University of São Paulo: In Brazil, black women have higher mortality by covid-19 than any group

MAfro-descendant women die more than covid-19 than all other groups (white women, white men and black men) in the base of the labor market, regardless of occupation, according to a survey carried out by the Solidarity Research Network and described in a technical note released in the last September 20th. According to the study, black men die more from covid-19 than white men regardless of occupation, both at the top and bottom of the labor market, while white women die less from covid-19 than white men in higher professions, but more die in occupations at the bottom of the labor market.

According to the technical note, analyzing the absolute number of workers’ deaths does not adequately reflect the risks of death by covid-19 within the occupations. Although agricultural workers, self-employed commerce and transport workers are the ones with the highest absolute volume of deaths, the scenario is different when looking at the proportion among the total number of deaths. Religious leaders, security, health and arts and cultural workers are the professionals with the highest relative rates of covid-19 deaths in 2020.

The purpose of the research is to examine deaths from covid-19 for different categories of workers, assuming that deaths from the disease are preventable. The bulletin analyzes deaths by covid-19 in 2020 in Brazil based on occupations held by workers and gender and race/color attributed to the person who died. The main objective is to observe which occupations have the highest volume of deaths from covid-19 in 2020, which occupations have the highest proportion of deaths from the disease in relation to the total number of deaths recorded in 2020 and how the chances of death by covid-19 express gender, race and color inequalities within occupations.

The data used in the study come from the Mortality Information System (SIM) of the Ministry of Health, for the year 2020. In total, they register 1,560,088 deaths, with 206,646 (13.2%) by covid-19. Of the total number of deaths, we consider those with reported occupation, for people between 18 and 65 years old, which add up to 67,536 cases (32.7% of the total number of deaths by covid-19). The analysis took place in two stages. First, the total volume of deaths by covid-19 was observed, together with the relative participation in the total number of deaths by occupations. In which occupations do people die most by covid-19 in absolute numbers? In which occupations do people die more by covid-19 – the preventable deaths – in relation to the total number of deaths?

Secondly, binary logistic regressions estimated the odds ratios of death per covid-19 according to race/color and sex. The models were estimated for each of the occupational groups and the variable age was included in order to control the propensity to death due to characteristics associated with the life cycle, including comorbidities. At the end, a model was estimated for each occupational group (77 in total). Occupational groups were built from the aggregation of occupational families from the Brazilian Classification of Occupations (CBO).

Graph 1 shows in which occupations people die more in general (size of the circles, the proportion in % of deaths per covid-19 in relation to total deaths), which occupations had more deaths in absolute numbers per covid-19 (X axis , horizontally), the proportion of deaths by covid-19 in relation to total deaths (avoidable deaths, Y axis). The farther to the right, the greater the absolute number of deaths per covid-19. The higher up, the more the disease affected the occupational group proportionally. The larger the circle, the more people die in that occupation, whether by covid-19 or not. The colors indicate the proportion ranges per covid-19 among the total number of deaths in the occupational group (red, equal to or greater than 20.0%; yellow, between 10.0% and 19.0%; green, less than 10, 0%).

In absolute numbers, Trade & Services workers (6,420) are the ones who died the most from covid-19, followed by Agriculture (3,384) and Transport (3,367). The relative rates, however, show that, among the preventable deaths, it was religious leaders (44%) who by far the most died of covid. In 2020, 305 deaths of people from this occupation were registered in Brazil, almost half of which were due to covid. the presidential decree nº 10.292, of March 25, 2020, established that religious activities of any kind were in the list of essential activities. This decree opened a series of divergences between the government, states and municipalities regarding the composition of these activities. Considering that churches and cults are activities that are usually carried out in closed places and with crowds of people, both risk factors for the transmission of sars-cov-2, it is noteworthy that religious leaders were the ones most likely to die by covid-19 in Brazil.

The second group is the Safety professionals (25.4.0%), an essential activity that was little covered with protection and prevention measures in the workplace, and which, because they did not have access to PPE, increased the proportion of deaths avoidable by covid-19 in the category. In third are the Health professionals (24.0%), who have worked intensely and daily in Basic Health Units, emergency care and hospitals where infected or sick people circulated. Among nursing professionals, this value is greater than one in four deaths. It is worth remembering that even the health professionals positioned on the front lines, at the beginning of the pandemic, did not have personal protective equipment (PPE).

The group of professionals from the Arts and Culture (21.7%) comes in fourth, despite the Aldir Blanc Law, which favored the sector and has been the only sectorial policy aimed at workers. Following are the rates of professional directors and managers (20.3%), higher education professionals (20.2%) and communication professionals (20.1%). The data show that the pandemic has affected, relatively, more privileged groups, precisely because they are those who die less in general. The results also show the impact of covid-19 on less qualified professionals who worked actively during the pandemic, such as those in Transport (especially bus drivers, truck drivers, taxi drivers, and application and private transport drivers). Here are activities classified as essential,

color and gender
The findings in this section demonstrate that, even with the same occupations, mortality by covid-19 is different for men and women, among white and black people. However, race and gender asymmetries are distinct. The data estimate the odds ratios of death from the disease, comparing white men, black men, white women and black women. The interpretation seeks to answer the following question: given that he died, what is the chance of having died from covid-19 in relation to any other cause, when compared to the reference group? To understand inequalities it is necessary to interpret them in a relational way, that is, comparing groups. Due to the already known advantaged position of white men in the labor market, this group was used as a basis for comparison,

