Twenty-first-century demographic and social inequalities of heat-related deaths in Brazilian urban areas.

Population exposure to heat waves (HWs) is increasing worldwide due to climate change, significantly affecting society, including public health. Despite its significant vulnerabilities and limited adaptation resources to rising temperatures, South America, particularly Brazil, lacks research on the health impacts of temperature extremes, especially on the role played by socioeconomic factors in the risk of heat-related illness. Here, we present a comprehensive analysis of the effects of HWs on mortality rates in the 14 most populous urban areas, comprising approximately 35% of the country's population. Excess mortality during HWs was estimated through the observed-to-expected ratio (O/E) for total deaths during the events identified. Moreover, the interplay of intersectionality and vulnerability to heat considering demographics and socioeconomic heterogeneities, using gender, age, race, and educational level as proxies, as well as the leading causes of heat-related excess death, were assessed. A significant increase in the frequency was observed from the 1970s (0-3 HWs year-1) to the 2010s (3-11 HWs year-1), with higher tendencies in the northern, northeastern, and central-western regions. Over the 2000-2018 period, 48,075 (40,448-55,279) excessive deaths were attributed to the growing number of HWs (>20 times the number of landslides-related deaths for the same period). Nevertheless, our event-based surveillance analysis did not detect the HW-mortality nexus, reinforcing that extreme heat events are a neglected disaster in Brazil. Among the leading causes of death, diseases of the circulatory and respiratory systems and neoplasms were the most frequent. Critical regional differences were observed, which can be linked to the sharp North-South inequalities in terms of socioeconomic and health indicators, such as life expectancy. Higher heat-related excess mortality was observed for low-educational level people, blacks and browns, older adults, and females. Such findings highlight that the strengthening of primary health care combined with reducing socioeconomic, racial, and gender inequalities represents a crucial step to reducing heat-related deaths.

Involvement of political and socio-economic factors in the spatial and temporal dynamics of COVID-19 outcomes in Brazil: A population-based study.

Background: Brazil has been severely impacted by COVID-19 pandemics that is aggravated by the absence of a scientifically-driven coordinated informative campaign and the interference in public health management, which ultimately affected health measures to avoid SARS-CoV2 spread. The decentralization and resultant conflicts in disease control activities produced different protection behaviours and local government measures. In the present study, we investigated how political partisanship and socio-economic factors determined the outcome of COVID-19 at the local level in Brazil. Methods: A retrospective study of COVID-19 deaths was carried out using mortality databases between Feb 2020, and Jun 2021 for the 5570 Brazilian municipalities. Socio-economic parameters including city categories, income and inequality indexes, health service quality and partisanship, assessed by the result of the second round of the 2018 Brazilian presidential elections, were included. Regression tree analysis was carried out to identify the statistical significance and conditioning relationships of variables. Findings: Municipalities that supported then-candidate Jair Bolsonaro in the 2018 elections were those that had the worst COVID-19 mortality rates, mainly during the second epidemic wave of 2021. This pattern was observed even considering structural inequalities among cities. Interpretation: In general, the first phase of the pandemic hit large and central cities hardest, while the second wave mostly impacted Bolsonarian municipalities, where scientific denialism among the population was stronger. Negative effects of partisanship towards the right-wing on COVID-19 outcomes counterbalances favourable socioeconomic indexes in affluent Brazilian cities. Our results underscore the fragility of public health policies which were undermined by the scientific denialism of right-wing supporters in Brazil. Funding: International joint laboratories of Institute de Recherche pour le Développement, a partnership between the University of Brasília and the Oswaldo Cruz Foundation (LMI-Sentinela - UnB - Fiocruz - IRD), Coordination for the Improvement of Higher Education Personnel (CAPES), National Council for Scientific and Technological Development (CNPq).