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Compreender a letalidade da COVID-19 na Europa: obesidade, PIB, poluição atmosférica e outros determinantes de saúde
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Advisor(s)
Abstract(s)
Observa-se um padrão desigual na taxa de letalidade da COVID-19
entre países europeus. De modo a investigar diferenças encontradas
entre países, este estudo tem como objetivo principal testar a associação
entre a letalidade por COVID-19 e determinantes de saúde. Como
objetivo secundário pretende-se analisar tipologias de países europeus
de acordo com o seu nível de letalidade da COVID-19. Foi medida a
força de associação entre a letalidade por COVID-19 e determinantes de
saúde, através do cálculo da matriz de correlação de Pearson. Foram
selecionados determinantes com correlação |ρ| ≥ 0 ,5 e através de uma
Análise de Componentes Principais foi calculado um índice de ‘vulnerabilidade’
à COVID-19 para cada país. O padrão geográfico do índice
de ‘vulnerabilidade’, foi analisado através de Análise de Clusters e validado
através de análise de regressão. Foi encontrada uma correlação
negativa e moderada com a letalidade ( ρ=-0,6) para o PIB per capita.
Observou-se uma correlação positiva moderada com a letalidade para
a obesidade, prevalência de fumadores e proporção de população em
risco de pobreza ( ρ=0,5). A exposição a poluição atmosférica apresentou
uma correlação positiva forte com a letalidade ( ρ=-0,7). Foram
identificados quatro grupos de países (Cluster 4, Cluster 3, Cluster 2,
Cluster 1), ordenados de acordo com a sua vulnerabilidade à COVID-19
(baixa-alta), permitindo identificar um padrão espacial com sentido norte-
sul e oeste-este na letalidade da COVID-19. Verificou-se que a letalidade
dos grupos de países nórdicos, Áustria e Suíça (Clusters 4 e 3),
é significativamente menor do que a observada no cluster de Portugal
(Cluster 2) [RR=0,50 (IC 95%: 0,35-0,70) e RR=0,63 (IC 95%: 0,44-0,89),
para o Cluster 4 e 3, respetivamente]. O grupo de países de leste (Cluster
1) foi o que apresentou maior taxa de letalidade, embora não difira
significativamente do grupo de países onde se inclui Portugal [RR=1,23
(IC 95%: 0,93-1,62)].
An uneven case fatality rate of COVID-19 is observed among European countries. In order to understand these differences, this study aims to test the association between COVID-19 case fatality rate and health determinants. As a secondary objective, typologies of European countries were analysed according to their level of lethality by COVID-19. The strength of association between COVID-19 case fatality rate and health determinants was measured by Pearson correlation. Determinants with correlation |ρ| ≥ 0.5 were selected and through Principal Components Analysis, an index of ‘vulnerability’ to COVID-19 was calculated for each country. The geographic pattern of the 'vulnerability' index was analysed through Cluster Analysis and validated through regression analysis. A negative and moderate correlation was found between case fatality rate (ρ=-0.6) and GDP per capita. There was a moderate positive correlation between case fatality rate and obesity, prevalence of smokers and proportion of the population at poverty risk o f ( ρ=0.5). Exposure to air pollutions howed as trong positive correlation with case fatality rate (ρ=-0.7). Four groups of countries were identified (Cluster 4, Cluster 3, Cluster 3, Cluster 1), sor ted according to their vulnerability to COVID-19 (low-higher). A spatial pattern with north-south and west-east direction was identified in COVID-19 lethality. Our findings suggest that the case fatality rate in clusters including Nordic countries, Austria a nd Switzerland ( Clusters 4 a nd 3), i s significantly lower than in the cluster including Portugal (Cluster 2) [RR=0.50 (95% CI: 0.35-0.70) and RR=0.63 (95% CI: 0.44-0, 89), for Cluster 4 and 3, respectively]. The Eastern countries (Cluster 1) were the ones with the highest case fatality rate, although it does not differ significantly from the group of countries where Portugal is included [RR=1.23 (95% CI: 0.93-1.62)].
An uneven case fatality rate of COVID-19 is observed among European countries. In order to understand these differences, this study aims to test the association between COVID-19 case fatality rate and health determinants. As a secondary objective, typologies of European countries were analysed according to their level of lethality by COVID-19. The strength of association between COVID-19 case fatality rate and health determinants was measured by Pearson correlation. Determinants with correlation |ρ| ≥ 0.5 were selected and through Principal Components Analysis, an index of ‘vulnerability’ to COVID-19 was calculated for each country. The geographic pattern of the 'vulnerability' index was analysed through Cluster Analysis and validated through regression analysis. A negative and moderate correlation was found between case fatality rate (ρ=-0.6) and GDP per capita. There was a moderate positive correlation between case fatality rate and obesity, prevalence of smokers and proportion of the population at poverty risk o f ( ρ=0.5). Exposure to air pollutions howed as trong positive correlation with case fatality rate (ρ=-0.7). Four groups of countries were identified (Cluster 4, Cluster 3, Cluster 3, Cluster 1), sor ted according to their vulnerability to COVID-19 (low-higher). A spatial pattern with north-south and west-east direction was identified in COVID-19 lethality. Our findings suggest that the case fatality rate in clusters including Nordic countries, Austria a nd Switzerland ( Clusters 4 a nd 3), i s significantly lower than in the cluster including Portugal (Cluster 2) [RR=0.50 (95% CI: 0.35-0.70) and RR=0.63 (95% CI: 0.44-0, 89), for Cluster 4 and 3, respectively]. The Eastern countries (Cluster 1) were the ones with the highest case fatality rate, although it does not differ significantly from the group of countries where Portugal is included [RR=1.23 (95% CI: 0.93-1.62)].
Description
Keywords
Letalidade COVID-19 Letalidade por COVID-19 Pandemia da COVID-19 Obesidade PIB Poluição Atmosférica Determinantes de Saúde Determinantes da Saúde e da Doença Europa Saúde Pública Portugal
Pedagogical Context
Citation
Boletim Epidemiológico Observações. 2021;10(Supl 13):10-18
Publisher
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP