This study sought to identify clusters of a high and low risk of incidence and mortality from COVID-19 throughout the pandemic period, from 2020 to 2022, in the Metropolitan Region of São Paulo (MRSP), analyzing their relationship with socioeconomic and demographic variables. Spatiotemporal and temporal variations in the clusters were determined using scan statistics, a multidimensional point process that performs multiple tests for each geographic point analyzed, in SaTScan v10.0. Socioeconomic and demographic differences were analyzed using the nonparametric Mann–Whitney and Kruskal–Wallis tests. Temporal clusters of high incidence and high mortality were observed in May 2020 and March to June 2021. In the spatiotemporal analysis, the clusters of high incidence and high mortality were concentrated in the city of São Paulo and neighboring cities, indicating that the capital was an area of influence and convergence at all times during the COVID-19 pandemic. Clusters of low mortality were found in the central region of the capital, which concentrates the highest incomes and the lowest percentages of Black, mixed-race, and Indigenous people in the MRSP. All clusters were identified in densely occupied areas and point to a pattern of disease spread that is related to income and ethnicity, as well as to the circulation dynamics of a metropolitan region.

Geographic Information Systems (GIS) played an important role in understanding the dynamics of the territorial spread of COVID-19 during the pandemic. Even today, it is important to understand such dynamics in view of the imminent risk of new epidemics and pandemics. This study aimed to identify space-time clusters of incidence and mortality due to COVID-19 during the pandemic, analyzing socioeconomic and demographic characteristics in order to highlight the priority areas for control and surveillance actions. This study was conducted in the Metropolitan Region of São Paulo (MRSP) from March 2020 to February 2022. To detect the clusters, a multidimensional punctual process was created to perform multiple tests for every geographic point using the SaTScan™ software. Socioeconomic and demographic differences were analyzed using nonparametric Mann-Whitney and Kruskal-Wallis tests. High-risk clusters of incidences were observed in May 2020 (RR=2; p-value <0.001) and March to June 2021 (RR=2.6; p-value <0.001) in the capital of São Paulo and neighboring municipalities, with statistically significant differences between the socioeconomic variables analyzed. No low-risk cluster of COVID-19 incidence was found, but low-risk clusters of mortality from COVID-19 were found in the period from July to December 2020 in the central region of the capital (RR=0.33; p-value <0.001), which concentrates the highest incomes and the lowest percentages of Black, Brown (Mixed-race), and Indigenous people in the MRSP.