BackgroundAlthough many studies identify the presence of comorbidities and socioeconomic vulnerabilities as risk factors for worse COVID-19 outcomes, few have addressed this issue in children. We aimed to study how these factors have impacted COVID-19 mortality in Brazilian children and adolescents. MethodsThis is an observational study using publicly available data from the Brazilian Ministry of Health. We studied 5,857 patients younger than 20 years old, all of them hospitalized with laboratory-confirmed COVID-19. We used multilevel mixed-effects generalized linear models to study mortality, stratifying the analysis by age, region of the country, presence of noncommunicable diseases, ethnicity, and socioeconomic development. FindingsIndividually, most of the comorbidities included were risk factors. Having more than one comorbidity increased almost tenfold the risk of death (OR 9{middle dot}67 95%CI 6{middle dot}89-13{middle dot}57). Compared to White children, Indigenous, Pardo (mixed), and East Asian had a significantly higher risk of mortality. We also found a regional effect (higher mortality in the North), and a socioeconomic effect (higher mortality among children from less socioeconomically developed municipalities). InterpretationBesides the impact of comorbidities, we identified ethnic, regional, and socioeconomic effects shaping the mortality of children hospitalized with COVID-19 in Brazil. Putting these findings together, we propose that there is a syndemic among COVID-19 and noncommunicable diseases, driven and fostered by large-scale sociodemographic inequalities. Facing COVID-19 in Brazil must also include addressing these structural issues. Our findings also identify risk groups among children that should be prioritized for public health measures, such as vaccination. FundingNone.
Noncommunicable Diseases, Sociodemographic Vulnerability, and the Risk of Mortality in Hospitalized Children and Adolescents with COVID-19 in Brazil: A Syndemic in Play