Estimating the effect of socio-economic factors on infant mortality rates in Latin America between 2000 and 2019: a panel data analysis.

OBJECTIVES: Infant mortality is a crucial indicator of socio-economic development, reflecting the conditions in which children are born and raised. Despite notable reductions in Latin America, infant mortality rates remain relatively high compared to other regions worldwide. By understanding the socio-economic factors that influence infant mortality, we not only uncover immediate causes of infant deaths but also shed light on broader socio-economic and healthcare disparities contributing to the burden of disease. This study analyzes the impact of socio-economic factors on infant mortality rates in Latin America from 2000 to 2019, estimating the speed and magnitude of the response of infant mortality rates to changes in specific socio-economic factors. STUDY DESIGN: Longitudinal panel study. METHODS: Panel data regression models were used to examine the influence of specific socio-economic factors on infant mortality rates in Latin America. Additionally, impulse response functions estimated by local projections were used to estimate the speed and magnitude of the impact of socio-economic factors on infant mortality rates. RESULTS: The results highlight the importance of factors such as healthcare expenditure, female literacy, public expenditures on education, maternal mortality, physician density, total fertility rate, and tuberculosis incidence as significant determinants of infant mortality rates in the region. CONCLUSION: This study adds to the existing literature by offering empirical evidence on the association between these socio-economic factors and infant mortality in Latin America. It also provides a foundation for future research that investigates specific cases within Latin America and examines the variations of these socio-economic factors within those countries.

The association between social support and self-rated health in midlife: are men more affected than women?

Social support from family and friends is recognized as an important social determinant of health, given its protective effects on individuals' physical and mental well-being. While most studies have focused on older adults, investigating midlife health is equally crucial since middle-aged individuals are also susceptible to the harmful health outcomes of inadequate social support from friends and family. This study contributes to the debate by examining whether social support is associated with self-rated health among middle-aged Brazilian adults and how this relationship varies between men and women. Using data from the nationwide Brazilian National Health Survey conducted in 2019, logistic regression models were employed to assess differences in self-rated health, accounting for confounding factors. The sample comprised 31,926 middle-aged adults, of which 52.5% were women. The overall prevalence of poor self-rated health was 40.7%, with a significant difference between men and women. Results from this study suggest that having no friends or family members to rely on, both during good and challenging times, was associated with poorer self-rated health. However, the strength of this association differs by gender, with social support from friends playing a more critical role in women's self-rated health. On the other hand, family support was associated with male self-rated health, particularly for men with three or more family members they can rely on. Future studies should consider cultural and contextual factors to better understand other dimensions of social support and its association with midlife health.

Urban-rural health disparities in Brazil: Do sociodemographic attributes play a role?

The debate over urban-rural health disparities in Latin American countries is disputed, and this relationship may not be as straightforward as initially thought. In this study, we investigate whether individual-level self-rated health (SRH) varies across urban and rural populations in the country and how sociodemographic attributes are associated with such differences. We relied on data from the Brazilian National Health Survey (n = 78,806), a nationwide household-based survey conducted in 2019 that is representative of Brazil, geopolitical macro-regions, states, and 27 state capitals. Logistic regression models were used to test for differences in SRH between urban and rural inhabitants. The findings suggest that Brazilian adults living in rural areas are at a higher risk of perceiving their health as poor than their urban counterparts. The urban-rural health disparities are significant and influenced by sociodemographic attributes, highlighting the importance of developing public health interventions to improve health outcomes in these populations.

COVID-19 vaccination and case fatality rates: a case report in a Brazilian municipality.

