Spatial analysis of hospital-related mortality due to COVID-19 among children and adolescents in Brazil

Costa, Silmery da Silva Brito; Branco, Maria dos Remédios Freitas Carvalho; Pereira, Andressa Rocha; Costa, Elisa Miranda; Araújo, Mayra Sharlenne Moraes; Oliveira, Daniel Cavalcante de; Oliveira, Bruno Luciano Carneiro Alves de; Rangel, Maurício Eduardo Salgado; Tonello, Aline Sampieri; Lopes, Denise Ailine Monteiro; Pinheiro, Vanessa Vieira; Câmara, Ana Patricia Barros; Santos, Alcione Miranda dos; Vasconcelos, Vitor Vieira

doi:10.1590/1413-81232024291.19892022

Brasil

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ARTIGO TEMÁTICO • Ciênc. saúde coletiva 29 (1) • Jan 2024 • https://doi.org/10.1590/1413-81232024291.19892022 linkcopy

Spatial analysis of hospital-related mortality due to COVID-19 among children and adolescents in Brazil

Análise espacial da mortalidade hospitalar por COVID-19 em crianças e adolescentes no Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Key words: Severe acute respiratory syndrome; Child; Adolescent; COVID-19; Spatial analysis

Federative Unit		0-28 days		29d-11 months		1-2 years		3-5 years		6-9 years		10-14 years		15-19 years		Total
Federative Unit		2020	2021	2020	2021	2020	2021	2020	2021	2020	2021	2020	2021	2020	2021	2020	2021
Acre	cases	0	0	4	6	2	3	4	2	1	1	3	0	17	11	31	23
Acre	deaths	0	0	2	1	1	0	1	0	0	0	1	0	3	2	8	3
	*HMR (%)		0	50	16,67	50	0	25	0	0	0	33,33		17,65	18,18	25,81	13,04
Alagoas	cases	11	27	36	78	49	65	55	32	28	23	30	11	55	40	264	276
Alagoas	deaths	5	1	5	12	3	3	4	1	2	1	4	1	13	9	36	28
	HMR (%)		3,70	13,89	15,38	6,12	4,62	7,27	3,13	7,14	4,35	13,33	9,09	23,64	22,5	13,64	10,14
Amazonas	cases	36	19	210	109	224	94	179	67	141	52	144	38	322	131	1256	510
Amazonas	deaths	6	0	14	8	4	6	5	1	1	3	4	3	24	6	58	27
	HMR (%)	16,67	0	6,67	7,34	1,79	6,38	2,79	1,49	0,71	5,77	2,78	7,89	7,45	4,58	4,62	5,29
Amapá	cases	7	5	73	31	65	34	32	16	25	9	26	11	27	23	255	129
Amapá	deaths	0	1	2	1	0	2	1	0	0	0	2	2	0	2	5	8
	HMR (%)	0	20	2,74	3,23	0	5,88	3,13	0	0	0	7,69	18,18	0	8,70	1,96	6,20
Bahia	cases	35	16	115	166	110	139	110	87	105	86	95	70	146	179	716	743
Bahia	deaths	7	0	22	9	4	8	3	5	4	5	8	7	18	23	66	57
	HMR (%)	20	0	19,13	5,42	3,64	5,76	2,73	5,75	3,81	5,81	8,42	10	12,33	12,85	9,22	7,67
Ceará	cases	34	41	119	141	97	98	70	76	66	72	94	61	193	141	673	630
Ceará	deaths	5	12	21	25	8	8	5	7	5	4	15	5	22	19	81	80
	HMR (%)	14,71	29,27	17,65	17,73	8,25	8,16	7,14	9,21	7,58	5,56	15,96	8,20	11,40	13,48	12,04	12,70
Distrito Federal	cases	11	5	73	46	39	48	30	24	32	20	39	24	61	71	285	238
Distrito Federal	deaths	0	0	1	1	0	1	0	1	1	0	1	0	4	3	7	6
	HMR (%)	0	0	1,37	2,17	0	2,08	0	4,17	3,13	0	2,56	0	6,56	4,23	2,46	2,52
Espírito Santo	cases	12	1	22	9	9	9	11	1	14	12	10	9	37	13	115	54
Espírito Santo	deaths	2	0	5	0	0	1	2	0	1	1	2	1	7	5	19	8
	HMR (%)	16,67	0	22,73	0	0	11,11	18,18	0	7,14	8,33	20	11,11	18,92	38,46	16,52	14,81
Goiás	cases	12	14	54	71	36	54	35	48	36	33	27	61	71	176	271	457
Goiás	deaths	1	3	6	5	1	6	0	4	1	4	3	8	11	15	23	45
	HMR (%)	8,33	21,43	11,11	7,04	2,78	11,11	0,00	8,33	2,78	12,12	11,11	13,11	15,49	8,52	8,49	9,85
Maranhão	cases	8	3	34	41	30	22	17	19	33	12	28	27	65	61	215	185
Maranhão	deaths	2	1	13	7	2	1	2	1	3	2	2	3	14	6	38	21
	HMR %)	25	33,33	38,24	17,07	6,67	4,55	11,76	5,26	9,09	16,67	7,14	11,11	21,54	9,84	17,67	11,35
Minas Gerais	cases	27	70	113	250	87	195	89	126	75	99	71	115	143	275	605	1130
Minas Gerais	deaths	2	9	6	10	4	7	2	6	4	6	4	9	10	23	32	70
	HMR (%)	7,41	12,86	5,31	4	4,60	3,59	2,25	4,76	5,33	6,06	5,63	7,83	6,99	8,36	5,29	6,19
