Study shows inequalities in the evolution of COVID-19 patients
COVID-19 has highlighted socioeconomic and health disparities in Brazil, emphasizing both the importance and shortcomings of the country’s public healthcare network, the SUS. This underscores the urgency of addressing the lack of investment in this crucial public health system.
This conclusion stems from COVID -19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. The study was conducted by researchers Margareth Portela, Mônica Martins, Sheyla Lemos, Carla Andrade, and Claudia Pereira from the National School of Public Health (Ensp/Fiocruz).
Featured in the International Journal for Equity in Health, the study reveals that disparities in the mortality rates of COVID-19 hospitalized patients were linked not only to age group and case severity but also to social and regional inequities and disparities in access to high-quality care.
The study used data from public sources, revealing that over 70 percent of COVID-19 hospitalizations in Brazil were handled by the SUS, benefiting the most vulnerable groups. However, despite this coverage, the SUS had the highest hospital mortality rate. Conversely, private and philanthropic hospitals, outside the SUS, most of which reimbursed by private health insurance accessible to the more privileged socioeconomic groups, demonstrated better outcomes.
Southern Brazil exhibited the most favorable performance among the macro-regions, while the North performed the least favorably. The study's results further indicate heightened hospital mortality rates from COVID-19 among black individuals across all Brazilian regions and among indigenous populations in the North and Central-West regions. Black and indigenous individuals residing in municipalities with lower Human Development Index (HDI) scores and those admitted to hospitals outside their city of residence faced elevated risks of in-hospital mortality. Additionally, hospital mortality rates peaked during the height of the pandemic but significantly declined following the achievement of reasonable COVID-19 vaccination coverage, beginning in July 2021.
According to the researchers, "the findings underscore the crucial role of the SUS in delivering healthcare, as the majority of COVID-19 hospitalizations were managed by the Brazilian public health system. However, the results also reveal shortcomings in the performance of SUS hospital units compared to the private sector and, in some regions, even to public hospital units not affiliated with the SUS. These disparities reflect long-standing structural and funding issues."
COVID-19 waves
The study also highlighted increased hospital mortality during the initial wave of the pandemic (April to August 2020) and the subsequent wave (December 2020 to May 2021), with a decrease observed in 2022, despite the ongoing third wave (January to February). March 2021 saw a peak in deaths, coinciding with hospitals operating at or beyond maximum capacity, resulting in shortages of critical resources like ventilators, oxygen, and ICU beds across the country.
"Drawing from lessons learned, improvements need to be made to better prepare the health system for future pandemics or other large-scale health emergencies. This includes investing in more health infrastructure, increasing healthcare workforce, providing enhanced training and support for these professionals, as well as improving salaries and working conditions, including access to protective equipment," the research suggests.
For the authors of the article, despite its challenges, the SUS has several strengths that make it essential, unique, and valuable to Brazilians.