Vaccination campaigns played a crucial role in reducing the incidence of COVID-19. However, a scant number of studies evaluated the impact of vaccination on case fatality rates (CFRs), including in Brazil. Our study aimed to compare CFRs according to vaccination status among subjects living in Arapongas (Paraná State, Brazil), considering the age composition of the population. Several strategies adopted by the Arapongas City Hall to minimize the spread of the virus were also elaborated upon. We accessed the 2021 database of the Arapongas Municipal Health Department, in which a total of 16,437 confirmed cases and 425 deaths were reported. The CFR was calculated as the ratio between COVID-19 deaths and the number of confirmed cases. Differences in age composition between unvaccinated and fully vaccinated individuals were observed in our study. Considering that CFR is a crude indicator and is highly sensitive to the age composition of the population, we adopted the average age distribution of confirmed cases among the three vaccination statuses (unvaccinated, partially, and fully) as a standard age distribution. The age-standardized CFR for unvaccinated and fully vaccinated groups were 4.55% and 2.42%, respectively. Fully vaccinated individuals showed lower age-specific CFRs in all age groups above 60 years than unvaccinated populations. Our findings strengthen the role of vaccination as a critical measure for preventing deaths among infected people and is particularly important to the ongoing reassessment of public health interventions and policies.

Probabilistic survival modeling in health research: an assessment using cohort data from hospitalized patients with COVID-19 in a Latin American city.

Probabilistic survival methods have been used in health research to analyze risk factors and adverse health outcomes associated with COVID-19. The aim of this study was to employ a probabilistic model selected among three distributions (exponential, Weibull, and lognormal) to investigate the time from hospitalization to death and determine the mortality risks among hospitalized patients with COVID-19. A retrospective cohort study was conducted for patients hospitalized due to COVID-19 within 30 days in Londrina, Brazil, between January 2021 and February 2022, registered in the database for severe acute respiratory infections (SIVEP-Gripe). Graphical and Akaike Information Criterion (AIC) methods were used to compare the efficiency of the three probabilistic models. The results from the final model were presented as hazard and event time ratios. Our study comprised of 7,684 individuals, with an overall case fatality rate of 32.78%. Data suggested that older age, male sex, severe comorbidity score, intensive care unit admission, and invasive ventilation significantly increased risks for in-hospital mortality. Our study highlights the conditions that confer higher risks for adverse clinical outcomes attributed to COVID-19. The step-by-step process for selecting appropriate probabilistic models may be extended to other investigations in health research to provide more reliable evidence on this topic.

Mapeando as disparidades socioeconômicas de saúde urbana: um estudo comparativo entre seis capitais brasileiras / Mapping socioeconomic disparities in urban health: a comparative study of six Brazilian capitals / Mapeando las disparidades socioeconómicas de salud urbana: un estudio comparativo entre seis capitales brasileñas

Resumo A cidade é um modo de viver, pensar e sentir. O modo de vida urbano é capaz de produzir ideias, comportamentos, valores e conhecimentos, mas também pode acirrar disparidades socioeconômicas e de saúde da população que ali reside. Este artigo examina as disparidades em saúde urbana em seis capitais brasileiras: São Paulo, Rio de Janeiro, Salvador, Fortaleza, Belo Horizonte e Manaus. Para quantificar e mapear as disparidades intraurbanas nesses espaços, foram utilizados os dados do Censo Demográfico de 2010 para a aplicação do índice de saúde urbana (ISU), uma métrica que sintetiza oito diferentes variáveis socioeconômicas e de saneamento desagregadas por setores censitários. Os resultados são discutidos à luz de três vertentes teóricas: a diferenciação centro-periferia; abordagem econômica da saúde; e epidemiologia social. As descobertas desse estudo revelam que os setores censitários que abrangem populações com maior status socioeconômico e melhores condições de saneamento apresentaram índices de saúde urbana mais elevados do que os da periferia da cidade. Há indícios de melhores indicadores de saúde urbana para o Rio de Janeiro e São Paulo, em comparação com as demais capitais analisadas. No entanto, há importantes nuances em cada uma das seis cidades estudadas, especialmente quando se atribuem diferentes pesos às variáveis que compõem o ISU, apesar da marcada segregação espacial comum a todas elas. Considerar as distinções dentro do espaço urbano é uma estratégia fundamental para a compreensão desses aspectos sociais e econômicos e seus potenciais desdobramentos nas condições de saúde da população.