Mato Grosso do Sul	cases	4	8	29	34	19	32	12	13	22	16	13	22	33	63	132	188
	deaths	0	0	0	2	0	0	0	1	3	2	0	0	1	5	4	10
	HMR %)	0	0	0	5,88	0	0	0	7,69	13,64	12,5	0	0	3,03	7,94	3,03	5,32
Mato Grosso	cases	11	12	84	69	84	61	88	42	102	44	190	79	517	177	1076	484
Mato Grosso	deaths	1	0	13	3	2	1	3	2	1	0	1	0	10	7	31	13
	HMR (%)	9,09	0	15,48	4,35	2,38	1,64	3,41	4,76	0,98	0	0,53	0	1,93	3,95	2,88	2,69
Pará	cases	26	19	193	127	191	99	120	65	88	45	98	65	207	146	923	566
Pará	deaths	7	2	22	8	14	5	8	1	3	0	10	7	25	16	89	39
	HMR (%)	26,92	10,53	11,40	6,30	7,33	5,05	6,67	1,54	3,41	0	10,20	10,77	12,08	10,96	9,64	6,89
Paraíba	cases	40	9	60	54	30	20	35	20	33	16	40	24	103	81	341	224
Paraíba	deaths	1	1	13	5	2	1	2	1	1	0	0	0	3	5	22	13
	HMR (%)	2,5	11,11	21,67	9,26	6,67	5	5,71	5	3,03	0	0	0	2,91	6,17	6,45	5,80
Pernambuco	cases	122	11	186	90	127	57	110	42	126	35	119	31	192	54	982	320
Pernambuco	deaths	27	5	26	12	8	2	9	1	8	3	9	7	21	12	108	42
	HMR (%)	22,13	45,45	13,98	13,33	6,30	3,51	8,18	2,38	6,35	8,57	7,56	22,58	10,94	22,22	11,00	13,13
Piauí	cases	3	5	38	23	38	19	24	13	32	9	31	28	68	34	234	131
Piauí	deaths	2	1	3	3	2	0	0	0	1	0	5	2	9	2	22	8
	HMR (%)	66,67	20	7,89	13,04	5,26	0	0	0	3,13	0	16,13	7,14	13,24	5,88	9,40	6,11
Paraná	cases	16	33	73	147	62	110	47	83	39	89	59	165	108	330	404	957
Paraná	deaths	1	1	1	8	2	3	1	7	2	3	3	14	13	27	23	63
	HMR (%)	6,25	3,03	1,37	5,44	3,23	2,73	2,13	8,43	5,13	3,37	5,08	8,48	12,04	8,18	5,69	6,58
Rio de Janeiro	cases	52	47	324	277	194	227	163	197	154	152	188	161	277	267	1352	1328
Rio de Janeiro	deaths	4	4	33	20	6	3	3	3	7	3	15	10	31	28	99	71
	HMR (%)	7,69	8,51	10,19	7,22	3,09	1,32	1,84	1,52	4,55	1,97	7,98	6,21	11,19	10,49	7,32	5,35
Rio Grande do Norte	cases	5	3	19	23	24	27	26	11	25	18	22	12	38	34	159	128
	deaths	0	0	1	1	4	0	4	0	1	3	1	1	6	5	17	10
	HMR (%)	0	0	5,26	4,35	16,67	0	15,38	0	4	16,67	4,55	8,33	15,79	14,71	10,69	7,81
Rondônia	cases	5	2	25	12	14	19	13	14	30	14	14	24	39	41	140	126
Rondônia	deaths	1	0	4	1	3	0	1	0	1	0	2	1	7	6	19	8
	HMR (%)	20	0	16	8,33	21,43	0	7,69	0	3,33	0	14,29	4,17	17,95	14,63	13,57	6,35
Roraima	cases	1	1	9	7	4	0	2	1	4	0	2	0	15	14	37	23
Roraima	deaths	1	0	5	6	3	0	1	1	1	0	1	0	5	2	17	9
	HMR (%)	100	0	55,56	85,71	75		50	100	25		50		33,33	14,29	45,95	39,13
Rio Grande do Sul	cases	18	19	59	106	57	60	41	45	52	38	35	53	118	189	380	510
	deaths	1	2	3	3	2	5	1	1	1	1	2	3	13	23	23	38
	HMR (%)	5,56	10,53	5,08	2,83	3,51	8,33	2,44	2,22	1,92	2,63	5,71	5,66	11,02	12,17	6,05	7,45
Santa Catarina	cases	11	29	57	91	26	62	23	36	31	33	43	56	61	156	252	463
Santa Catarina	deaths	2	6	2	7	1	2	4	0	1	0	4	3	8	13	22	31
	HMR (%)	18,18	20,69	3,51	7,69	3,85	3,23	17,39	0	3,23	0	9,30	5,36	13,11	8,33	8,73	6,70
Sergipe	cases	70	28	180	122	115	74	81	45	77	35	58	29	83	46	664	379
Sergipe	deaths	5	1	17	8	8	3	0	3	7	3	6	5	8	8	51	31
	HMR (%)	7,14	3,57	9,44	6,56	6,96	4,05	0	6,67	9,09	8,57	10,34	17,24	9,64	17,39	7,68	8,18
São Paulo	cases	101	114	542	671	381	537	346	371	332	298	387	381	686	830	2775	3202
São Paulo	deaths	7	17	20	20	11	10	6	17	10	12	27	23	56	68	137	167
	HMR (%)	6,93	14,91	3,69	2,98	2,89	1,86	1,73	4,58	3,01	4,03	6,98	6,04	8,16	8,19	4,94	5,22
Tocantins	cases	9	8	37	23	26	17	26	13	29	15	22	10	27	31	176	117
Tocantins	deaths	0	0	0	3	1	0	0	1	0	1	1	1	4	4	6	10
	HMR (%)	0	0	0	13,04	3,85	0	0	7,69	0	6,67	4,55	10	14,81	12,90	3,41	8,55
Total	cases	687	549	2768	2824	2140	2182	1789	1509	1732	1276	1888	1567	3709	3614	14713	13521
Total	deaths	90	67	260	189	96	78	68	65	70	57	133	116	346	344	1063	916
	HMR (%)	13,10	12,20	9,39	6,69	4,49	3,57	3,80	4,31	4,04	4,47	7,04	7,40	9,33	9,52	7,22	6,77

