172 lines
5.6 KiB
YAML
172 lines
5.6 KiB
YAML
abstract: 'Background COVID-19 spread rapidly in Brazil despite the country''s well
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established health and social protection systems. Understanding the
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relationships between health-system preparedness, responses to COVID-19,
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and the pattern of spread of the epidemic is particularly important in a
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country marked by wide inequalities in socioeconomic characteristics
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(eg, housing and employment status) and other health risks (age
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structure and burden of chronic disease).
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Methods From several publicly available sources in Brazil, we obtained
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data on health risk factors for severe COVID-19 (proportion of the
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population with chronic disease and proportion aged >= 60 years),
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socioeconomic vulnerability (proportions of the population with housing
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vulnerability or without formal work), health-system capacity (numbers
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of intensive care unit beds and physicians), coverage of health and
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social assistance, deaths from COVID-19, and state-level responses of
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government in terms of physical distancing policies. We also obtained
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data on the proportion of the population staying at home, based on
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locational data, as a measure of physical distancing adherence. We
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developed a socioeconomic vulnerability index (SVI) based on household
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characteristics and the Human Development Index. Data were analysed at
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the state and municipal levels. Descriptive statistics and correlations
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between state-level indicators were used to characterise the
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relationship between the availability of health-care resources and
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socioeconomic characteristics and the spread of the epidemic and the
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response of governments and populations in terms of new investments,
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legislation, and physical distancing. We used linear regressions on a
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municipality-by-month dataset from February to October, 2020, to
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characterise the dynamics of COVID-19 deaths and response to the
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epidemic across municipalities.
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Findings The initial spread of COVID-19 was mostly affected by patterns
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of socioeconomic vulnerability as measured by the SVI rather than
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population age structure and prevalence of health risk factors. The
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states with a high (greater than median) SVI were able to expand
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hospital capacity, to enact stringent COVID-19-related legislation, and
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to increase physical distancing adherence in the population, although
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not sufficiently to prevent higher COVID-19 mortality during the initial
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phase of the epidemic compared with states with a low SVI. Death rates
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accelerated until June, 2020, particularly in municipalities with the
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highest socioeconomic vulnerability. Throughout the following months,
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however, differences in policy response converged in municipalities with
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lower and higher SVIs, while physical distancing remained relatively
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higher and death rates became relatively lower in the municipalities
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with the highest SVIs compared with those with lower SVIs.
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Interpretation In Brazil, existing socioeconomic inequalities, rather
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than age, health status, and other risk factors for COVID-19, have
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affected the course of the epidemic, with a disproportionate adverse
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burden on states and municipalities with high socioeconomic
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vulnerability. Local government responses and population behaviour in
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the states and municipalities with higher socioeconomic vulnerability
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have helped to contain the effects of the epidemic. Targeted policies
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and actions are needed to protect those with the greatest socioeconomic
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vulnerability. This experience could be relevant in other low-income and
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middle-income countries where socioeconomic vulnerability varies
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greatly.Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.'
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affiliation: 'Atun, R (Corresponding Author), Harvard TH Chan Sch Publ Hlth, Dept
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Global Hlth \& Populat, Boston, MA 02115 USA.
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Rocha, Rudi; Massuda, Adriano, Fundacao Getulio Vargas, Sao Paulo Sch Business Adm,
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Sao Paulo, Brazil.
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Rocha, Rudi; Rache, Beatriz; Nunes, Leticia, Inst Estudos Polit Saude, Sao Paulo,
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Brazil.
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Atun, Rifat; Castro, Marcia C., Harvard TH Chan Sch Publ Hlth, Dept Global Hlth
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\& Populat, Boston, MA 02115 USA.
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Spinola, Paula, UCL, Ctr Global Hlth Econ, London, England.
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Lago, Miguel, Inst Estudos Polit Saude, Rio De Janeiro, Brazil.'
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author: Rocha, Rudi and Atun, Rifat and Massuda, Adriano and Rache, Beatriz and Spinola,
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Paula and Nunes, Leticia and Lago, Miguel and Castro, Marcia C.
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author-email: ratun@hsph.harvard.edu
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author_list:
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- family: Rocha
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given: Rudi
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- family: Atun
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given: Rifat
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- family: Massuda
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given: Adriano
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- family: Rache
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given: Beatriz
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- family: Spinola
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given: Paula
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- family: Nunes
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given: Leticia
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- family: Lago
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given: Miguel
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- family: Castro
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given: Marcia C.
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da: '2023-09-28'
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doi: 10.1016/S2214-109X(21)00081-4
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earlyaccessdate: MAY 2021
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esi-highly-cited-paper: Y
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esi-hot-paper: N
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files: []
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issn: 2214-109X
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journal: LANCET GLOBAL HEALTH
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keywords-plus: COMMUNICATION
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language: English
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month: JUN
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number: '6'
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number-of-cited-references: '38'
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orcid-numbers: 'Spinola, Paula/0000-0002-4554-4250
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Castro, Marcia/0000-0003-4606-2795'
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pages: E782-E792
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papis_id: 226fc75d3a4c55779118d4e972112da8
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ref: Rocha2021effectsocioeconomic
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researcherid-numbers: 'Spinola, Paula/HKW-4879-2023
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Castro, Marcia/S-2681-2019'
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times-cited: '131'
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title: 'Effect of socioeconomic inequalities and vulnerabilities on health-system
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preparedness and response to COVID-19 in Brazil: a comprehensive analysis'
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type: article
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unique-id: WOS:000652845500025
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usage-count-last-180-days: '5'
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usage-count-since-2013: '35'
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volume: '9'
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web-of-science-categories: Public, Environmental \& Occupational Health
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year: '2021'
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