Socioeconomic factors have exacerbated the impact of COVID–19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID–19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID–19 mortality in large urban centers in Brazil. We compiled weekly COVID–19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID–19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID–19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID–19, as supported by the observed associations in this study.

Background: Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15–24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries. Methods: This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010–2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects. Findings: The mean sub-city homicide rate per 100,000 in persons aged 15–24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25–39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84–0.90) and 0.90 (CI 0.86–0.93) for education and 0.87 (CI 0.81–0.92) and 0.92 (CI 0.87–0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10–1.48) and 1.21 (CI 1.07–1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07–1.21) and 1.07 (CI 1.02–1.12) in male and female, respectively). Interpretation: City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region. Funding: The Wellcome Trust [ 205177/Z/16/Z ].

Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.

We analyzed the impact of the efforts to combat the COVID-19 pandemic on the prices of food sold by a food supply center located in the sixth largest city in Brazil. We examined the percentage change in the prices of 20 types of foods, adjusted by market conditions, using municipal contingency plan stages to compare opening and closing of non-essential services, including bars and restaurants (stage 1: first phase of essential services-only; stage 2: flexibilization; and stage 3: second phase of essential services-only with a “pre-pandemic” period [stage 0]). Log-prices were lower in all contingency stages for leafy greens (variation: 42% to 56%) and vegetables (variation: 28% to 40%). Log-prices of eggs and fruit were 20% and 16% lower during stages 1 and 3, respectively. Strategies to combat the COVID-19 pandemic lowered the prices of eggs, fruit, leafy greens, and vegetables regardless of the market conditions. Accordingly, the supply and demand for fresh and minimally processed foods were affected by the economic crisis and difficulties to access and/or buy perishable foods more often. The impacts of efforts to defeat the pandemic must ensure the human right to adequate food, considering that low prices do not necessarily indicate food security.

A insegurança alimentar gera graves implicações para a saúde e a vida das populações. Muitos determinantes sociais já foram identificados, mas a compreensão da insegurança alimentar ainda é limitada devido a uma visão fragmentada que desarticula as diferentes dimensões de vulnerabilidade. Este estudo objetiva analisar a (in)segurança alimentar sob o olhar da interseccionalidade, tendo como local de estudo duas favelas de Belo Horizonte (Minas Gerais, Brasil) e seus entornos. A análise transversal foi realizada com dados do inquérito domiciliar do Projeto BH-Viva. A variável de desfecho foi a insegurança alimentar, e as variáveis de exposição foram obtidas pela construção interseccional de indicadores de vulnerabilidade social (sexo, raça/cor e Índice de Vulnerabilidade Socioeconômica Sensível à Insegurança Alimentar - IVSIA, construído a partir dos domínios trabalho e renda, escolaridade e condições de domicílio). As associações entre a insegurança alimentar e as exposições foram estimadas por meio de modelos de regressão logística, e o efeito das categorias de interseccionalidade sobre a insegurança alimentar foi capturado por termos de interação apropriados. Entre as pessoas em condições socioeconômicas desfavoráveis (IVSIA), as mulheres negras apresentaram as maiores chances de apresentar insegurança alimentar (OR = 7,50; IC95%: 3,20-17,58) do que homens negros e mulheres brancas. Os resultados revelam que a insegurança alimentar é marcada por processos de vulnerabilização interseccionais, em que se sobrepõem os efeitos de privação socioeconômica, sexismo, patriarcado e racismo. Dessa forma, reforçam a necessidade de pesquisas com abordagens interseccionais para identificar os padrões e as principais vítimas da insegurança alimentar, bem como a urgência de políticas públicas voltadas para as necessidades desses grupos.