Agregação de fatores de risco do óbito por COVID-19 em Vila Velha,  Espírito Santo, Brasil

Victor Guedes  Gazoni; Sophya Freire Murad Moraes de   Almeida; Matheus Rogério  Zanotti; Isabela Cardoso  Martinelli; Samuel Faustino  Silva; Caroline Costa  Tuma; Mylene Murad  Moraes; Wanêssa Lacerda Poton

doi:10.23925/1984-4840.2025v27a20

Authors

Victor Guedes Gazoni Universidade Vila Velha
Sophya Freire Murad Moraes de Almeida Universidade Vila Velha
Matheus Rogério Zanotti Universidade Vila Velha
Isabela Cardoso Martinelli Universidade Vila Velha
Samuel Faustino Silva Universidade Vila Velha
Caroline Costa Tuma Universidade Vila Velha
Mylene Murad Moraes Universidade Vila Velha
Wanêssa Lacerda Poton Universidade Vila Velha

DOI:

https://doi.org/10.23925/1984-4840.2025v27a20

Keywords:

Death, Mortality, COVID-19, Risk Factors, Comorbidity

Abstract

Introduction: COVID-19 presents higher lethality in individuals with comorbidities. However, the aggregation of some of these conditions and their association with increased risk of death has not yet been evaluated, with a view to guiding prevention strategies and clinical management. Objective: To analyze the aggregation of four comorbidities
(cardiopathies, pneumopathies, diabetes, and obesity) in COVID-19 lethality. Method: A cross-sectional study including 390,454 COVID-19 patients residing in Vila Velha (ES), who died from COVID-19 between April 2020 and May 2022. Aggregation was analyzed by comparing the observed prevalence with the expected prevalence across various groupings. Poisson regression was used to identify the risk of death, and analyses were conducted using Stata 16.0. Results: The lethality rate was 0.7%, and prevalence was higher among men, individuals of Yellow/Indigenous race, the elderly, and illiterate individuals. The risk of death was 313% higher in obese patients (HR 4.13; 95%CI 3.39–5.03), 126% higher in diabetics (HR 2.26; 95%CI 1.98–2.58), 90% higher in those with cardiopathies (HR 1.90; 95%CI 1.68–2.15), and 85% higher in those with pneumopathies (HR 1.85; 95%CI 1.49–2.31). The aggregation of two, three, or four comorbidities increased disease lethality. Conclusion: Obesity, diabetes, cardiopathies, and pneumopathies—whether isolated or combined—increase COVID-19 lethality.

Downloads

Download data is not yet available.

References

Organização Pan-Americana da Saúde (OPAS). Histórico da pandemia de COVID-19 [Internet]. [acesso em 28 fev. 2024]. Disponível em: https://www.paho.org/pt/covid19/historico-da-pandemia-covid-19

Brasil. Ministério da Saúde. Primeiro caso de Covid-19 no Brasil permanece sendo o de 26 de fevereiro [Internet]. [acesso em 28 fev. 2024]. Disponível em: https://www.gov.br/saude/pt-br/assuntos/noticias/2020/julho/primeiro-caso-de-covid-19-no-brasil-permanece-sendo-o-de-26-de-fevereiro

Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55(5):2000547. doi: 10.1183/13993003.00547-2020.

Djaharuddin I, Munawwarah S, Nurulita A, Ilyas M, Tabri NA, Lihawa N. Comorbidities and mortality in COVID-19 patients. Gac Sanit 2021;35 Suppl 2:S530-2. doi: 10.1016/j.gaceta.2021.10.085.

Bae S, Kim SR, Kim MN, Shim WJ, Park SM. Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis. Heart 2021;107:373-80. doi: 10.1136/heartjnl-2020-317901.

Parohan M, Yaghoubi S, Seraji A, Javanbakht MH, Sarraf P, Djalali M. Risk factors for mortality in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies. Aging Male 2020;23(5):1416-24. doi: 10.1080/13685538.2020.1774748.

Harrison SL, Buckley BJR, Rivera-Caravaca JM, Zhang J, Lip GYH. Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews. Eur Heart J Qual Care Clin Outcomes 2021;7(4):330-9. doi: 10.1093/ehjqcco/qcab029.

Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020;92(7):791-6. doi: 10.1002/jmv.25770.

Anderson MR, Geleris J, Anderson DR, Zucker J, Nobel YR, Freedberg D, et al. Body mass index and risk for intubation or death in SARS-CoV-2 infection: a retrospective cohort study. Ann Intern Med 2020;173(10):782-90. doi: 10.7326/M20-3214.

