Raça/cor/etnia e outros fatores associados a complicações da COVID-19

Abstract

Introduction: COVID-19 is an infectious condition that affects the respiratory tract, caused by a new coronavirus, the SARS-CoV-2, with high power of dissemination, which has brought biological, epidemiological, sanitary repercussions, in addition to causing social impacts, economic and political in Brazil and in the world. Skin color/race/ethnicity, along with other sociodemographic and health conditions, have been identified as potential factors associated with the worsening of the condition, especially in subgroups considered vulnerable and requiring precautions to contain this condition. Objectives: I) To investigate the association between race/skin color and hospitalization or death due to COVID-19 (Study 1), through a systematic review with meta-analysis (Study 1). II) To identify, through a cross sectional study, sociodemographic factors associated with COVID-19, in the municipality of Camaçari, Bahia (Study 2). Method: Study 1- A systematic review was undertaken with meta-analysis relevant to the influence of skin color/race/ethnicity on the association between hospitalization and death from COVID-19. In order to do so, the guided eligibility criteria were rigorously followed and the structured search was conducted using the electronic databases: MedLine/PubMed Web of Science, Scopus, BVS, and MedRxviv until August 2022. A total of 5,028 records were identified, and in the end, 41 articles met the eligibility criteria: 18 articles presented measures of association for both outcomes, 16 included only measures of association between race/color and hospitalization for COVID-19, and 07 met the criteria for the outcome mortality and black race/skin color. Subsequently, data extraction and evaluation of the quality of the studies by two collaborators, independently, obtaining the measures of global association between race/skin color and hospitalization, death by COVID-19 (OR and respective confidence intervals) at 95%); the Higgins and Thompson indicator (I2 ) was also estimated to assess statistical heterogeneity between studies. Study 2 – An observational, cross-sectional study was conducted, based on the collection of information from the Department of Informatics of the Unified Health System (OpenDATASUS), including confirmed cases of COVID-19, in the municipality of Camaçari, Bahia, between 2020 and 2021. Initially, the distribution of 34,660 confirmed COVID-19 cases by race/color was investigated. Then, the distribution of the disease was also determined, for investigated covariates, using the chi-square test with a significance level of 5%. To test the hypothesis of association between the race/skin color variable and COVID-19, adjusted for the covariates of interest, non-conditional regression analysis was used, estimating the odds ratio measures and their respective confidence interval. The STATA 17 statistical package was used throughout the study. Results: In Study 1, according to the global metaanalytic measure, black race/skin color was associated with hospitalization for COVID-19 (OR= 1.97; 95% CI: 1.75-2.23: I²= 58.5%), as well as death by COVID-19 (OR= 1.54; 95% CI: 1.20-1.98: I²= 38.7%). For Study 2, an analysis between the years 2020 and 2021, for confirmed cases, 19.7% of the race/color question was not filled out in the first year, while in the following year, the total of ignored information about race/color, was 28.54%. In addition, black individuals under the age of 60 years, with a higher proportion of males and a higher occurrence of at least one risk factor for COVID-19, were more affected by the disease, when compared to non-black individuals. Blacks without comorbidities were 16% more likely to die (OR: 1.16; 95% CI 1.02 - 1.31), when compared to non-blacks, these findings were statistically significant, when adjusting for the variables age and sex (p<0.018). Conclusion: Study 1 - the findings showed evidence that black race/skin color is a factor associated with both hospitalization and mortality from COVID-19. Study 2 - black individuals with COVID-19 who had no prior previous risk factor for the disease had a higher risk of mortality when compared to non-black individuals, despite the considerable proportion of lack of data for the race/skin color variable. Therefore, from an ethnic-racial perspective, it is extremely important to promote actions so that the race/skin color issue is adequately filled in the forms and systems of health services, in order to generate more reliable information, which are indispensable tools to mitigate health-related disparities of the black population and other vulnerable population subgroups.