Inequalities and risk factors of COVID-19 patients with Down syndrome: a Brazilian cross-sectional, analytical-exploratory study

Introduction: People with Down’s syndrome, compose the group that has shown a significantly higher risk of severe illness or death from SARS-CoV-2 infection. This study analysed mortality risk in patients with Down syndrome infected by Sars-Cov-2 considering clinical and sociodemographic determinants. Methods: For this purpose, we retrieved data from COVID-19 patients with and without Down syndrome admitted to the Brazilian hospitals with symptoms of SARS. The relationship between variables and deaths was assessed by univariate analysis, and the relative risks and confidence intervals were analyzed by Poisson regression with robust variance. Coefficients Pearson’s and Spearman’s were used to assess the relationship of Brazilian social indexes and rate of deaths. Results: Out of 2597 COVID-19 patients with Down syndrome, 1105 (42.5%) died during hospitalization, and the mortality risk was 23.4% higher than patients without Down syndrome. The variables age >60 years, residence in the North region of Brazil, illiterate, and required ICU admission or mechanical ventilation were independently associated with higher mortality risk for patients with Down syndrome. The mortality rate also was negatively associated with Gross Domestic Product per capita and with literacy level and was positively associated with poverty level. Conclusions: In the present study, we showed that school attainment/literacy correlated with the risk of mortality of Down syndrome patients infected by Sars-Cov-2 in the less favored Brazil regions. Our study suggests the need to develop education strategies and health promotion programs to mitigate the risk of mortality in COVID-19 patients with Down syndrome.