Age group	Cluster	2020 *FU	Average *HMR	Cluster	2021 FU	Average HMR
	C1	1	0	C1	3	1
	C2	7	7	C2	7	6
0-28 days	C3	6	10	C3	12	12
	C4	5	17	C4	2	23
	C5	8	22	C5	3	28
	C1	10	5	C1	11	5
	C2	9	12	C2	8	7
29 days to <1 year	C3	6	16	C3	5	11
	C4	1	23	C4	2	13
	C5	1	30	C5	1	52
	C1	13	3	C1	1	0
	C2	7	6	C2	4	2
1-2 years	C3	4	8	C3	8	4
	C4	2	12	C4	8	5
	C5	1	25	C5	6	6
	C1	8	2	C1	6	2
	C2	5	3	C2	7	4
3-5 years	C3	9	5	C3	12	5
	C4	4	7	C4	1	7
	C5	1	11	C5	1	25
	C1	4	1	C1	2	0
	C2	6	3	C2	6	2
6-9 yeas	C3	8	4	C3	9	5
	C4	6	5	C4	8	7
	C5	3	6	C5	2	8
	C1	2	2	C1	2	0
	C2	5	5	C2	2	3
10-14 years	C3	10	7	C3	11	6
	C4	9	9	C4	6	9
	C5	1	13	C5	6	12
	C1	1	2	C1	2	6
	C2	3	7	C2	12	9
15-19 years	C3	9	9	C3	6	10
	C4	11	12	C4	4	13
	C5	3	14	C5	3	16

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[TFN1] *HMR: Hospital Mortality Rate (HMR). Data extracted from opendatasus.saude.gov.br/dataset.

[TFN2] Source: Authors.