Spatial analysis of socio-economic factors and their relationship with the cases of COVID-19 in Pernambuco, Brazil

The geographical distribution and socioeconomic risk factors of COVID-19, tuberculosis and leprosy in Fortaleza, Brazil

BACKGROUND

Fortaleza (Brazil) is high endemic for coronavirus disease 2019 (COVID-19), tuberculosis (TB) and leprosy. These three diseases share respiratory droplets through coughing or sneezing as the main mode of transmission but differ in incubation time, with COVID-19 having a short and leprosy a long incubation time. Consequently, contacts of a patient are at higher risk of infection and developing these diseases. There might be scope for combined preventive measures, but a better understanding of the geographical distribution and relevant socioeconomic risk factors of the three diseases is needed first. This study aims to describe the geographic distribution of COVID-19, TB and leprosy incidence and to identify common socioeconomic risk factors.

METHODS

The total number of new cases of COVID-19, TB and leprosy, as well as socioeconomic and demographic variables, were retrieved from official registers. The geographical distribution of COVID-19, TB and leprosy rates per neighbourhood was visualised in Quantum GIS, and spatial autocorrelation was measured with Moran's I in GeoDa. A spatial regression model was applied to understand the association between COVID-19, TB, leprosy rates, and socioeconomic factors.

RESULTS

COVID-19 and TB showed a more homogenous distribution, whereas leprosy is located more in the south and west of Fortaleza. One neighbourhood (Pedras) in the southeast was identified as high endemic for all three diseases. Literacy was a socioeconomic risk factor for all three diseases: a high literacy rate increases the risk of COVID-19, and a low literacy rate (i.e., illiteracy) increases the risk of TB and leprosy. In addition, high income was associated with COVID-19, while low income with TB.

CONCLUSIONS

Despite the similar mode of transmission, COVID-19, TB and leprosy show a different distribution of cases in Fortaleza. In addition, associated risk factors are related to wealth in COVID-19 and to poverty in TB and leprosy. These findings may support policymakers in developing (partially combined) primary and secondary prevention considering the efficient use of resources.

Association of socioeconomic indicators with COVID-19 mortality in Brazil: a population-based ecological study

The article presents an analysis of the spatial distribution of mortality from COVID-19 and its association with socioeconomic indicators in the north-eastern region of Brazil - an area particularly vulnerable with regard to these indicators. This populationbased ecology study was carried out at the municipal level in the years 2020 and 2021, with analyses performed by spatial autocorrelation, multiple linear regression and spatial autoregressive models. The results showed that mortality from COVID-19 in this part of Brazil was higher in the most populous cities with better socioeconomic indicators. Factors such as the onset of the COVID-19 pandemic in large cities, the agglomerations existing within them, the pressure to maintain economic activities and mistakes in the management of the pandemic by the Brazilian federal Government were part of the complex scenario related to the spread of COVID-19 in the country and this study was undertaken in an attempt to understand this situation. Analysing the different scenarios is essential to face the challenges posed by the pandemic to the world's health systems.

Deforestation impacts on dengue incidence in the Brazilian Amazon

The objective of the study is to perform the spatial analysis of the conditioning factors for the increase in the incidence rate of dengue cases in municipalities located in the Amazon biome, in the period from 2016 to 2021. Three statistical approaches were applied: Moran's index, ordinary least squares regression, and geographically weighted regression. The results revealed that the incidence rates of dengue cases cluster in two areas, both located in the south of the Amazon biome, which is associated with the Arc of Deforestation. The variable deforestation influences the increase in dengue incidence rates revealed by the OLS and GWR model. The adjusted R² of the GWR model was 0.70, that is, the model explains about 70% of the total case variation of dengue incidence rates in the Amazon biome. The results of the study evidence the need for public policies aimed at the prevention and combat of deforestation in the Amazon region.

The long-term dynamic relationship between communicable disease spread, economic prosperity, greenhouse gas emissions, and government health expenditures: preparing for COVID-19-like pandemics

The spread of communicable diseases, such as COVID-19, has a detrimental effect on our socio-economic structure. In a dynamic log-run world, socio-economic and environmental factors interact to spread communicable diseases. We investigated the long-term interdependence of communicable disease spread, economic prosperity, greenhouse gas emissions, and government health expenditures in India's densely populated economy using a variance error correction (VEC) approach. The VEC model was validated using stationarity, cointegration, autocorrelation, heteroscedasticity, and normality tests. Our impulse response and variance decomposition analyses revealed that economic prosperity (GNI) significantly impacts the spread of communicable diseases, greenhouse gas emissions, government health expenditures, and GNI. Current health expenditures can reduce the need for future increases, and the spread of communicable diseases is detrimental to economic growth. Developing economies should prioritize economic growth and health spending to combat pandemics. Simultaneously, the adverse effects of economic prosperity on environmental degradation should be mitigated through policy incentives.

Human Development Index Is Associated with COVID-19 Case Fatality Rate in Brazil: An Ecological Study

The Human Development Index measures a region's development and is a step for development debate beyond the traditional, economic perspective. It can also determine the success of a country's response to the COVID-19 pandemic, mainly affecting the case fatality rate among severe cases of SARS-CoV-2 infection. We aimed to associate the Human Development Index with the case fatality rate due to COVID-19 in each Brazilian state and the Federal District, taking into account comorbidities and the need for invasive mechanical ventilation. We also evaluated the influence of the GINI index, number of intensive care unit beds, and occupied households in subnormal clusters on the case fatality rate. We performed an ecological study including two populations: COVID-19 individuals that did not require the mechanical ventilation protocol; and COVID-19 individuals under invasive mechanical ventilation. We performed a Pearson correlation test and a univariate linear regression analysis on the relationship between Human Development Index, Human Development Index-Education Level, Human Development Index-Life Expectancy, and Human Development Index-Gross National Income per capita and COVID-19 deaths. The same analyses were performed using the other markers. We grouped the patients with COVID-19 according to comorbidities and the need for invasive mechanical ventilation. Alpha = 0.05. We included 848,501 COVID-19 individuals, out of which 153,710 needed invasive mechanical ventilation and 314,164 died, and 280,533 COVID-19 individuals without comorbidity, out of which 33,312 needed invasive mechanical ventilation and 73,723 died. We observed a low negative Pearson correlation between the Human Development Index and death and a moderate negative Pearson correlation between the Human Development Index and deaths of individuals on invasive mechanical ventilation, with or without comorbidity. The univariate linear analysis showed the case fatality rate depends on at least 20-40% of the Human Development Index. In Brazil, regions with a low Human Development Index demonstrated a higher case fatality rate due to COVID-19, mainly in individuals who needed invasive mechanical ventilation, than regions with a higher Human Development Index. Although other indexes studied, such as intensive care unit beds and GINI, were also associated with the COVID-19 case fatality rate, they were not as relevant as the Human Development Index. Brazil is a vast territory comprising cultural, social, and economic diversity, which mirrors the diversity of the Human Development Index. Brazil is a model nation for the study of the Human Development Index's influence on aspects of the COVID-19 pandemic, such as its impact on the case fatality rate.