Social Determinants of COVID-19 Outcomes in Latin America During Vaccine Rollout: A Real-World Study

OBJECTIVES: Latin American (LATAM) countries face underlying social challenges that shape responses to public health policies. We aimed to explore social determinants related to hospitalization and death among COVID-19 cases in LATAM in the context of the vaccine rollout.

METHODS: Retrospective study using national COVID-19 surveillance databases from Argentina, Brazil, Colombia, and Mexico, from January 2021 to December 2022. Multivariate logistic regression models were used to identify sociodemographic factors associated with hospitalization and death among laboratory-confirmed COVID-19 cases, adjusting for confounders (age, sex, ethnicity, comorbidities, and vaccination status).

RESULTS: We analyzed 35,598,818 cases. Of these, 2,632,283 (7.4%) cases required hospitalization, and 881,232 (2.5%) resulted in death. Hospitalized cases were predominantly male (54.3%) and over 50 years old (63.1%). In Brazil, the highest proportion of hospitalized cases were from São Paulo (29.9%) and Minas Gerais (13.1%), whereas in Colombia, they were from Bogotá (24.5%) and Antioquia (11.5%). Indigenous ethnicity accounted for 0.2% to 1.6% of hospitalized cases across countries. Older age groups had significantly increased odds of hospitalization. In cases >85 years, the odds ratio (OR) for hospitalization ranged from 4.57 (95%CI 4.43-4.72) in Mexico to 44.83 (95%CI 43.45-46.27) in Brazil. For males, the OR ranged from 1.42 (95%CI 1.40-1.43) in Colombia to 1.67 (95%CI 1.66-1.68) in Mexico. The odds of death were significantly higher in cases of indigenous ethnicity, ranging between 1.11 (95%CI 1.03-1.18) in Colombia and 1.85 (95%CI 1.77-1.94) in Mexico. Unvaccinated COVID-19 cases had higher odds of hospitalization (OR 5.66 in Colombia, and 2.46 in Brazil) and death (OR 33.10 in Colombia and 2.23 in Brazil) compared to fully-vaccinated cases.

CONCLUSIONS: These findings highlight the influence of social determinants, including age, sex, and ethnicity, on COVID-19 outcomes in LATAM during vaccine rollout. Addressing these factors is relevant to mitigating the impact of emerging diseases in the region.