Estado do Espírito Santo. Secretaria de Saúde. Boletim epidemiológico: Espírito Santo contra o COVI-19 [Internet]. Disponível em: https://saude.es.gov.br/Media/sesa/coronavirus/Boletins/104_INFORME_EPIDEMIOLOGICO_SEMANA_08_22%20(1)%20(2)%20(1)%20_incompleto%2006-06.pdf

Peckham H, Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun 2020;11(1):6317. doi: 10.1038/s41467-020-19741-6.

Fang X, Li S, Yu H, Wang P, Zhang Y, Chen Z, et al. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging 2020;12(13):12493-503. doi: 10.18632/aging.103579.

Papadopoulos V, Li L, Samplaski M. Why does COVID-19 kill more elderly men than women? Is there a role for testosterone? Andrology 2021;9(1):65-72. doi: 10.1111/andr.12868.

Shaw AC, Joshi S, Greenwood H, Panda A, Lord JM. Aging of the innate immune system. Curr Opin Immunol 2010;22(4):507-13. doi: 10.1016/j.coi.2010.05.003.

Hallal PC, Hartwig FP, Horta BL, Silveira MF, Struchiner CJ, Vidaletti LP, et al. SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys. Lancet Glob Health 2020;8(11):e1390-8. doi: 10.1016/S2214-109X(20)30387-9.

Araújo EM, Caldwell KL, Santos MPA, Souza IM, Rosa PLFS, Santos ABS, et al. Morbimortalidade pela Covid-19 segundo raça/cor/etnia: a experiência do Brasil e dos Estados Unidos. Saúde em Debate 2020;44(spe4):191-205. doi: 10.1590/0103-11042020E412.

Baqui P, Bica I, Marra V, Ercole A, van der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Global Health 2020;8:e1018–26. doi: 10.1016/S2214-109X(20)30285-0.

Oh J, Min J, Kang C, Kim E, Lee JP, Kim H, et al. Excess mortality and the COVID-19 pandemic: causes of death and social inequalities. BMC Public Health 2022;22(1):2293. doi: 10.1186/s12889-022-14785-3.

Ross CE, Wu C-L. The links between education and health. Am Sociol Rev 1995;60(5):719–45. doi: 10.2307/2096319

Negri F, Galiezz R, Miranda P, Koeller P, Zucoloto G, Costa J, et al. Socioeconomic factors and the probability of death by Covid-19 in Brazil. J Public Health 2021;43(3):493-8. doi: 10.1093/pubmed/fdaa279.

CDC COVID-19 Response Team. Characteristics of health care personnel with COVID-19—United States, 12 Feb-9 Apr 2020 [Internet]. MMWR Morb Mortal Wkly Rep 69:477-81. doi: 10.15585/mmwr.mm6915e6.

Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, et al. Coronavirus Pandemic Epidemiology Consortium. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health 2020;5(9):e475-83. doi: 10.1016/S2468-2667(20)30164-X.

Teixeira CFS, Soares CM, Souza EA, Lisboa ES, Pinto ICM, Andrade LR, et al. The health of healthcare professionals coping with the Covid-19 pandemic. Cien Saude Colet 2020;25(9):3465-74. doi: 10.1590/1413-81232020259.19562020.

Tartof SY, Qian L, Hong V, Wei R, Nadjafi RF, Fischer H, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med 2020;173(10):773-81. doi: 10.7326/M20-3742.

Heredia FP, Gómez-Martínez S, Marcos A. Obesity, inflammation and the immune system. Proc Nutr Soc 2012;71(2):332-8. doi: 10.1017/S0029665112000092.

Bergman J, Ballin M, Nordström A, Nordström P. Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study. Eur J Epidemiol 2021;36(3):287-98. doi: 10.1007/s10654-021-00732-w.

Garces TS, Sousa GJB, Cestari VRF, Florêncio RS, Damasceno LLV, Pereira MLD, et al. Diabetes como um fator associado ao óbito hospitalar por COVID-19 no Brasil, 2020. Epidemiol Serv Saude 2022;31(1):e2021869. doi: 10.1590/S1679-49742022000100021.

Garreta E, Prado P, Stanifer ML, Monteil V, Marco A, Ullate-Agote A, et al. A diabetic milieu increases ACE2 expression and cellular susceptibility to SARS-CoV-2 infections in human kidney organoids and patient cells. Cell Metab 2022;34(6):857-73.e9. doi: 10.1016/j.cmet.2022.04.009.

Halpin DMG, Rabe AP, Loke WJ, Grieve S, Daniele P, Hwang S, et al. Epidemiology, healthcare resource utilization, and mortality of asthma and COPD in COVID-19: a systematic literature review and meta-analyses. J Asthma Allergy 2022;15:811-25. doi: 10.2147/JAA.S360985.

Wickham RJ. Secondary analysis research. J Adv Pract Oncol 2019;10(4):395-400. doi: 10.6004/jadpro.2019.10.4.7.