Perception of Risk for Developing Severe Illness or Complications from COVID-19 in Brazil: Focus on Factors Linked to Socially Vulnerable Populations, 2020–2023

In this study, the aim was to comparatively examine the perception of risk for developing severe illness or complications due to COVID-19 among the general population and socially vulnerable populations in Brazil, focusing on uncovering the associated factors that disproportionately impacted people experiencing homelessness and slum dwellers. This study is part of the project "Social Thermometer-COVID-19 in Brazil", which employed a hybrid approach, combining a national online survey with field research in state capitals and the Federal District. Data collection took place from August 2020 to October 2023, and the data were analyzed using descriptive statistics and logistic regression. A total of 5094 participants were included in this study, with 2363 from the general population and 2731 from the socially vulnerable population. Among the general population, the majority of participants were women, white individuals, those with higher incomes, formal employment, and higher education levels. Concerning the vulnerable population, most were men, Black individuals, those with lower incomes, unemployment, and lower education levels. It was observed that 87% of the general population perceived a risk of severe COVID-19, compared to 74% of the vulnerable population. Slum dwellers who received emergency aid (OR_a = 1.39; 95% CI: 1.02-1.91), adhered to mask-wearing practices (OR_a = 1.93; 95% CI: 1.39-2.66), used COVID-19-related medications (ORa = 2.13; 95% CI: 1.31-3. 64), and those with pre-existing conditions, such as high blood pressure (OR_a = 1.86; 95% CI: 1.20-2.98), demonstrated a heightened perception of risk for severe COVID-19 complications. Among the homeless population, individuals who wore masks (OR_a = 1.67; 95% CI: 1.26-2.20 and had been vaccinated (OR_a = 1.44; 95% CI: 1.04-1.98) were also more likely to perceive a high risk. In conclusion, in this study, significant disparities are revealed in the perception of COVID-19 risk between the general and socially vulnerable populations in Brazil. Factors such as receiving emergency aid, adherence to mask-wearing, use of COVID-19-related medications, and pre-existing health conditions were associated with increased risk perception. Despite facing greater socioeconomic challenges, vulnerable groups, particularly those experiencing homelessness and slum dwellers, showed a lower perception of the risk for severe COVID-19 complications.