During the Covid-19 health emergency, infections detected among users of the private health subsector were around 43.9% more than in the public. However, the fatality rate was – also on average – 46.4% higher in the public than in the private. In that period, Uruguay was the country with the highest rate of infection diagnoses on the continent.
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This is what the research indicates Socioeconomic inequalities in health outcomes during the Covid 19 pandemic health emergency in Uruguay carried out by university professors, almost entirely from the Faculty of Medicine of the University of the Republic (Udelar), among whom the doctors Leonel Briozzo, grade 5 of Gynecology and Obstetrics, former undersecretary of Public Health during the government of José Mujica, stand out. , and Alicia Aleman, professor of the Academic Unit of Preventive and Social Medicine.
The work, currently in the process of review and arbitration, is scheduled to be published in the next issue of the Medical Journal of Uruguaybefore the end of the year. As Briozzo told Searchalthough this means that the data is still under “review”, the differences found according to the subsectors “are significant.”
One of the global conclusions is that, appealing to reports from the Economic Commission for Latin America and the Caribbean (ECLAC), in the period in which the health emergency lasted in Uruguay—from March 13, 2020 to April 5, 2022— , this country was “the one that had the most infection diagnoses in America,” said Briozzo.
“This may be due to the high level of testing that took place here. Kits were widely available. It may be related to the rapid contagion and the characteristics of the population, but it surely had to do with the high level of testing,” Aleman said. The United States—which was in second place—also had a high detection capacity and, however, those infected were fewer, Briozzo pointed out.
Numerical discrepancy
What also stood out was the discordance between what happened in the public subsector of the National Integrated Health System (SNIS), with the State Health Services Administration (ASSE) at the helm, and in the private subsector. The former ministerial leader indicated that this variable was taken as an indicator proxy (indirect) to investigate how the pandemic unfolded according to socioeconomic strata: 75% of those in income quintile 1 and 50% of those in income quintile 2, the lowest, are served in the public sector, while almost 80% of 4th graders and almost 90% of 5th graders attend private school.
Aleman gave the numbers broken down by year, always every 1,000 people. In 2020, the year the pandemic hit, 3.02 cases were detected in the public and 7.21 in the private sector; in the second year, with the terrible omicron variant, they were 91.16 and 100.23, respectively; in 2022, 84.96 and 150.48.
In case fatality, this term understood as the rate of patients who die (mortality is a function of the total population), for every 1,000 infected the relationship was the inverse. In 2020 the rate was 18 in the public versus 11 in the private, in 2021 it was 17 and 14, respectively, and in the short period of the end of the health emergency in 2022 it was 3.5 and 2, the doctor specified. and teacher. In this last year, vaccination had already been extended.
Data disaggregated by year is more reliable. Averaging over the three years is not the most appropriate, since, Briozzo pointed out, the population varies each year. However, he pointed out that as an “approximation” it can be said that in the public subsector during the health emergency, 59.7 infections were detected per 1,000 inhabitants compared to 85.9 per 1,000 in the private sector. Using this same criterion, the fatality rate in the public subsector was on average 13.08 per 1,000 infected versus 8.93 per 1,000 in the private sector. “It is important to note that every year the differences were statistically significant; that is, not due to chance,” he stressed.
Explanations
For Briozzo, the “interesting” nature of these numbers, which reflect “more infections in the private area” at the same time as “more deaths in the public,” leads us to propose “that there was unequal behavior in the face of the health emergency” between both subsectors.
Aleman points out that a hypothesis that explains this reality could be the difference in the distribution of different populations with risk factors: more obese, more diabetics, more hypertensive, more elderly people. “However, in the public sector people are younger. Regarding the other risk factors, the latest study is from 2013 and, although there could be more hypertensives, in the others there are no significant differences. We do know that in general it is a sector where poorer people are served. It could be due to having less access to health services, which are problems typical of poverty. Poor people died more. “That could be a factor, but we can’t say for sure,” he added.
Not reaching a clear conclusion at that point makes this research, according to Aleman, an exploratory study.
During the development of the pandemic itself, the government positively evaluated its response to the crisis. When asked about this, the researchers did not want to make a value judgement. “Perhaps we should have had differential strategies,” said Aleman. “The important thing from an academic point of view is to put the issue on the table and draw lessons learned. This is original, contradictory and unequal data. What was it due to? What could have been changed? That is something to continue investigating, like the differences between Montevideo and the interior,” Briozzo said. And he added: “Political considerations are something else.”
