Latent class analysis of COVID-19 symptoms in Brazil: results of the PNAD-COVID19 survey

Moreira, Rafael da Silveira

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Brasil

Cadernos de Saúde Pública

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ARTICLE • Cad. Saúde Pública 37 (1) • 2021 • https://doi.org/10.1590/0102-311X00238420 copy

Latent class analysis of COVID-19 symptoms in Brazil: results of the PNAD-COVID19 survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

The lack of mass testing for COVID-19 diagnosis creates the need to determine the magnitude of the disease based on its clinical symptoms. The study aimed to analyze the profile of COVID-19 symptoms and related aspects in Brazil. The author analyzed the sample of participants from the Brazilian National Household Sample Survey (PNAD-COVID19) conducted in May 2020. Latent class analysis (LCA) was performed with sociodemographic covariables and 11 symptoms reported by 346,181 individuals. Rao-Scott test and standardized residual analysis were used to measure the association with the pattern of health services use. Spatial scan analysis was performed to identify areas at risk of COVID-19 cases. LCA showed six classes of symptoms based on the pattern of answers by participants: (1) all the symptoms; (2) high prevalence of symptoms; (3) predominance of fever; (4) predominance of cough/sore throat; (5) mild symptoms with predominance of headache; and (6) absence of symptoms. Female sex, brown skin color, the North and Northeast regions of Brazil, and all three older age brackets showed stronger association with the class with all the symptoms (class 1). Most use of health services was also by this group of individuals, but with different profiles of use. Spatial analysis showed juxtaposition of this class with areas at greater risk of COVID-19. These finding underline the importance of investigating symptoms for the epidemiological identification of possible cases in a scenario with low population testing rates.

Keywords:
COVID-19; Latent Class Analysis; Pandemics; Epidemiological Monitoring

	All the symptoms		High prevalence of the symptoms		Predominance of fever		Predominance of cough/sore throat		Mild symptoms with predominance of headache
	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI	OR	95%CI
Sex
Male	1.00		1.00		1.00		1.00		1.00
Female	1.31	1.13-1.53	1.10	0.97-1.25	2.13	1.80-2.51	2.11	1.91-2.35	0.75	0.61-0.93
Color
White	1.00		1.00		1.00		1.00		1.00
Black	1.19	0.92-1.53	1.10	0.91-1.34	1.55	1.24-1.93	1.15	0.98-1.34	1.06	0.80-1.39
Asian-descendant and Indigenous	1.43	0.95-2.15	1.80	1.08-3.01	1.02	0.50-2.05	1.33	0.98-1.81	1.47	0.94-2.28
Brown	1.34	1.13-1.58	1.16	1.02-1.31	1.20	1.04-1.39	1.06	0.97-1.15	1.03	0.91-1.18
Schooling
None	1.00		1.00		1.00		1.00		1.00
Incomplete primary	2.01	1.41-2.86	1.32	0.99-1.76	1.26	0.84-1.87	1.97	1.40-2.87	0.89	0.67-1.18
Primary and secondary	3.22	2.28-4.54	1.84	1.33-2.55	1.36	0.66-2.79	2.14	1.45-3.15	0.84	0.60-1.18
University and graduate	3.18	2.23-4.52	1.24	0.85-1.81	1.65	0.82-3.30	3.04	2.01-4.61	1.27	0.71-2.26
Age
Quartile 1 (1 years and under)	1.00		1.00		1.00		1.00		1.00
Quartile 2 (19-36 years)	2.88	2.27-3.66	1.55	1.28-1.87	7.07	2.52-19.86	5.30	3.73-7.54	0.92	0.65-1.29
Quartile 3 (37-53 years)	3.64	2.90-4.57	1.73	1.38-2.17	9.64	3.34-27.84	6.01	4.12-8.78	0.71	0.43-1.16
Quartile 4 (53 years and older)	2.23	1.71-2.91	1.17	0.95-1.44	9.63	2.33-39.73	3.63	2.27-5.81	1.25	0.65-2.38
Region
Southeast	1.00		1.00		1.00		1.00		1.00
North	8.35	5.21-13.39	9.25	5.79-14.78	1.27	0.69-2.36	1.04	0.86-1.25	0.54	0.27-1.06
Northeast	2.30	1.69-3.14	5.51	3.68-8.25	0.83	0.45-1.53	1.09	0.95-1.24	0.63	0.43-0.92
South	0.27	0.13-0.57	0.29	0.13-0.64	1.11	0.73-1.69	1.14	1.01-1.29	0.90	0.73-1.11
Central	0.34	0.15-0.76	0.73	0.48-1.11	0.69	0.54-0.87	0.82	0.69-0.97	0.51	0.38-0.68

