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

Diego Ricardo Xavier; Eliane Lima E Silva; Flávio Alves Lara; Gabriel R R E Silva; Marcus F Oliveira; Helen Gurgel; Christovam Barcellos

doi:10.1016/j.lana.2022.100221

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

Lancet Reg Health Am. 2022 Jun:10:100221. doi: 10.1016/j.lana.2022.100221. Epub 2022 Mar 14.

Authors

Diego Ricardo Xavier^{1

2}, Eliane Lima E Silva^{2

3}, Flávio Alves Lara⁴, Gabriel R R E Silva^{2

3}, Marcus F Oliveira⁵, Helen Gurgel^{2

3}, Christovam Barcellos^{1

2}

Affiliations

¹ Health Information Laboratory, Health Communication and Information Institute, Oswaldo Cruz Foundation (Fiocruz), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ 21045-900, Brazil.
² International Joint Laboratory, LMI Sentinela (UnB - Fiocruz - IRD), Brasília-DF, Montpellier, France, Rio de Janeiro, RJ, Brazil.
³ Laboratory of Geography, Environment and Health (LAGAS), Geography Department, Brasília University (UnB), Brasília, DF, Brazil.
⁴ Cellular Microbiology Laboratory, Oswaldo Cruz Foundation (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ, Brazil.
⁵ Institute of Medical Biochemistry Leopoldo de Meis, Health Sciences Centre, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Abstract

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).

Keywords: Brazil; COVID-19; Data mining; Pandemic; Politics; Social inequalities.