Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil

Detalhes bibliográficos
Autor(a) principal: Bastos, Leonardo S. L.
Data de Publicação: 2022
Outros Autores: Aguilar, Soraida, Rache, Beatriz, Maçaira, Paula, Baião, Fernanda, Cerbino-Neto, José, Rocha, Rudi, Hamacher, Silvio, Ranzani, Otavio T., Bozza, Fernando A.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/55905
Resumo: Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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spelling Bastos, Leonardo S. L.Aguilar, SoraidaRache, BeatrizMaçaira, PaulaBaião, FernandaCerbino-Neto, JoséRocha, RudiHamacher, SilvioRanzani, Otavio T.Bozza, Fernando A.2022-12-11T12:42:14Z2022-12-11T12:42:14Z2022BASTOS, Leonardo S. L. et al. Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil. The Lancet Regional Health - Americas, v. 14, p. 1-13, Oct. 2022.2667-193Xhttps://www.arca.fiocruz.br/handle/icict/5590510.1016/j.lana.2022.100335Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil / Pontifical Catholic University of Rio de Janeiro. Tecgraf Institute. Rio de Janeiro, RJ, Brazil.Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil.Instituto de Estudos para Políticas de Saúde. São Paulo, SP, Brasil.Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil.Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.Instituto de Estudos para Políticas de Saúde. São Paulo, SP, Brasil / Fundação Getulio Vargas. São Paulo School of Business Administration. São Paulo, SP, Brazil / Universidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brazil.Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil / Pontifical Catholic University of Rio de Janeiro. Tecgraf Institute. Rio de Janeiro, RJ, Brazil.Barcelona Institute for Global Health. ISGlobal. Universitat Pompeu Fabra. CIBER Epidemiología y Salud Pública. Barcelona, Spain / Faculdade de Medicina da Universidade de São Paulo. Hospital das Clinicas. Heart Institute. Pulmonary Division. São Paulo, SP, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.Background: There is limited information on the inequity of access to vaccination in low-and-middle-income countries during the COVID-19 pandemic. Here, we described the progression of the Brazilian immunisation program for COVID-19, and the association of socioeconomic development with vaccination rates, considering the potential protective effect of primary health care coverage. Methods: We performed an ecological analysis of COVID-19 immunisation data from the Brazilian National Immunization Program from January 17 to August 31, 2021. We analysed the dynamics of vaccine coverage in the adult population of 5,570 Brazilian municipalities. We estimated the association of human development index (HDI) levels (low, medium, and high) with age-sex standardised first dose coverage using a multivariable negative binomial regression model. We evaluated the interaction between the HDI and primary health care coverage. Finally, we compared the adjusted monthly progression of vaccination rates, hospital admission and in-hospital death rates among HDI levels. Findings: From January 17 to August 31, 2021, 202,427,355 COVID-19 vaccine doses were administered in Brazil. By the end of the period, 64·2% of adults had first and 31·4% second doses, with more than 90% of those aged ≥60 years with primary scheme completed. Four distinct vaccine platforms were used in the country, ChAdOx1-S/nCoV-19, Sinovac-CoronaVac, BNT162b2, Ad26.COV2.S, composing 44·8%, 33·2%, 19·6%, and 2·4% of total doses, respectively. First dose coverage differed between municipalities with high, medium, and low HDI (Median [interquartile range] 72 [66, 79], 68 [61, 75] and 63 [55, 70] doses per 100 people, respectively). Municipalities with low (Rate Ratio [RR, 95% confidence interval]: 0·87 [0·85-0·88]) and medium (RR [95% CI]: 0·94 [0·93-0·95]) development were independently associated with lower vaccination rates compared to those with high HDI. Primary health care coverage modified the association of HDI and vaccination rate, improving vaccination rates in those municipalities of low HDI and high primary health care coverage. Low HDI municipalities presented a delayed decrease in adjusted in-hospital death rates by first dose coverage compared to high HDI locations. Interpretation: In Brazil, socioeconomic disparities negatively impacted the first dose vaccination rate. However, the primary health care mitigated these disparities, suggesting that the primary health care coverage guarantees more equitable access to vaccines in vulnerable locations.engElsevierPrimary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazilinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleCOVID-19Human developmentLow-and-middle-income countriesPrimary healthcareSocioeconomic factorsVaccineinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; 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dc.title.en_US.fl_str_mv Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
title Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
spellingShingle Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
Bastos, Leonardo S. L.
COVID-19
Human development
Low-and-middle-income countries
Primary healthcare
Socioeconomic factors
Vaccine
title_short Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
title_full Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
title_fullStr Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
title_full_unstemmed Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
title_sort Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil
author Bastos, Leonardo S. L.
author_facet Bastos, Leonardo S. L.
Aguilar, Soraida
Rache, Beatriz
Maçaira, Paula
Baião, Fernanda
Cerbino-Neto, José
Rocha, Rudi
Hamacher, Silvio
Ranzani, Otavio T.
Bozza, Fernando A.
author_role author
author2 Aguilar, Soraida
Rache, Beatriz
Maçaira, Paula
Baião, Fernanda
Cerbino-Neto, José
Rocha, Rudi
Hamacher, Silvio
Ranzani, Otavio T.
Bozza, Fernando A.
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Bastos, Leonardo S. L.
Aguilar, Soraida
Rache, Beatriz
Maçaira, Paula
Baião, Fernanda
Cerbino-Neto, José
Rocha, Rudi
Hamacher, Silvio
Ranzani, Otavio T.
Bozza, Fernando A.
dc.subject.en.en_US.fl_str_mv COVID-19
Human development
Low-and-middle-income countries
Primary healthcare
Socioeconomic factors
Vaccine
topic COVID-19
Human development
Low-and-middle-income countries
Primary healthcare
Socioeconomic factors
Vaccine
description Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-12-11T12:42:14Z
dc.date.available.fl_str_mv 2022-12-11T12:42:14Z
dc.date.issued.fl_str_mv 2022
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.citation.fl_str_mv BASTOS, Leonardo S. L. et al. Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil. The Lancet Regional Health - Americas, v. 14, p. 1-13, Oct. 2022.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/55905
dc.identifier.issn.en_US.fl_str_mv 2667-193X
dc.identifier.doi.none.fl_str_mv 10.1016/j.lana.2022.100335
identifier_str_mv BASTOS, Leonardo S. L. et al. Primary healthcare protects vulnerable populations from inequity in COVID-19 vaccination: An ecological analysis of nationwide data from Brazil. The Lancet Regional Health - Americas, v. 14, p. 1-13, Oct. 2022.
2667-193X
10.1016/j.lana.2022.100335
url https://www.arca.fiocruz.br/handle/icict/55905
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dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
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