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COVID-19 Mortality in Public Hospitals in the State of Espírito Santo, Brazil: An Analysis of the Three Waves of the Pandemic
21 Pages Posted: 25 Mar 2022
More...Abstract
Background: In Brazil, the political scenario and the lack of integration of national planning policies with states and municipalities did not favor the confrontation of the pandemic. Given this, the use of existing information in information systems can be a good tool to monitor the epidemic, to plan measures of prevention and control, and to evaluate the impact of this new virus on the morbidity and mortality profile in Brazil.
Objective: To analyze COVID-19 deaths in public hospitals in the state of Espírito Santo, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables. Methods: Observational analytical study, where 5,436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between April 1, 2020, and August 31, 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson’s chi-square, Fisher’s Exact or Friedman’s tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses.
Results: The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O 2 saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability/confusion, adynamia/weakness, chronic cardiovascular disease, neoplasms, diabetes mellitus, individuals from the metropolitan region, central/north region. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves (p<0.05).
Conclusion: To the best of our knowledge, this is the first study conducted in Brazil that analyzes COVID-19 mortality in public hospitals, besides providing stratified information between the three different waves of the pandemic. We conclude that the time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021 which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics. The analysis of deaths by COVID-19 is extremely relevant to support the management in the planning of the Health Care Network (Rede de Atenção à Saúde).
Funding Information: No financial support.
Declaration of Interests: All authors declare no competing interests.
Ethics Approval Statement: : This study involves human participants and was approved by an Ethics Committee or Institutional Board - Centro de Ciências da Saúde da Universidade Federal do Espírito Santo - CEP/CCS/UFES) and approved under opinion no. 4166025 of July 21, 2020), in accordance with the relevant guidelines from the Declaration of Helsinki and the ethical principles in the National Health Council of Brazil.
Keywords: Keywords: Coronavirus Infections, COVID-19, mortality, Public Health Surveillance, Epidemiologic Monitoring, Health Management, Public Hospitals.
Suggested Citation: Suggested Citation