Abstract A city is a way of living, thinking, and feeling. The urban lifestyle can produce ideas, behaviors, values, and knowledge. Still, it can also intensify socioeconomic and health disparities in the population. This article examines urban health disparities in six Brazilian capitals: São Paulo, Rio de Janeiro, Salvador, Fortaleza, Belo Horizonte, and Manaus. To quantify and map intra-urban disparities in these spaces, data from the 2010 Demographic Census are used to apply the Urban Health Index, a metric that synthesizes eight different socio-economic and sanitation variables disaggregated by census tracts. The results are discussed in light of three theoretical perspectives: center-periphery differentiation, the economic approach to health, and social epidemiology. The findings of this study reveal that census tracts covering populations with higher socio-economic status and better sanitation conditions exhibited higher urban health index scores than those in the city's periphery. Results indicate better urban health indicators for Rio de Janeiro and São Paulo, compared to the other capitals analyzed. However, there are important nuances in each of the six cities, especially when assigning different weights to the variables that compose the Urban Health Index, despite the marked spatial segregation common to all. Considering distinctions within urban space is a fundamental strategy to understand these social and economic aspects and their potential implications for population health conditions.

Resumen La ciudad es una forma de vivir, pensar y sentir. El modo de vida urbano es capaz de producir ideas, comportamientos, valores y conocimientos, pero también lo es de intensificar las disparidades socioeconómicas y de salud de la población que reside en ella. Este artículo examina las disparidades en salud urbana en seis capitales brasileñas: São Paulo, Río de Janeiro, Salvador, Fortaleza, Belo Horizonte y Manaus. Para cuantificar y mapear las disparidades intraurbanas en estos espacios, se utilizan datos del censo demográfico de 2010 para aplicar el índice de salud urbana, una métrica que sintetiza ocho diferentes variables socioeconómicas y de saneamiento desagregadas por sectores censales. Los resultados se discuten a la luz de tres perspectivas teóricas: la diferenciación centro-periferia, el enfoque económico de la salud y la epidemiología social. Los hallazgos de este estudio revelan que los sectores censales que abarcan poblaciones con un mayor estatus socioeconómico y mejores condiciones de saneamiento presentaron puntajes más altos en el índice de salud urbana que los de la periferia de la ciudad. Hay indicios de mejores indicadores de salud urbana para Río de Janeiro y São Paulo, en comparación con las demás capitales analizadas. Sin embargo, se observan matices importantes en cada una de las seis ciudades analizadas, especialmente al asignar diferentes pesos a las variables que componen el pindice de salud urbana, a pesar de la marcada segregación espacial común a todas ellas. Considerar las distinciones dentro del espacio urbano es una estrategia fundamental para comprender estos aspectos sociales y económicos y sus posibles implicaciones en las condiciones de salud de la población.

O impacto da mortalidade por causas externas na esperança de vida nos municípios produtores de petróleo da Bacia de Campos/RJ / The impact of mortality from external causes on life expectancy in the oil-producing municipalities in the Campos Basin/RJ / El impacto de la mortalidad por causas externas en la esperanza de vida en los municipios petroleros de la Cuenca de Campos, Río de Janeiro

