Iniquidades na ocorrência da COVID-19 em coorte de mulheres em idade reprodutiva, em inquérito de base populacional e em notificações oficiais

Abstract

The COVID-19 pandemic exposed health inequalities in Brazil, affecting vulnerable populations and showing high incidence and mortality rates in areas with worse socioeconomic indicators and low access to health services. In Fortaleza, these disparities were even more pronounced, highlighting the need for more inclusive prevention strategies appropriate to living conditions in regions where risk was prominent. This thesis aims to analyze factors associated with COVID-19 occurrence and vaccination in Brazil during 2020, and in the city of Fortaleza between 2020 and 2023. To this end, socioeconomic risk factors associated with COVID-19 in Brazil were prospectively investigated through PNAD COVID-19, examining reports of symptoms and testing in a national cohort established through record linkage from May to November 2020. In Fortaleza, socioeconomic characteristics and epidemiological indicators of incidence, mortality, and case fatality by neighborhood were compared using data from the IntegraSUS platform and the 2010 Demographic Census. Also in Fortaleza, data from the ZIF Cohort were used to investigate the effect of food insecurity on COVID-19 vaccination among women aged 15 to 39 years living in high-risk areas for disease mortality, applying Poisson regression models and structural equation modeling to assess unadjusted and adjusted socioeconomic associations. Longitudinal analyses at the national scale indicated higher risks of symptomatic cases in the Northeast and North regions, while spatial studies in Fortaleza identified clusters of high case fatality in neighborhoods with worse socioeconomic indicators. In critical areas of the city, food insecurity was associated with lower receipt of COVID-19 vaccines. Unjust inequalities amplified the pandemic's impact on population health, requiring intersectoral policies to combat hunger and improve access to health services. This points to the imperative of territorialized approaches and integrated actions to reduce inequities in potential health crises.