Trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, 2020–2022

Santos, Hebert Luan Pereira Campos dos; Trindade, Emmanuel Santos; Oliveira, Esly Rebeca Amaral; Cordeiro, Marcos Vinicius da Silva; Oliveira, Rian Silva de; Lima, Elvira Caires de; Santos, Adriano Maia dos; Prado, Nília Maria de Brito Lima

doi:10.11606/s1518-8787.2024058006032

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Original Article • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058006032 copy

Trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, 2020–2022

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the incompleteness and trend of incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death, in Brazil, between April 2020 and April 2022.

METHODS

Ecological time series study on the incompleteness of the race/color variable in hospitalizations due to COVID-19 whose outcome was death in Brazil, its macro-regions and Federative Units (FU), by joinpoint regression, calculation of Monthly Percent Change (MPC) and Average Monthly Percent Change (AMPC), based on data from the Hospital Information System of the Unified Health System (SIH/SUS).

RESULTS

The incompleteness of the race/color variable in COVID-19 hospitalizations with a death outcome in Brazil was 25.85%, considered poor. All regions of the country had a poor degree of incompleteness, except for the South, which was considered regular. In the period analyzed, the joinpoint analysis revealed a stable trend in the incompleteness of the race/color variable in Brazil (AMPC = 0.54; 95%CI: -0.64 to 1.74; p = 0.37) and in the Southeast (AMPC = -0.61; 95%CI: -3.36 to 2.22; p = 0.67) and North (AMPC = 3.74; 95%CI: -0.14 to 7.78; p = 0.06) regions. The South (AMPC = 5.49; 95%CI: 2.94 to 8.11; p = 0.00002) and Northeast (AMP = 2.50; 95%CI: 0.77 to 4.25; p = 0.005) regions showed an increase in the incompleteness trend, while the Midwest (AMPC = -2.91 ; 95%CI: -5.26 to -0.51; p = 0.02) showed a downward trend.

CONCLUSION

The proportion of poor completeness and the stable trend of incompleteness show that there was no improvement in the quality of filling in the race/color variable during the COVID-19 pandemic in Brazil, a fact that may have increased health inequalities for the black population and made it difficult to plan strategic actions for this population, considering the pandemic context. The results found reinforce the need to encourage discussion on the subject, given that the incompleteness of health information systems increases inequalities in access to health services and compromises the quality of health data.

Information Systems; Black People; Time Series Studies; Health Observatory; COVID-19; Health of Ethnic Minorities; Pandemics; Ethnic Inequality

Region/UF	Incompleteness (%)	Classification^a
Brazil	25.85	Poor
Northern Region	20.72	Poor
Rondônia	34.52	Poor
Acre	10.59	Regular
Amazonas	15.77	Regular
Roraima	6.46	Good
Pará	21.13	Poor
Amapá	57.52	Very poor
Tocantins	3.01	Excellent
Northeast Region	39.18	Poor
Maranhão	51.76	Very poor
Piauí	50.36	Very poor
Ceará	27.93	Poor
Rio Grande do Norte	47.36	Poor
Paraíba	41.81	Poor
Pernambuco	36.78	Poor
Alagoas	28.28	Poor
Sergipe	75.67	Very poor
Bahia	32.65	Poor
Midwest Region	40.62	Poor
Mato Grosso do Sul	16.87	Regular
Mato Grosso	29.89	Poor
Goiás	51.12	Very poor
Federal District	57.28	Very poor
Southeast Region	22.17	Poor
Minas Gerais	16.6	Regular
Espírito Santo	18.27	Regular
Rio de Janeiro	38.72	Poor
São Paulo	18.39	Regular
Southern Region	12.94	Regular
Paraná	15.24	Regular
Rio Grande do Sul	16.32	Regular
Santa Catarina	2.72	Excellent