Resumo O crescimento da mortalidade por causas externas no Brasil tem se tornado objeto de preocupação entre pesquisadores e formuladores de políticas públicas nos últimos anos. No âmbito dos municípios produtores de petróleo da Bacia de Campos/RJ, embora muito se conheça sobre os padrões migratórios nesta região que é considerada um aspecto relevante da urbanização brasileira, as informações sobre os demais componentes da dinâmica demográfica ainda são escassas. Este estudo amplia a discussão sobre as disparidades de saúde na região, investigando o impacto da mortalidade por causas externas na expectativa de vida da população entre os períodos 2010-2014 e 2015-2019. Utilizando dados de óbitos e estimativas populacionais, foram construídas tabelas de múltiplo decremento para avaliar o ganho na expectativa de vida se a mortalidade por causas externas fosse excluída do risco de óbito e como esses ganhos diferem entre homens e mulheres. Também avaliaram-se cenários distintos de redução da mortalidade por homicídios e acidentes de trânsito, as duas principais causas de morte do grupo de causas externas. Os resultados revelam ganhos médios substanciais de expectativa de vida para ambos os sexos, especialmente para os homens. As simulações realizadas mostraram que a redução da mortalidade por acidentes de trânsito e homicídios pode trazer ganhos importantes para a população, destacando a relevância de investir em políticas públicas que combatam as causas externas de mortalidade em uma região marcada por desigualdades sociais e econômicas.

Abstract The growth of mortality due to external causes in Brazil has become a concern among researchers and public policy makers in recent years. In the municipalities that produce oil in the Campos Basin, although much is known about migration patterns in this region, considered a relevant aspect of Brazilian urbanization, information on other components of demographic dynamics is still scarce. This study expands the discussion on health disparities in the region by investigating the impact of mortality due to external causes on life expectancy of the population between 2010-2014 and 2015-2019. Using death data and population estimates, we constructed multiple decrement tables to assess the gain in life expectancy if mortality due to external causes were excluded from the risk of death and how these gains differ between men and women. We also evaluated different scenarios reducing mortality due to homicides and traffic accidents, the two main causes of death in the external causes group. The results reveal substantial average gains in life expectancy for both sexes, especially for men. The simulations performed showed that reducing mortality due to traffic accidents and homicides can bring important gains to the population, highlighting the importance of investing in public policies that combat external causes of mortality in a region marked by social and economic inequalities.

Resumen El crecimiento de la mortalidad por causas externas en Brasil se ha convertido en objeto de preocupación entre investigadores y formuladores de políticas públicas en los últimos años. En el ámbito de los municipios productores de petróleo de la Cuenca de Campos (Río de Janeiro), aunque se sabe mucho sobre los patrones migratorios en esta región que se considera un aspecto relevante de la urbanización brasileña, la información sobre los demás componentes de la dinámica demográfica sigue siendo escasa. Este estudio amplía la discusión sobre las disparidades de salud en la región, investigando el impacto de la mortalidad por causas externas en la esperanza de vida de la población entre 2010-2014 y 2015-2019. Con datos de defunciones y estimaciones poblacionales, construimos tablas de múltiple decremento para evaluar la ganancia en la esperanza de vida si la mortalidad por causas externas fuera excluida del riesgo de defunción y cómo estas ganancias difieren entre hombres y mujeres. También evaluamos escenarios distintos de reducción de la mortalidad por homicidios y accidentes de tráfico, las dos principales causas de muerte del grupo de causas externas. Los resultados revelan ganancias medias sustanciales de esperanza de vida para ambos sexos, en especial para los hombres. Las simulaciones mostraron que la reducción de la mortalidad por accidentes de tráfico y homicidios puede traer ganancias importantes para la población, destacando la importancia de invertir en políticas públicas que combatan las causas externas de mortalidad en una región marcada por desigualdades sociales y económicas.

The association between social support and self-rated health in midlife: are men more affected than women? / Associação entre suporte social e autoavaliação de saúde na meia-idade: seriam os homens mais afetados que as mulheres? / La asociación entre el apoyo social y la autoevaluación de salud en la mediana edad: ¿se afectan los hombres más que las mujeres?

