Racial death toll: when surviving COVID-19 in a Brazilian metropolis depends on your skin color

Abstract

Abstract The COVID-19 pandemic did not impact and still now does not impact people homogeneously. In Brazil, race shows itself as an important difference in health events, including COVID-19 outcomes. We observed, during the pandemic, a higher lethality pattern among black and brown populations. Considering the most important factor for the disease severity in Brazil are, in order of relevance, age, socioeconomic factors and, only then, comorbidities, and that black and brown Brazilians have much poorer socioeconomic conditions compared to white people, we can understand these populations as part of a group under greater risk of aggravation by COVID-19. Besides, it is known that black and brown people face more difficulties to access healthcare services, a way that sometimes they are not even aware of the comorbidities possessed, which can potentially aggravate COVID-19, or present fewer possibilities to control these diseases. Nonetheless, intrinsic, institutional, and structural racism, a health social determinant shown by many indicators such as mortality rates of black and brown populations, presents itself in all healthcare levels in Brazil. Thus, this study aims to analyze the racial differential for COVID-19 survival amongst hospitalized patients in Rio de Janeiro during the COVID-19 pandemic. We performed a survival analysis from selected notifications of COVID-19-induced induced Severe Acute Respiratory Syndrome in Rio de Janeiro from the date of the first death registered in Brazil to the end of the Public Healthcare Emergency of National Interest, in order to evaluate the times between the first symptoms and hospitalization; hospitalization and outcome (death); and first symptoms and outcomes (death), relating those to the variable of interest race and the covariables age; sex; presence or absence of major signs/symptoms; presence or absence of multimorbidities; resident of Rio de Janeiro or not; resident of urban/rural areas; ICU hospitalization or not. With that, we aim to characterize hospitalized COVID-19 cases in Rio de Janeiro regarding sociodemographic and clinical variables, describe the course between initial symptomatology and outcomes of the in-patients who utterly passed, analyze the survival probability of in-patients according to their race/skin color; relate social health determinants aspects to the survival rates of the hospitalized patients.