Spatial disparities of COVID-19 pandemic in cerebrovascular diseases in Brazil

The Covid-19 pandemic emphasized healthcare inequalities. This study aimed to estimate the spatial effects of socioeconomic factors and healthcare coverage on hospitalizations and hospital mortality rates due to cerebrovascular diseases (CD) according to skin color self-identification before and during the Covid-19 pandemic in São Paulo, Brazil.

This ecological study evaluated CD hospitalizations and hospital deaths (2019-2021) by skin color self-identification in the 63 microregions of the state of São Paulo. To determine spatial autocorrelation, we used the global and local Moran index. We also evaluated the local effects of wealth level (IPRS), the number of hospital beds, health coverage (ESF), and proportions of Black, Brown, Yellow, and Indigenous (BBYI) populations using Geographically Weighted Poisson Regression.

We observe significant global and local spatial autocorrelation in CD hospitalizations and mortality in the BBYI group before and during the pandemic, particularly in the metropolitan region. In 2020, we identify differences in hospitalization and mortality rates among BBYI individuals, with a higher risk of hospital death. For hospitalizations, IPRS, the number of beds, and ESF show significant associations, contributing to a decreased risk in the north, east, south, and west. For mortality, IPRS is associated with decreased risk, while ESF and BBYI proportions are associated with increased risk in the south, southeast, and metropolitan regions.

The Covid-19 pandemic impacts CD hospitalizations and hospital deaths, particularly among the BBYI population. The presence of spatial autocorrelation in BBYI and the local effects of IPRS, ESF, and BBYI proportions underscore persistent inequalities related to skin color self-identification, geographic microregion, and socioeconomic level in access to healthcare resources during the pandemic.