Abstract: Social support from family and friends is recognized as an important social determinant of health, given its protective effects on individuals' physical and mental well-being. While most studies have focused on older adults, investigating midlife health is equally crucial since middle-aged individuals are also susceptible to the harmful health outcomes of inadequate social support from friends and family. This study contributes to the debate by examining whether social support is associated with self-rated health among middle-aged Brazilian adults and how this relationship varies between men and women. Using data from the nationwide Brazilian National Health Survey conducted in 2019, logistic regression models were employed to assess differences in self-rated health, accounting for confounding factors. The sample comprised 31,926 middle-aged adults, of which 52.5% were women. The overall prevalence of poor self-rated health was 40.7%, with a significant difference between men and women. Results from this study suggest that having no friends or family members to rely on, both during good and challenging times, was associated with poorer self-rated health. However, the strength of this association differs by gender, with social support from friends playing a more critical role in women's self-rated health. On the other hand, family support was associated with male self-rated health, particularly for men with three or more family members they can rely on. Future studies should consider cultural and contextual factors to better understand other dimensions of social support and its association with midlife health.

Resumo: O suporte social de familiares e amigos é reconhecido como um importante determinante social da saúde com base em seus efeitos protetores sobre o bem-estar físico e mental dos indivíduos. Embora a maioria das pesquisas tenha se concentrado em adultos mais velhos, investigar a saúde na meia-idade é igualmente crucial, já que estes indivíduos também são suscetíveis aos resultados prejudiciais à saúde decorrentes do suporte social inadequado de amigos e familiares. Este estudo contribui para o debate ao examinar se o suporte social está associado à autoavaliação da saúde entre adultos brasileiros de meia-idade e como essa relação varia entre homens e mulheres. Usando dados da Pesquisa Nacional de Saúde realizada em 2019, modelos de regressão logística foram empregados para avaliar diferenças na autoavaliação da saúde, contabilizando fatores de confusão. A amostra foi composta por 31.926 adultos de meia-idade, dos quais 52,5% eram mulheres. A prevalência geral de autoavaliação de saúde ruim foi de 40,7%, com diferença significativa entre homens e mulheres. Os resultados deste estudo sugerem que não ter amigos ou familiares com quem contar em momentos bons ou desafiadores esteve associado à pior autopercepção de saúde. No entanto, a força dessa associação difere de acordo com o gênero, sendo que o suporte social de amigos desempenha um papel mais importante na autoavaliação da saúde das mulheres do que na dos homens. Por outro lado, o apoio familiar esteve associado à autoavaliação da saúde masculina, particularmente para homens com três ou mais membros da família com quem podem contar. Estudos futuros devem considerar fatores culturais e contextuais para compreender melhor outras dimensões do suporte social e sua associação com a saúde na meia-idade.

Resumen: El apoyo social de la familia y de amigos se reconoce como un importante determinante social de salud basado en sus efectos protectores sobre el bienestar físico y mental de los individuos. Aunque la mayoría de las investigaciones se ha centrado en adultos mayores, investigar la salud en la mediana edad también es esencial, una vez que estos individuos también son susceptibles a los resultados perjudiciales para la salud resultantes de un apoyo social inadecuado de amigos e de la familia. Este estudio contribuye al debate al investigar si el apoyo social está asociado con la autoevaluación de salud entre adultos brasileños de mediana edad y cómo esa relación varía entre hombre y mujeres. Usando datos de la Encuesta Nacional de Salud realizada en 2019, se utilizaron modelos de regresión logística para evaluar diferencias en la autoevaluación de salud, contabilizando factores de confusión. La muestra se compuso de 31.926 adultos de mediana edad, de los cuales el 52,5% eran mujeres. La prevalencia general de autoevaluación de mala salud fue del 40,7%, con diferencia significativa entre hombres y mujeres. Los resultados de este estudio sugieren que no tener amigos o familiares en los que confiar en buenos o malos momentos se asoció con la peor autopercepción de salud. Sin embargo, la fuerza de esa asociación es diferente según el género, ya que el apoyo social de amigos es más importante en la autoevaluación de salud de las mujeres que en la autoevaluación de los hombres. Por otro lado, el apoyo familiar se asoció con la autoevaluación de la salud masculina, particularmente para hombres que tenían tres o más personas de la familia en los que confiar. Estudios futuros deben tener en cuenta factores culturales y contextuales para mejor comprender otras dimensiones del apoyo social y su asociación con la salud en la mediana edad.