Region/UF	Period	MPC (95%CI)	p-value	Trends	AMPC (95%CI)	p-value	Trends
Brazil	Apr/20–Jun/20	16.96 (4.92 to 30.38)	0.008	Growth	0.54 (-0.64 to 1.74)	0.37	Stability
	Jun/20–Nov/20	-4.66 (-7.89 to -1.33)	0.010	Reduction
	Nov/20–Aug/21	2.48 (1.27 to 3.70)	0.0006	Growth
	Aug/21–Apr/21	-2.04 (-3.19 to -0.87)	0.002	Reduction
Northern Region	Apr/20–Jun/20	32.26 (-11.54 to 97.74)	0.16	Stability	3.74 (-0.14 to 7.78)	0.06	Stability
	Jun/20–Dec/21	-0.66 (-2.05 to 0.75)	0.33	Stability
	Dec/21–Apr/22	11.71 (-1.63 to 26.86)	0.08	Stability
Amazonas	Apr/20–Apr/22	-0.03 (-2.64 to 2.66)	0.98	Stability	-0.03 (-2.64 to 2.66)	0.98	Stability
Pará	Apr/20–Sep/20	13.17 (-3.99 to 33.41)	0.13	Stability	2.13 (-2.58 to 7.06)	0.38	Stability
	Sep/20–Aug/21	-10.31 (-15.30 to -5.02)	0.0009	Reduction
	Aug/21–Apr/22	14.50 (5.67 to 24.07)	0.002	Growth
Northeast Region	Apr/20–Jun/20	24.07 (0.54 to 53.09)	0.04	Growth	2.50 (0.77 to 4.25)	0.005	Growth
Northeast Region	Jun/20–Abr/22	0.73 (0.23 to 1.24)	0.006	Growth	2.50 (0.77 to 4.25)	0.005	Growth
Maranhão	Apr/20–Jun/20	55.78 (-2.86 to 149.81)	0.06	Stability	2.06 (-3.19 to 7.60)	0.45	Stability
	Jun/20–Feb/22	0.47 (-0.92 to 1.89)	0.49	Stability
	Feb/22–Abr/22	-21.77 (-51.22 to 25.45)	0.29	Stability
Piauí	Apr/20–Jun/20	-31.85 (-55.81 to 5.10)	0.08	Stability	-3.09 (-6.43 to 0.37)	0.08	Stability
Piauí	Jun/20–Abr/22	0.06 (-0.96 to 1.10)	0.9	Stability	-3.09 (-6.43 to 0.37)	0.08	Stability
Ceará	Apr/20–Sep/21	3.85 (1.65 to 6.09)	0.002	Growth	2.76 (-4.96 to 11.11)	0.49	Stability
	Sep/21–Dec/21	-28.11 (-60.93 to 32.29)	0.27	Stability
	Dec/21–Apr/22	28.47 (5.94 to 55.80)	0.01	Growth
Rio Grande do Norte	Apr/20–Apr/22	1.85 (0.64 to 3.07)	0.004	Growth	1.85 (0.64 to 3.07)	0.004	Growth
Paraíba	Apr/20–Apr/22	-0.39 (-2.23 to 1.47)	0.66	Stability	-0.39 (-2.23 to 1.47)	0.66	Stability
Pernambuco	Apr/20–Jun/20	38.54 (-3.12 to 98.10)	0.07	Stability	3.62 (-1.86 to 9.41)	0.2	Stability
	Jun/20–Nov/20	-9.16 (-18.87 to 1.72)	0.09	Stability
	Nov/20–Feb/21	27.52 (-10.82 to 82.34)	0.17	Stability
	Feb/21–Abr/22	-0.33 (-1.99 to 1.35)	0.68	Stability
Alagoas	Apr/20–Aug/20	-36.29 (-57.68 to -4.08)	0.03	Reduction	-4.51 (-10.95 to 2.40)	0.2	Stability
Alagoas	Aug/20–Abr/22	3.54 (-0.07 to 7.28)	0.05	Stability	-4.51 (-10.95 to 2.40)	0.2	Stability
Bahia	Apr/20–Apr/22	-1.98 (-3.49 to -0.45)	0.01	Reduction	-1.98 (-3.49 to -0.45)	0.01	Reduction
Midwest Region	Apr/20–Nov/20	-9.27 (-12.53 to -5.90)	0.00003	Reduction	-2.91 (-5.26 to -0.51)	0.02	Reduction
	Nov/20–Feb/21	7.80 (-5.98 to 23.60)	0.26	Stability
	Feb/21–Abr/22	-2.49 (-3.88 to -1.08)	0.002	Reduction
Goiás	Apr/20–Apr/22	-1.79 (-2.95 to -0.62)	0.004	Reduction	-1.79 (-2.95 to -0.62)	0.004	Reduction
Federal District	Apr/20–Apr/22	-2.03 (-2.80 to -1.25)	0.00002	Reduction	-2.03 (-2.80 to -1.25)	0.00002	Reduction
Southeast Region	Apr/20–Jun/20	12.48 (-7.30 to 36.48)	0.21	Stability	-0.61 (-3.36 to 2.22)	0.67	Stability
	Jun/20–Sept/20	-10.06 (-25.88 to 9.14)	0.26	Stability
	Sep/20–Sep/21	2.47 (1.14 to 3.82)	0.001	Growth
	Sep/21–Apr/22	-4.97 (-7.40 to -2.48)	0.0008	Reduction
Rio de Janeiro	Apr/20–Apr/22	0.65 (-0.48 to 1.80)	0.25	Stability	0.65 (-0.48 to 1.80)	0.25	Stability
São Paulo	Apr/20–Jun/20	17.57 (-11.27 to 55.79)	0.24	Stability	-1.77 (-5.74 to 2.36)	0.4	Stability
	Jun/20–Sept/20	-13.87 (-35.00 to 14.13)	0.27	Stability
	Sep/20–Nov/21	0.90 (-0.58 to 2.40)	0.22	Stability
	Nov/21–Apr/22	-8.23 (-13.83 to -2.27)	0.01	Reduction
Southern Region	Apr/20–Jun/20	73.07 (32.04 to 126.84)	0.0005	Growth	5.49 (2.94 to 8.11)	0.00002	Growth
	Jun/20–Out/21	2.77 (1.60 to 3.95)	0.0001	Growth
	Oct/21–Apr/22	-4.09 (-8.38 to 0.39)	0.07	Stability
Paraná	Apr/20–Aug/20	31.79 (14.08 to 52.25)	0.0007	Growth	5.48 (2.92 to 8.11)	0.00002	Growth
Paraná	Aug/20–Abr/22	0.89 (-0.37 to 2.16)	0.16	Stability	5.48 (2.92 to 8.11)	0.00002	Growth

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[1] Correspondence: Nília Maria de Brito Lima Prado Universidade Federal da Bahia Instituto Multidisciplinar em Saúde Rua Hormindo Barros, 58, Quadra 17, Lote 58 45029-094 Vitória da Conquista, BA, Brasil E-mail: nilia.prado@ufba.br