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COVID-19: study analyzes 250 thousand hospitalizations in Brazil

According to the study, 80% of patients who needed invasive ventilation died in the country. Mortality of hospitalized patients was higher in the North and Northeast, regions that have fewer hospital beds and ICUs per capita


Vulnerable groups including black, indigenous and illiterate people were hardest hit, according to the survey

Published in The Lancet Respiratory Medicine the study entitled “Characterization of the first 250?000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data analyzed the first 250,000 hospitalizations for COVID-19 in Brazil, recorded between February 16 and August 15, 2020, revealing how characteristics of color and age, the need for mechanical ventilation or hospitalization in Intensive Care Units (ICU) affected mortality, as well as the distribution of these data by region. The work, carried out in collaboration between researchers from Brazilian and foreign institutions, aimed to analyze the characteristics of inpatients and examine the impact of the disease on health resources and in-hospital mortality.

According to Doctor Fernando Augusto Bozza, head of the Clinical Research Laboratory for Intensive Care Medicine at the National Institute of Infectious Diseases Evandro Chagas of the Oswaldo Cruz Foundation (INI/Fiocruz), the study did a retrospective analysis of hospitalizations of patients over 20 years of age diagnosed with COVID-19 confirmed by RT-PCR and registered in the Influenza Surveillance Information System (Sivep-Gripe), Brazils National Surveillance System. The researchers compared the regional load of hospital admissions, stratified by age, admission to intensive care units and the use of respiratory support.

According to the researcher, the results showed that although COVID-19 did put pressure on the health system in all regions, the need for hospitalization and mortality at the beginning of the pandemic was considerably greater in the North and Northeast regions. “General hospital mortality was 38% for the whole country. In the North, 6,727 people lost their lives, which represents almost half of those hospitalized. In the Northeast region, 21,858 died, which represents 48%”, details Dr. Bozza. The South was the least affected, 7,697 deaths, that is, a rate of 31% among those hospitalized.

In addition, the study also highlighted regional disparities between people hospitalized in ICUs. When comparing the percentage by region, the data show that 79% of the people hospitalized in these units died in the North; 66% in the Northeast; 53% in the South; 51% in the Midwest; and 49% in the Southeast. In total, 59% of those admitted to Brazilian ICUs lost their lives and 80% of those who needed mechanical ventilation died, that is, of the 45,205 intubated people, 36,046 died.

According to Doctor Bozza, mortality among patients under 60 is another aspect that draws attention. “Although the North and Northeast regions have a higher proportion of young people, this population has also been affected. It was observed that a significant percentage of people hospitalized and who died were less than 60 years old”, he points out. The data point to a mortality rate of 31% in the Northeast, against 15% in the South.

Another aspect that highlights the inequalities, according to the researcher, concerns vulnerable groups that include blacks, indigenous people and illiterates, who, according to the survey, were the most affected. According to the data, 43% of blacks and browns lost their lives, followed by 42% of indigenous people, against 40% of Asians and 36% of whites. The proportion of deaths was also lower when the level of education was assessed: 63% illiterate; 30% with high school degrees and 23% with undergraduate courses.

Finally, Dr. Bozza points out that, to date, the mortality data of patients hospitalized with COVID-19 and its effects on health systems in low and middle income countries are quite limited. In this sense, the research contributes by documenting the effect of the pandemic on the populations and the Brazilian health system, and by showing the importance of having a balanced, impartial and fair health system, especially for the most vulnerable, he concludes .

The group of researchers who developed the work also has the participation of professionals from the University of São Paulo (USP), Pontifical Catholic University of Rio de Janeiro (PUC-RJ), DOR Institute for Research and Education (Idor) and the Barcelona Institute for Global Health (ISGlobal).