

Socioeconomic inequality in hospital case fatality rate and care among children and adolescents hospitalized for COVID-19 in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the association of hospital case fatality rate and care received by children and adolescents hospitalized for COVID-19 with the gross domestic product (GDP) per capita of Brazilian municipalities and regions of residence.

Methods:

Data were collected from the Influenza Epidemiological Surveillance Information System and the Brazilian Institute of Geography and Statistics. The dichotomous outcomes analyzed were hospital case fatality rate of COVID-19, biological samples collected for COVID-19 diagnosis, X-rays, computed tomography (CT) scans, use of ventilatory support, and intensive care unit hospitalization. The covariates were municipal GDP per capita and the Brazilian region of residence. Poisson regression was used for the outcomes recorded in 2020 and 2021 in Brazil, covering the two COVID-19 waves in the country, adjusted for age and gender.

Results:

The hospital case fatality rate was 7.6%. In municipalities with lower GDP per capita deciles, the case fatality rate was almost four times higher among children and twice as high in adolescents compared to cities with higher deciles. Additionally, residents of municipalities with lower GDP per capita had fewer biological samples collected for diagnosis, X-ray examinations, and CT scans. We found regional disparities associated with case fatality rate, with worse indicators in the North and Northeast regions. The findings remained consistent over the two COVID-19 waves.

Conclusion:

Municipalities with lower GDP per capita, as well as the North and Northeast regions, had worse indicators of hospital case fatality rate and care.

Keywords:
COVID-19; Child; Mortality; Hospitalization; Health status disparities

		Sample (n)	Biological samples collected (%)	X-ray examinations (%)	Computed tomography scans (%)	Ventilatory support (%)	ICU hospitalization (%)	Case fatality rate (%)
Income decile
	1 (poorest)	367	92.6	38.1	5.7	51.5	28.6	15.5
	2	522	88.9	39.7	10.9	54	26.6	12.1
	3	476	93.7	43.3	6.3	54.8	30.9	10.9
	4	708	90.1	38	8.6	48.4	27.1	9.3
	5	1,138	96.4	39.3	7.6	47.5	26.7	7.6
	6	1,042	96.7	38.6	10.5	51	31.7	8.5
	7	2,027	96.4	34.1	9.6	45.6	30.7	6.7
	8	1,461	97.1	38.6	16.5	53.3	29.6	8.1
	9	2,743	96	38	11.3	49.9	26.1	4.1
	10 (richest)	5,799	98.4	44.1	11.8	54.7	32.1	4.1
Region
	Northeast	3,492	94.7	33.6	7.7	51.5	34.7	11.1
	North	2,331	91.5	38.6	6.7	39.9	15.8	6.7
	Midwest	1,360	98.0	39.2	16.0	49.6	32.8	5.2
	South	2,039	98.9	44.5	12.7	53	24.2	4.5
	Southeast	7,061	97.9	42.7	12.6	55.3	33	4.4
	Total sample	16,283	96.5	40.1	11	51.5	29.8	6.3

		Biological samples collected (95%CI)	X-ray examinations (95%CI)	Computed tomography scans (95%CI)	Ventilatory support (95%CI)	ICU hospitalization (95%CI)	Case fatality rate (95%CI)
Income decile^* * Values adjusted for gender and age; ICU: intensive care unit.
	1 (poorest)	1.00	1.00	1.00	1.00	1.00	1.00
	2	0.96 (0.92–1.00)	1.04 (0.88–1.23)	1.85 (1.14–2.98)	1.05 (0.92–1.19)	0.93 (0.75–1.15)	0.79 (0.56–1.10)
	3	1.01 (0.97–1.05)	1.13 (0.96–1.34)	1.11 (0.65–1.91)	1.07 (0.94–1.21)	1.08 (0.87–1.33)	0.70 (0.49–0.99)
	4	0.97 (0.94–1.01)	1.00 (0.85–1.17)	1.48 (0.92–2.38)	0.94 (0.83–1.06)	0.95 (0.77–1.16)	0.60 (0.43–0.84)
	5	1.04 (1.01–1.07)	1.03 (0.89–1.20)	1.29 (0.81–2.04)	0.92 (0.82–1.04)	0.93 (0.77–1.13)	0.49 (0.36–0.67)
	6	1.04 (1.01–1.08)	1.01 (0.87–1.18)	1.85 (1.18–2.89)	0.99 (0.88–1.11)	1.11 (0.92–1.33)	0.55 (0.40–0.74)
	7	1.04 (1.01–1.07)	0.90 (0.78–1.03)	1.63 (1.06–2.52)	0.89 (0.79–0.99)	1.07 (0.90–1.28)	0.43 (0.33–0.58)
	8	1.05 (1.02–1.08)	1.02 (0.88–1.18)	2.75 (1.79–4.23)	1.03 (0.93–1.15)	1.04 (0.87–1.24)	0.53 (0.39–0.71)
	9	1.04 (1.01–1.07)	1.00 (0.87–1.15)	1.91 (1.25–2.93)	0.97 (0.87–1.08)	0.92 (0.77–1.09)	0.27 (0.20–0.36)
	10 (richest)	1.06 (1.03–1.09)	1.16 (1.01–1.32)	2.01 (1.32–3.06)	1.06 (0.96–1.18)	1.12 (0.95–1.33)	0.27 (0.20–0.35)
Region^* * Values adjusted for gender and age; ICU: intensive care unit.
	Northeast	1.00	1.00	1.00	1.00	1.00	1.00
	North	0.97 (0.95–0.98)	1.15 (1.07–1.23)	0.89 (0.74–1.08)	0.78 (0.73–0.82)	0.46 (0.41–0.51)	0.60 (0.51–0.72)
	Midwest	1.04 (1.02–1.05)	1.17 (1.07–1.26)	2.12 (1.79–2.50)	0.96 (0.91–1.03)	0.94 (0.86–1.03)	0.47 (0.37–0.60)
	South	1.04 (1.04–1.05)	1.33 (1.24–1.42)	1.63 (1.39–1.91)	1.03 (0.98–1.09)	0.70 (0.64–0.76)	0.40 (0.32–0.50)
	Southeast	1.03 (1.03–1.04)	1.27 (1.21–1.34)	1.62 (1.43–1.85)	1.07 (1.03–1.12)	0.95 (0.90–1.01)	0.40 (0.35–0.46)

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[1] Corresponding author: Caroline Fabrin. Rua Delfino Conti, s/n, Trindade, CEP: 88040-370, Florianópolis (SC), Brasil. E-mail: carolinefabrin@gmail.com