Social Inequality and Mortality from Covid-19 in Brazil: An Ecological Study

Background: Research on the COVID-19 pandemic has shown that poor socioeconomic conditions are linked to higher mortality rates from the disease. However, some studies have identified factors such as population density and the absence of policies restricting movement as important to mortality rates.Objective: The aim of this study is to analyze the relationship between COVID-19 mortality rates and demographic indicators, disease incidence, and social determinants of health in Brazil, comparing the years 2020 and 2021.Method: We conducted a population-based ecological study using cities in Brazil as units of analysis. We employed multiple linear regression and evaluated our results based on the theoretical model built for this purpose.Results: Our regression identified changes in the association between variables and COVID-19 mortality rates in the first two years of the pandemic in Brazil. Some socioeconomic indicators lost statistical significance in the second year of the pandemic.Conclusion: The disease initially spread in Brazil's most populous cities, with the highest population density, economic activity, and strongest socioeconomic indicators. Despite the disease's spread across the country, mortality rates from COVID-19 have not decreased in large cities, complicating the pandemic situation in Brazil.