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Santos, Victor, Santos Siqueria, Thayane, CubasAtienzar, Ana, da Rocha Santos, Maria, Fontes Vieirae, Sarah Cristina, de Siqueira Alves Lopes, Aline, Santos Silva, José Rodrigo, Martins-Filho, Paulo Ricardo, Cuevas, Luis 
ORCID: https://orcid.org/0000-0002-6581-0587 and Gurgel, Ricardo Queiroz
(2022)
'Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: a nationwide population-based ecological study'. The Lancet Regional Health - Americas, Vol 13, p. 100311.
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Abstract
Background
Data regarding the geographical distribution of cases and risk factors for COVID-19 death in children and adolescents are scarce. We describe the spatial distribution of COVID-19 cases and deaths in paediatric population and their association with social determinants of health in Brazil.
Methods
This is a population-based ecological study with a spatial analysis of all cases and deaths due to COVID-19 in Brazil among children and adolescents aged 0-19 years from March 2020 to October 2021. The units of analysis were the 5,570 municipalities. Data on COVID-19 cases and deaths, social vulnerability, health inequities, and health system capacity were obtained from publicly available databases. Municipalities were stratified from low to very high COVID-19 incidence and mortality using K-means clustering procedures and spatial clusters and relative risks were estimated using spatial statistics with Poisson probability models. The relationship between COVID-19 estimates and social determinants of health was explored by using multivariate Beta regression techniques.
Findings
A total of 33,991 COVID-19 cases and 2,424 deaths among children and adolescents aged 0-19 years were recorded from March 2020 to October 2021. There was a spatial dependence for the crude mortality coefficient per 100,000 population in the paediatric population aged 0-19 years (I Moran 0·10; P < 0·001). Forty municipalities had higher mortality rates, of which 20 were in states from the Northeast region. Seven spatial clusters were identified for COVID-19 mortality, with four clusters in the Northeast region and three in the North region. Municipalities with higher social inequality and vulnerability had higher COVID-19 mortality in the paediatric population.
Interpretation
The main clusters of risk for mortality among children and adolescents were identified in municipalities in the North and Northeast regions, which are the regions with the worst socioeconomic indicators greatest health disparities in the country. Our findings confirmed the higher burden of COVID-19 for Brazilian paediatric population in municipalities with higher social inequality and vulnerability and worse socioeconomic indicators. To reduce the burden of COVID-19 on children, mass immunisation is necessary.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19 WS Pediatrics > By Age Groups > WS 440 Preschool child WS Pediatrics > By Age Groups > WS 460 Adolescence (General) |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1016/j.lana.2022.100311 |
| Depositing User: | Clare Bennett |
| Date Deposited: | 19 Jul 2022 15:16 |
| Last Modified: | 19 Jul 2022 15:16 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20710 |
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