COVID-19 lethality in non-elderly individuals in cities with different Human Development Index

Dear Editor,

Many risk factors are associated with COVID-19 mortality, especially in those aged >65 years and associated with co-morbidities. At first, it was assumed that people aged <65 years have a lower risk of dying from COVID-19.¹ However, SARV-CoV-2 is currently spreading quickly in poor regions and differences in COVID-19 have been shown, especially by age group. In Brazil, around 15% of COVID-19 deaths have been in people aged <50 years. In Mexico, around 25% of fatalities have been aged 25–49 years. In India, nearly half of those who died were aged <60 years. These rates are 10 times greater than in Italy or Spain.

Brazil has many regional inequalities. About 13.5 million Brazilians live in extreme poverty,² according to the World Bank definition (daily income ≤$1.25). Pernambuco state, in the Northeast of Brazil, is the poorest region in the country. Pernambuco has 9278 million inhabitants in 185 cities that have shown different COVID-19 mortality rates: 4.2–39.7 per 100,000 inhabitants.

The Human Development Index (HDI) is an instrument used to evaluate the level of social welfare and economic development of a population. The HDI is the statistical index, between 0 and 1, of three indicators: life expectancy; years of schooling; and income per capita. The HDI reflects the social and economic status of people in different regions. Recife, the capital and largest city of Pernambuco state, has the highest HDI (0.772) and Manari has the lowest HDI (0.487).^3,4

Briefly, we analyzed the distribution of COVID-19 lethality in non-elderly people (aged <60 years). COVID-19 lethality data were taken from 12 cities of Pernambuco state, Brazil.⁵ The data are presented in Table 1. It was observed that COVID-19 lethality in people aged <60 years was inversely correlated with the HDI (Pearson’s correlation coefficient = –0.7351).

OPEN IN VIEWER

Table 1.

COVID-19 mortality in people aged <60 years in cities in Pernambuco state with different HDI.

City	HDI	Cases	Deaths	Lethality (%)
Ipojuca	0.619	91	14	15.38
Paudalho	0.639	37	10	27.03
Vitoria de Santo Antao	0.640	155	26	16.77
Moreno	0.652	57	10	17.54
Sao Lourenco da Mata	0.653	176	19	10.80
Caruaru	0.677	128	14	10.94
Cabo de Santo Agostinho	0.686	225	31	13.78
Camaragibe	0.692	332	24	7.23
Jaboatao dos Guararapes	0.717	1037	95	9.16
Paulista	0.732	640	49	7.66
Olinda	0.735	839	52	6.20
Recife	0.772	4360	327	7.50

People with a disadvantaged socioeconomic status had a higher COVID-19 lethality, including younger people. Very high population density and low levels of income and education affect living conditions in many ways, such as lack of food, precarious hygiene standards, and overcrowded and deprived housing conditions, all of which puts these people at greater risk of being exposed to SARS-CoV-2. In addition, nutritional deficiencies are common in these people, which competes for immunological deficiencies. Besides, disadvantaged people frequently have delayed medical care, which may worsen the prognosis of COVID-19. People with a disadvantaged socioeconomic status may be considered high-risk populations at the time of the COVID-19 pandemic.