COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

Abstract Background The COVID-19 pandemic occurred in an unfavorable political context in Brazil, and problems accumulated in the Unified Health System (SUS) over time. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic inequities across the country. This work was aimed at studying variations in COVID-19 inpatient mortality in Brazil throughout the pandemic in the period from 2020–2022, focusing on differences across public, private and philanthropic (private nonprofit) inpatient healthcare units, providers and nonproviders of services to the Unified Health System (SUS). Methods This cross-sectional study used secondary data from the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE). The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS’ Hospitalization Information System (SIH-SUS) and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 150 cases in the period. Data analyses explored the occurrence of hospitalizations and inpatient mortality over time and across the groups of hospitals defined by juridical ownership and participation in SUS. Moreover, general linear mixed models were estimated to identify independent effects on COVID-19 inpatient mortality of characteristics of patients, healthcare processes, healthcare units and municipalities. Results Approximately 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, but SUS hospitals had worse inpatient mortality than others. Northern Brazil experienced the highest chances of inpatient mortality, with no significant differentiation among inpatient care unit types. Black individuals had higher chances of COVID-19 inpatient mortality in all regions of the country, as well as indigenous individuals in the North and mixed-race individuals in the South. Additionally, inpatient mortality was higher in the first (Apr-Aug 2020) and second (Dec 2020-May 2021) pandemic waves, becoming lower in 2022, even during the third wave (Jan-Feb 2022). Conclusions COVID-19 exposed SUS healthcare weaknesses resulting from long-term disinvestment, and its lower performance is a problem to be addressed.