COVID-19 vaccination and case fatality rates: a case report in a Brazilian municipality / Vacinação contra a COVID-19 e taxas de letalidade: relato de caso em uma cidade brasileira / Vacunación contra el COVID-19 y tasas de letalidad: reporte de caso en una ciudad brasileña

Vaccination campaigns played a crucial role in reducing the incidence of COVID-19. However, a scant number of studies evaluated the impact of vaccination on case fatality rates (CFRs), including in Brazil. Our study aimed to compare CFRs according to vaccination status among subjects living in Arapongas (Paraná State, Brazil), considering the age composition of the population. Several strategies adopted by the Arapongas City Hall to minimize the spread of the virus were also elaborated upon. We accessed the 2021 database of the Arapongas Municipal Health Department, in which a total of 16,437 confirmed cases and 425 deaths were reported. The CFR was calculated as the ratio between COVID-19 deaths and the number of confirmed cases. Differences in age composition between unvaccinated and fully vaccinated individuals were observed in our study. Considering that CFR is a crude indicator and is highly sensitive to the age composition of the population, we adopted the average age distribution of confirmed cases among the three vaccination statuses (unvaccinated, partially, and fully) as a standard age distribution. The age-standardized CFR for unvaccinated and fully vaccinated groups were 4.55% and 2.42%, respectively. Fully vaccinated individuals showed lower age-specific CFRs in all age groups above 60 years than unvaccinated populations. Our findings strengthen the role of vaccination as a critical measure for preventing deaths among infected people and is particularly important to the ongoing reassessment of public health interventions and policies.

As campanhas de vacinação desempenharam um papel crucial na redução da incidência da COVID-19. No entanto, um número escasso de estudos avaliou o impacto da vacinação nas taxas de letalidade, inclusive no Brasil. Este estudo teve como objetivo comparar as taxas de letalidade de acordo com a situação vacinal dos residentes do Município de Arapongas (Paraná, Brasil), considerando a composição etária da população. Várias estratégias adotadas pela Prefeitura Municipal para minimizar a propagação do vírus também foram elaboradas. Acessou-se a base de dados de 2021 da Secretaria Municipal de Saúde de Arapongas, onde foram notificados 16.437 casos confirmados e 425 óbitos. A taxa de letalidade foi calculada como a razão entre as mortes por COVID-19 e o número de casos confirmados. Este estudo inédito observou diferenças na composição etária entre indivíduos não vacinados e totalmente vacinados. Considerando que a taxa de letalidade é um indicador bruto e altamente sensível à composição etária da população, adotou-se a distribuição etária média dos casos confirmados entre os três níveis vacinais (não vacinados, parcialmente vacinados e completamente vacinados) como distribuição etária padrão. A taxa de letalidade padronizada por idade para os não vacinados e completamente vacinados foi de 4,55% e 2,42%, respectivamente. Indivíduos completamente vacinados apresentaram menores taxas de letalidade específicas por idade em todas as faixas etárias acima de 60 anos em comparação às populações não vacinadas. Estes achados fortalecem o papel da vacinação como uma medida essencial para a prevenção de mortes entre pessoas infectadas e é de particular importância para a reavaliação contínua das intervenções e políticas de saúde pública.

