Health Revolution Institute
Quality Revolution Unit
Joaquim Cardoso MSc.
April 22, 2022
Key messages
- The In-Hospital Mortality rate of Brazilian Private Hospitals was 7.8%, according to the study of “de Oliveira Lima, H (2022)”
- The In-Hospital Mortality rate of Brazilian Public Hospitals was 38.0% , according to a study of “Ranzani, O. T. et al.(2021)”
- Therefore the In-Hospital Mortality Rate for Covid-19 patients was almost 5 times higher (4,87 times) in Public Hospitals (38.0%) than in Private Hospitals (7.8%) in Brazil, proportionately, comparing both studies.
- Of many factors at play, more investments in infrastructure and healthcare professionals’ qualification (as well as ensuring an adequate workload) is key, especially in the public system, to start closing the gap (de Oliveira Lima, H ,2022)
What is the In-Hospital Mortality rate of Brazilian Private Hospitals?
On Friday 22nd, I republished here the article of “De Oliveira Lima, H. et al. 2022”, with the title “Coronavirus disease-related in-hospital mortality: a cohort study in a private healthcare network in Brazil.”
The research was a longitudinal retrospective cohort study of patients ≥ 20 years-old who were hospitalized due to COVID-19 in 52 hospitals comprising a private Brazilian healthcare network (Rede D’Or São Luiz).
The results of the study showed that in total, 38,937 patients were hospitalized and 3058 (7.8%) died of COVID-19.
What is the In-Hospital Mortality rate of Brazilian Public Hospitals?
According to “Ranzani, O. T. et al., 2021” , in a study where 232 036 (91%) of 254 288 patients had a defined hospital outcome when the data were exported, in-hospital mortality was 38% (87 515 of 232 036 patients) overall.
What is the difference between Public and Private Hospitals in Brazil, for “In-Hospital Mortality Rate for Covid-19 Patients”, comparing the two studies?
- When comparing the In-Hospital Mortality Rates of Public Hospitals (38.%), with the rate of Private Hospitals (7.8%), the In-Hospital Mortality Rate for Covid-19 patients, was almost 5 times higher in Public than in Private Hospitals in Brazil, proportionately, considering both studies.
- Indeed, when compared to > 250,000 COVID-19 patients admitted to (all) Brazilian hospitals between Feb-Aug 2020, the proportion of deaths in our cohort was substantially lower in all age groups, being more pronounced in patients between 20 and 39 years-old (88% mortality reduction), and less so (though still significant) in patients ≥ 80 years-old (25% reduction) (p < 0.001) (“De Oliveira Lima, H. et al. 2022”)
What are the causes for this huge difference?
- Such large variability is likely multifactorial, including local infrastructure, availability (and qualification) of human (as well as equipment, pharmacologic and technological) resources, combined with patients’ underlying socioeconomic and health (i.e., comorbidities) conditions 24. (Ñamendys-Silva, S. A., et al, 2020)
- Notably, in countries like Brazil with drastic socioeconomic disparities, access to private healthcare arguably allows for better (and ongoing) assistance which may (and likely do) contribute to better optimization of chronic conditions/comorbidities, thereby potentially impacting COVID-19-related survival rates.
What are the recommendations?
- Nevertheless, years (or even decades) worth of life expectancy gains in Brazil have been rapidly reversed by the pandemic (Castro, M. C. et al., 2021), and the significant difference in in-hospital mortality between Brazilian hospitals in general (38%) (Ranzani, O. T. et al., 2021) and the local private healthcare (7.8%), although multifactorial, arguably reflects the historical socioeconomic abyss existent in the country.
- Of many factors at play, more investments in infrastructure and healthcare professionals’ qualification (as well as ensuring an adequate workload) is key, especially in the public system, to start closing the gap.
Main references
Ranzani, O. T. et al. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: A retrospective analysis of nationwide data. Lancet Respir. Med. 9, 407–418
de Oliveira Lima, H., da Silva, L.M., de Campos Vieira Abib, A. et al. Coronavirus disease-related in-hospital mortality: a cohort study in a private healthcare network in Brazil. Sci Rep 12, 6371 (2022).
Additional references
Castro, M. C. et al. Reduction in life expectancy in Brazil after COVID-19. Nat. Med. https://doi.org/10.1038/s41591-021-01437-z (2021).
Ñamendys-Silva, S. A., Gutiérrez-Villaseñor, A. & Romero-González, J. P. Hospital mortality in mechanically ventilated COVID-19 patients in Mexico. Intensive Care Med. 46, 2086–2088. https://doi.org/10.1007/s00134-020-06256-3 (2020).
About the authors of the original publications
Coronavirus disease-related in-hospital mortality: a cohort study in a private healthcare network in Brazil — Scientific Reports
Helidea de Oliveira Lima 1 ,
Leopoldo Muniz da Silva 2 ,
Arthur de CamposVieiraAbib 2 ,
Leandro ReisTavares 1 ,
Daniel Wagner de Castro Lima Santos 3 ,
Ana Claudia Lopes Fernandes de Araújo 1 ,
Laise Pereira Moreira 1 ,
Saullo Queiroz Silveira 2 ,
Vanessa de Melo SilvaTorres 1 ,
Deborah Simões 1 ,
Ramiro Arellano 4 ,
Anthony M.‑H. Ho 4 &
Glenio B. Mizubuti 4
1 Rede D’Or, Av. Presidente Juscelino Kubitschek, 1839, São Paulo, SP, Brazil.
2 Department of Anesthesiology, São Luiz Hospital-Rede D’Or-CMA, Rua Alceu de Campos Rodrigues, 229, São Paulo, SP, Brazil.
3 Department of Infectious Disease, São Luiz Jabaquara Hospital-Rede D’Or, Rua Perobas, 344, São Paulo, SP, Brazil.
4 Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data
The Lancet
Otavio T Ranzani, PhD †
Leonardo S L Bastos, MSc †
João Gabriel M Gelli, BSc
Janaina F Marchesi, PhD
Prof Fernanda Baião, PhD
Prof Silvio Hamacher, PhD
Prof Fernando A Bozza, PhD
January 15, 2021
Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain (O T Ranzani PhD);
Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (O T Ranzani);
Department of Industrial Engineering (L S L Bastos MSc, J G M Gelli BSc, Prof F Baião PhD, Prof S Hamacher PhD), and
Tecgraf Institute (L S L Bastos, J G M Gelli, J F Marchesi PhD, Prof S Hamacher),
Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil; Critical Care Lab, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (Prof F A Bozza PhD); and
D’Or Institute for Research and Education, Rio de Janeiro, Brazil (Prof F A Bozza)
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