Variables	All the symptoms (n = 1,315; 0.38%)	High prevalence of symptoms (n = 4,204; 1.21%)	Predominance of fever (n = 2,391; 0.70%)	Predominance of cough/sore throat (n = 9,598; 2.77%)	Mild symptoms with predominance of headache (n = 6,361; 1.84%)	Without symptoms (n = 322,310; 93.10%)	Total (N = 346,179; 100.00%)
Went to healthcare service
Yes	47.00 **	31.90 **	28.80 **	13.30	12.70	8.00	15.50
No	53.00	68.10	71.20	86.70 **	87.30 **	92.00 **	84.50
Measure taken
Stayed at home *
Yes	94.30 **	91.00 **	92.00 **	84.80 **	83.10	80.20	83.90
No	5.70	9.00	8.00	15.20	16.90	19.80 **	16.10
Called a healthcare worker *
Yes	23.00 **	16.30 **	11.30 **	5.10	5.50	3.10	6.10
No	77.00	83.70	88.70	94.90 **	94.50	96.90 **	93.90
Self-medication *
Yes	68.70 **	72.10 **	78.20 **	55.70	55.20	54.10	58.00
No	31.30	27.90	21.80	44.30 **	44.80 **	45.90 **	42.00
Medication prescribed by physician *
Yes	27.10 **	19.60 **	11.40	12.00	18.00 **	13.70	14.70
No	72.90	80.40	88.60 **	88.00 **	82.00	86.30 **	85.30
Received visit from a healthcare worker from the SUS *
Yes	6.00 **	4.00	4.40	2.80	3.80 **	2.40	3.10
No	94.00	96.00	95.60	97.20	96.20	97.60 **	96.90
Received visit from a private healthcare worker *
Yes	4.10 **	2.00 **	1.90 **	0.80	0.60	0.60	0.90
No	95.90	98.00	98.10	99.20	99.40 **	99.40 **	99.10
Healthcare service
UBS/Family health team *
Yes	47.50	48.20	46.90	54.20 **	48.90	41.60	48.20
No	52.50	51.80	53.10	45.80	51.10	58.40 **	51.80
UPA *
Yes	34.60 **	28.30 **	26.00	18.50	15.90	18.00	22.90
No	65.40	71.70	74.00	81.50 **	84.10 **	82.00 **	77.10
Hospital in the SUS *
Yes	24.10	20.60	21.40	14.80	18.50	20.40	19.50
No	75.90	79.40	78.60	85.20 **	81.50	79.60	80.50
Private physician’s office
Yes	8.30	7.90	7.80	9.20	10.50	12.40	9.40
No	91.70	92.10	92.20	90.80	89.50	87.60	90.60
Private urgent care service *
Yes	4.50	6.10 **	4.10	1.90	2.20	3.00	3.70
No	95.50	93.90	95.90	98.10 **	97.80 **	97.00	96.30
Private hospital
Yes	14.30	13.10	10.60	10.00	11.80	11.30	11.80
No	85.70	86.90	89.40	90.00	88.20	88.70	88.20
Hospitalized *
Yes	23.30 **	13.20	8.20	7.80	3.80	9.40	10.90
No	70.60	85.20	90.20	91.40 **	95.00 **	90.20	87.30
Unable to obtain admission	6.10 **	1.70	1.60	0.80	1.20	0.50	1.80

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[1] Correspondence
R. S. Moreira Instituto Aggeu Magalhães, Fundação Oswaldo Cruz. Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, PE 50670-420, Brasil. rafael.moreira@fiocruz.br