Las campañas de vacunación juegan un papel clave en la reducción de la propagación del COVID-19. Sin embargo, pocos estudios evalúan el impacto de la vacunación en las tasas de letalidad, incluso en Brasil. Este estudio tuvo por objetivo comparar las tasas de letalidad según el estado de vacunación de los residentes de Arapongas (Paraná, Brasil) a partir de la composición por grupo de edad de la población. El Ayuntamiento Municipal aplicó varias estrategias para mitigar la propagación del virus. Se accedió a la base de datos de 2021 del Departamento de Salud de Arapongas, donde se reportaron 16.437 casos confirmados y 425 defunciones. Se calculó la tasa de letalidad como la relación entre las muertes por COVID-19 y el número de casos confirmados. Este estudio inédito evaluó las diferencias en la composición por grupo de edad entre individuos no vacunados y los individuos totalmente vacunados. Teniendo en cuenta que tasa de letalidad es un indicador bruto y muy sensible a la composición por grupo de edad de la población, se adoptó la distribución estándar por grupo de edad de los casos confirmados entre los tres niveles de vacunación (no vacunados, parcialmente vacunados y totalmente vacunados). La tasa de letalidad estandarizada por edad para los no vacunados y los totalmente vacunados fue del 4,55% y del 2,42%, respectivamente. Los individuos totalmente vacunados tenían más baja tasa de letalidad por grupo de edad en todos los grupos de edad superiores a los 60 años en comparación con las poblaciones no vacunadas. Estos hallazgos confirman el papel de la vacunación como una medida esencial de prevención de muertes entre los infectados y es importante para la reevaluación en curso de las intervenciones y políticas de salud pública.

Machine learning and comorbidity network analysis for hospitalized patients with COVID-19 in a city in Southern Brazil.

The large amount of data generated during the COVID-19 pandemic requires advanced tools for the long-term prediction of risk factors associated with COVID-19 mortality with higher accuracy. Machine learning (ML) methods directly address this topic and are essential tools to guide public health interventions. Here, we used ML to investigate the importance of demographic and clinical variables on COVID-19 mortality. We also analyzed how comorbidity networks are structured according to age groups. We conducted a retrospective study of COVID-19 mortality with hospitalized patients from Londrina, Parana, Brazil, registered in the database for severe acute respiratory infections (SIVEP-Gripe), from January 2021 to February 2022. We tested four ML models to predict the COVID-19 outcome: Logistic Regression, Support Vector Machine, Random Forest, and XGBoost. We also constructed a comorbidity network to investigate the impact of co-occurring comorbidities on COVID-19 mortality. Our study comprised 8358 hospitalized patients, of whom 2792 (33.40%) died. The XGBoost model achieved excellent performance (ROC-AUC = 0.90). Both permutation method and SHAP values highlighted the importance of age, ventilatory support status, and intensive care unit admission as key features in predicting COVID-19 outcomes. The comorbidity networks for old deceased patients are denser than those for young patients. In addition, the co-occurrence of heart disease and diabetes may be the most important combination to predict COVID-19 mortality, regardless of age and sex. This work presents a valuable combination of machine learning and comorbidity network analysis to predict COVID-19 outcomes. Reliable evidence on this topic is crucial for guiding the post-pandemic response and assisting in COVID-19 care planning and provision.

The impact of COVID-19 vaccination on case fatality rates in a city in Southern Brazil.

BACKGROUND: Recent studies have established that vaccination plays a significant role in reducing COVID-19-related deaths. Here, we investigated differences in COVID-19 case fatality rates (CFRs) among vaccinated and unvaccinated populations, and analyzed whether the age composition of confirmed cases has a significant effect on the variations in the observed CFRs across these groups. METHODS: The study considered 59,853 confirmed cases and 1,687 deaths from COVID-19, reported between January 1 to October 20, 2021, by the Health Department of Londrina, a city in Southern Brazil. We used Negative Binomial regression models to estimate CFRs according to vaccination status and age range. RESULTS: There are significant differences between the CFR for fully vaccinated and unvaccinated populations (IRR = 0.596, 95% CI [0.460 - 0.772], P < .001). Vaccinated populations experience fatality rates 40.4% lower than non-vaccinated. In addition, the age composition of confirmed cases explains more than two-thirds of the variation in the CFR between these 2 groups. CONCLUSIONS: Our novel findings reinforce the importance of vaccination as an essential public health measure for reducing COVID-19 fatality rates in all age groups. The results also provide means for accurately assessing differences in CFRs across vaccinated and unvaccinated populations. Such assessment is essential to inform and determine appropriate containment and mitigation interventions in Brazil and elsewhere.

