Title : Social determinants of health associated with the presence of post covid-19 sequelae in the Brazilian population

Background: The impacts of COVID-19 extend beyond the acute phase of the disease and may result in persistent sequelae that affect quality of life and are unevenly distributed across population groups. These disparities may be influenced by social determinants of health (SDH). This study aimed to characterize the clinical conditions of Brazilian adults in the post-COVID-19 context and to investigate the association between social determinants of health and the presence of post-COVID-19 sequelae.

Methods: This descriptive, quantitative, multicenter study was conducted across the five regions of Brazil. The sample consisted of 854 individuals who met the following inclusion criteria: aged 18 years or older, Brazilian nationality, and a previous diagnosis of COVID-19. Data were collected using the COVID-19 Monitoring Software, through a questionnaire link distributed via mobile messaging applications. The software included a Social Determinants of Health questionnaire based on the Dahlgren and Whitehead model. Descriptive analyses and multiple logistic regression were performed to investigate factors associated with the presence of post-COVID-19 sequelae. Adjusted odds ratios (aOR), 95% confidence intervals (95% CI), and p-values were estimated, adopting a significance level of 5%. The study was approved by a Research Ethics Committee and funded by CNPq/DECIT/MCTIC (Grant No. 445654/2023-6).

Results: Participants were predominantly female (74.5%), aged 18–39 years (65.2%), and self-identified as White (62.2%). Most reported regular physical activity (62.8%), no alcohol consumption (74.4%), and non-smoking status (75.7%). Regarding post-COVID-19 clinical conditions, most participants had not required hospitalization (93.4%) and had not experienced COVID-19 recurrence (52.9%). Despite this, a high prevalence of persistent sequelae was observed (64.3%), while only 26.7% sought healthcare services related to these conditions. In the analysis of associations between SDH and post-COVID-19 sequelae, female participants were more likely to report sequelae than males (aOR=3.87; 95% CI: 2.76–5.44; p<0.001). Non-White participants had twice the odds of reporting post-COVID-19 sequelae (aOR=2.04; 95% CI: 1.46–2.84; p<0.001). Diabetes mellitus was also significantly associated with the outcome (aOR=5.30; 95% CI: 1.73– 16.24; p=0.003). No statistically significant associations were identified for the remaining variables included in the logistic regression model.

Conclusions: Post-COVID-19 sequelae remained highly prevalent among participants even after the acute phase of infection. Female sex, non-White race/ethnicity, and diabetes mellitus were independently associated with their occurrence. These findings highlight the importance of incorporating social determinants of health into the planning of long-term monitoring and care strategies for individuals with post-COVID-19 conditions, contributing to the reduction of health inequities.

Prof. Dr. Francisca Elisângela Teixeira Lima is a faculty member at the Federal University of Ceará (UFC), Brazil, and a researcher in the Graduate Program in Nursing. She is a registered nurse with a PhD in Nursing and conducts research in the fields of Public Health, Health Promotion, Social Determinants of Health, Quality of Life, Post-COVID-19 Conditions, Child Health, and Educational Technologies in Health. She coordinates and collaborates on research projects funded by national research agencies, including a project supported by CNPq/DECIT/MCTIC (Grant No. 445654/2023-6).