The table below presents the summary of the results for the occupational groups that reported statistical significance: in 29 groups 77.38% of the deaths analyzed in the regression model are concentrated. With the exception of Safety and Health professionals, occupational groups are ordered, from top to bottom, by a socioeconomic scale of occupation. In simple terms, as you go down to read the table, we go to the base of the social pyramid. The positive sign indicates that the chance of the group having died from covid-19 is higher than that of white men in that specific occupation. The negative sign indicates the opposite, that is, the chance is less.

The pattern is very demarcated. Black men die more than covid-19 than white men in virtually all occupations – the only exceptions are agricultural workers. Racial inequality in the chances of death by covid-19 among men is transversal to the entire labor market, regardless of the type of activity, the sector, whether it is occupations that are at the top or bottom of the social pyramid. The reasons for this pattern can be found in two main factors. Firstly, in the different forms of labor insertion. Even exercising the same occupations, blacks tend to have a significantly more precarious insertion, whether due to the type of bond (formal or informal) or the nature of the establishments (more or less structured). This precariousness ends up implying, too,

The second reason is due to inequalities in access to resources that are added to environmental factors. In addition to being occasionally more exposed to environmental factors that affect health conditions (unhealthy housing, inadequate access to water, diet with low nutritional quality, spaces that affect mental status, among others), black men also tend to register scarcer access to health services.

The effect of sex on the chances of mortality, however, is distinct. The comparison between white women and white men shows that women die less than covid-19 than men in higher occupations, but this relationship is inverted at the base of society. That is, white men die less than covid-19 than white women among workers in industry, cleaning and conservation, domestic workers, and agriculture. Differences in health care practices between men and women are smaller in the lower strata. Even exercising the same occupations, the insertion occurs in a segmented way, being able to privilege men with positions less exposed to contagion. Furthermore, a possible effect of maternal mortality on the results cannot be disregarded, in addition to the fact that the pandemic has burdened women even more in the tasks of caring for children and the elderly who, at times, may be infected, which increases the risk of contagion from them in relation to men. It is known that this is more pronounced among those of lower socioeconomic status.

Finally, the results for black women show racial and gender inequality combined. Among higher occupations, the only occupations that reported statistical significance between black women and white men were nursing professionals (with black women with less chance) and with “other health professionals”, with black women dying more.

Unlike white women, however, there was no statistically significant difference in any occupation of the upper spectrum. Far from saying that white men and black women are little different at the top of the structure. The data and the specialized literature simply suggest that black women are heavily underrepresented in these groups. On the other hand, differences become visible in less educated occupations. Not only do black women have greater chances of mortality due to covid-19 compared to white men in practically all occupations with less education, but there are also greater chances in relation to white women (the only exception is among urban cleaning workers) . To the gender disparities that explain the differences between white men and women at the base of the structure,

The authors of the note point out that, even after being vaccinated, keeping the environments ventilated and the use of N95/PFF2 masks as a barrier to the propagation of respiratory droplets is an effective procedure to prevent the transmission of the sars-cov-2 virus and, therefore, guarantee the control of the pandemic, as insistently recommended by the World Health Organization (WHO). Vaccines protect against serious illness and prevent deaths, not always from infection and transmission of the virus. Governments and companies must invest in the acquisition and distribution of higher quality masks, prioritizing the most exposed categories of workers.

According to the researchers, as the HIV pandemic taught, and the Brazilian response to it exemplified for the world, education and prevention initiatives in the workplace have a huge impact on people’s lives and on the control of the pandemic. In the case of covid-19 transmission modes, prevention in the workplace is even more relevant: it can guarantee a work environment free from transmission and infection, and that outbreaks of infection in the workplace spread or reach the families of the workers. Unions and workers’ organizations have always been very relevant actors in guaranteeing the constitutional right to health – from prevention to treatment. They can describe the dynamics of infection in different work environments and categories, raise local and sectorial data on illness and death from covid-19.

The note concludes that the covid-19 pandemic has globally uncovered racial and gender inequalities in the risk of death. This study indicates the relevance of studying and facing the dynamics of this inequality for certain professions. By prioritizing prevention campaigns in those work environments that produce greater exposure to covid-19, by encouraging health education and prevention, distributing PFF2 or N95 masks and teaching their correct use, by insisting on ventilation and the necessary physical distance in workplaces , it should be remembered that the greatest exposure to risk has color and gender.

The Solidarity Research Network has researchers from the Humanities, Exact and Biological Sciences, in Brazil and in other countries. There are more than 100 researchers mobilized to improve the quality of public policies of the federal and state and municipal governments, who seek to act in the midst of the covid-19 crisis to save lives.

Researchers carry out a rigorous survey of data, to generate insightful information, create indicators and develop models and analyzes to monitor and identify paths for public policies and examine the responses that the population offers.

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