Análisis de la variabilidad geográfica, inequidades en salud y COVID-19 en Bariloche, Rio Negro, durante los años 2020-2021.

Abstract

Health inequities are systematic differences observed in the health status of different population groups. The city of San Carlos de Bariloche, in the province of Río Negro, Argentina, presents a very marked economic gradient. This city was particularly affected by the coronavirus pandemic during the years 2020 and 2021, having a constant incidence of cases and associated mortality in said period. The objective of this study is to analyze the geographic variability and the relationship between social determinants of health and mortality from COVID-19 in the city of San Carlos de Bariloche. Methodology: Positive cases for COVID-19 were selected from the database of the National Epidemiological Surveillance System, from January 2020 to December 2021. They were geocoded and incorporated into a geographic information system (GIS) modeling individual data on age, gender and mortality that were articulated with the data of the National Institute of Statistics and Censuses, incorporating aspects of people, households and dwellings according to census radii. A 3-step analysis framework was established to measure health inequity, based on the unequal distribution of housing and household, the quality of materials, and access to services. We complement this framework by performing a multivariate analysis of inequity to predict mortality in the period. Results: In total, 21,381 people were diagnosed with COVID-19 and reported to the National Epidemiological Surveillance System (SISA). The mean age was 39.1 years (16.8) and 52.2% were women. There were 485 deaths from coronavirus in that period, with a lethality of 2.26%. The variability observed between delegations such as the Urban area or El Cóndor, belonging to the South region of the City, which present unemployment percentages (43% and 47%), non-literacy (6% and 7%), households with NBI (13 % and 26%), higher percentage of homes with overcrowding (3% and 8%), insufficient construction quality (16% and 9%) and poor connection to services (16% and 15%) was significant (p < 0 .01) in all cases. The lethality had a variation of more than 2% between delegations (p < 0.01). Belonging to a territory with vulnerability predicted a 4-fold increase in mortality from COVID-19, OR 4.14 95% CI 0.41-14.3 (p < 0.001) and independent of other variables not included in the model. Conclusions: There is great social and economic variability among the territorial delegations of the city of San Carlos de Bariloche. People with inequalities related to individuals, their homes, and dwellings may be at higher risk of dying from coronavirus. On the other hand, the factors inherent to these axes are 8 relate differently to constitute the vulnerability of the people who inhabit a certain territory and this dynamic vulnerability affects mortality from COVID-19. Understanding the impact of social vulnerability at the local and regional scale can help communities become more resilient when faced with disease outbreaks, epidemics, and pandemics.