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Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil
Open accessAbstract
Background: Heterogeneity in COVID-19 morbidity and mortality is often associated with a country's health-services structure and social inequality. This study aimed to characterize social inequalities in COVID-19 mortality in São Paulo, the most populous city in Brazil and Latin America. Methods: We conducted a population-based study, including COVID-19 deaths among São Paulo residents from March to September 2020. Age-standardized mortality rates and unadjusted rate ratios (RRs) [with corresponding 95% confidence intervals (CIs)] were estimated by race, sex, age group, district of residence, household crowding, educational attainment, income level and percentage of households in subnormal areas in each district. Time trends in mortality were assessed using the Joinpoint model. Results: Males presented an 84% increase in COVID-19 mortality compared with females (RR = 1.84, 95% CI 1.79–1.90). Higher mortality rates were observed for Blacks (RR = 1.77, 95% CI 1.67–1.88) and mixed (RR = 1.42, 95% CI 1.37–1.47) compared with Whites, whereas lower mortality was noted for Asians (RR = 0.63, 95% CI 0.58–0.68). A positive gradient was found for all socio-economic indicators, i.e. increases in disparities denoted by less education, more household crowding, lower income and a higher concentration of subnormal areas were associated with higher mortality rates. A decrease in mortality over time was observed in all racial groups, but it started earlier among Whites and Asians. Conclusion: Our results reveal striking social inequalities in COVID-19 mortality in São Paulo, exposing structural inequities in Brazilian society that were not addressed by the governmental response to COVID-19. Without an equitable response, COVID-19 will further exacerbate current social inequalities in São Paulo.
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“there is ample research supporting the expectation that COVID-19 cases and deaths would be concentrated in lower income sub-city units.”
From Social epidemiology of urban COVID-19 inequalities in Latin America and Canada (2024) · cites this paper as [20]
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“There is now a preponderance of evidence demonstrating that the epidemic has disproportionately affected lower income sub-city units, and the Americas is no exception [17–22].”
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Metadata
- Authors
- Ribeiro, K. B., Ribeiro, A. F., Veras, M. A. D. S. M., & de Castro, M. C.
- Affiliations
- Faculdade de Ciências Médicas da Santa Casa de São Paulo (BR)
- Universidade Municipal de São Caetano do Sul (BR)
- Harvard TH Chan School of Public Health, Department of Global Health and Population, Boston, United States of America
- Corresponding author
- Ribeiro, Karina Braga
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-02-28
- Volume
- 50
- Issue
- 3
- Pages
- 732-742
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC7989375
- OpenAlex
- W3134855230
- Cited by
- 134
- References
- 41
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 27 · 2023: 23 · 2022: 47 · 2021: 17
- FWCI
- 11.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Epidemiology (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Governo Brasil
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 mortality, social inequality, health disparities, racial disparities, sex differences, socioeconomic status, household crowding, educational attainment, income, urban districts, São Paulo, mortality trends, COVID-19 pandemic response
- MeSH terms
- COVID-19, SARS-CoV-2, Brazil, Cities, Crowding, Family Characteristics, Female, Humans, Male, Mortality, Socioeconomic Factors
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