Movimentos pendulares e integração regional no leste fluminense / Commuting and regional integration in eastern Rio de Janeiro / Movilidad circular e integración regional en el este de Río de Janeiro

A pendularidade é uma importante medida para avaliar os processos de integração das cidades e a dinâmica populacional regional. Em 2015, o IBGE identificou a intensificação dos movimentos pendulares entre os municípios do leste fluminense, de Arraial do Cabo a São João da Barra, considerando-os aspectos relevantes da urbanização brasileira. Contudo, pouco se sabe sobre o peso da pendularidade entre esses municípios e o nível de interação que eles estabelecem com Macaé, principal destino dos pendulares na região. Esse trabalho analisa o grau de integração regional do vetor leste fluminense, a partir dos dados censitários de 2000 e 2010. A pendularidade por trabalho e/ou estudo observada em Macaé o coloca em posição de destaque entre os municípios selecionados. Afirmamos, portanto, que Macaé não é apenas uma cidade em movimento, mas também um município potencialmente integrador do mercado de trabalho das demais municipalidades da região. É em torno desse município que o tecido urbano regional tem se reorganizado. Esse estudo pode iluminar novas discussões sobre os processos recentes de urbanização no estado do Rio de Janeiro, sobretudo por se tratar de uma região demograficamente integrada, mas politicamente fragmentada.

Commuting is an important measure to assess cities' integration processes and regional population dynamics. In 2015, IBGE identified an intensification of the movement of people between the municipalities in eastern Rio de Janeiro, from Arraial do Cabo to São João da Barra, considering them relevant aspects of Brazilian urbanization. However, little is known about the weight of commuting between these municipalities, the levels of connections between them and the interaction between these municipalities and Macaé, the main destination of commuters in the area. This work analyzes the extent of regional integration of the eastern Rio de Janeiro vector from the 2000 and 2010 census data. The commuting due to work and/or study observed in Macaé places the municipality in a prominent position among the selected municipalities. We affirm that Macaé is not just a moving city, but a municipality that potentially integrates the labor market of other municipalities in the region. This study may illuminate new discussions about the recent urbanization processes in the state of Rio de Janeiro, mainly because it is a region demographically integrated, but politically fragmented.

La movilidad circular es una medida importante para evaluar los procesos de integración de las ciudades y la dinámica regional de la población. En 2015, el IBGE identificó una intensificación del movimiento de personas entre los municipios del este de Río de Janeiro, considerándolo un aspecto relevante de la urbanización brasileña. Sin embargo, se sabe poco sobre el peso de la movilidad entre estos municipios, el nivel de conexiones entre ellos y el nivel de interacción entre estos municipios y Macaé, el principal destino de quienes se movilizan circularmente en la región. Este trabajo analiza el grado de integración regional del vector fluminense oriental basado en los datos de los censos de 2000 y de 2010. La movilidad para el trabajo o el estudio observada en Macaé coloca al municipio en una posición prominente entre los municipios seleccionados. Por lo tanto, afirmamos que Macaé no es solo una ciudad en movimiento, sino un municipio que potencialmente integra el mercado laboral de otros municipios de la región. Es alrededor de este municipio que el tejido urbano regional se ha reorganizado. Este estudio puede iluminar nuevas discusiones sobre los recientes procesos de urbanización en el estado de Río de Janeiro, principalmente porque es una región demográficamente integrada, pero políticamente fragmentada.