{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:15:28Z","timestamp":1760058928020,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior\u2014Brasil (CAPES)","award":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"],"award-info":[{"award-number":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"]}]},{"DOI":"10.13039\/501100001807","name":"S\u00e3o Paulo Research Foundation (FAPESP)","doi-asserted-by":"publisher","award":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"],"award-info":[{"award-number":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior\u2014Brasil (CAPES)","award":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"],"award-info":[{"award-number":["001","2021\/08263-7","2022\/08510-7","88887.657730\/2021-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: This study investigated the determinants of COVID-19 mortality and its temporal trends within S\u00e3o Paulo state\u2019s Departamentos Regionais de Sa\u00fade (DRS) (health regions) to inform the development of targeted public health interventions. Methods: Utilizing an ecological study design, we analyzed confirmed COVID-19 cases and deaths (February 2020\u2013December 2021) obtained from the COVID Panel, incorporating relevant social and health indicators. The Generalized Additive Model for Location, Scale, and Shape (GAMLSS) was used to identify key determinants, and temporal trends in mortality and vaccination rates were analyzed across each DRS. Results: The average mortality rate was 15.1 deaths per 100,000 inhabitants (median 7.00). Higher chronic disease mortality was associated with an increase in COVID-19 mortality. Moreover, an increase in the percentage of adults led to a decrease in deaths from COVID-19. Conclusions: COVID-19 mortality in S\u00e3o Paulo is shaped by a complex interplay of 12 behavioral, economic, demographic, and environmental factors. Region-specific public health policies should consider these factors, along with geographic, socioeconomic, and budgetary contexts, to effectively address health disparities across the state\u2019s DRS.<\/jats:p>","DOI":"10.3390\/ijerph22050772","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T11:31:49Z","timestamp":1747135909000},"page":"772","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of COVID-19 Mortality and Temporal Trends in the Health Regions of the State of S\u00e3o Paulo, Brazil"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-3574","authenticated-orcid":false,"given":"Tatiana Pestana","family":"Barbosa","sequence":"first","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-8719","authenticated-orcid":false,"given":"Thais Zamboni","family":"Berra","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7862-1355","authenticated-orcid":false,"given":"Ant\u00f4nio Carlos Vieira","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Nursing, State University of Minas Gerais, Passos Campus, Passos 37900-106, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5596-0047","authenticated-orcid":false,"given":"Yan Mathias","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5378-6962","authenticated-orcid":false,"given":"Reginaldo Bazon Vaz","family":"Tavares","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1636-1988","authenticated-orcid":false,"given":"Fernando Span\u00f3 Junqueira","family":"de Paiva","sequence":"additional","affiliation":[{"name":"Polytechnic School, University of S\u00e3o Paulo, S\u00e3o Paulo 05508-010, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas Bodini","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8453-0695","authenticated-orcid":false,"given":"Titilade Kehinde Ayandeyi","family":"Teibo","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1659-8321","authenticated-orcid":false,"given":"Juliana Soares Ten\u00f3rio","family":"de Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2329-6268","authenticated-orcid":false,"given":"Ariela Fehr","family":"T\u00e1rtaro","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4792-8714","authenticated-orcid":false,"given":"Ricardo Alexandre","family":"Arc\u00eancio","sequence":"additional","affiliation":[{"name":"Department of Maternal-Infant and Public Health Nursing, Ribeir\u00e3o Preto College of Nursing, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14040-902, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.26633\/RPSP.2022.6","article-title":"Morbimortalidade por COVID-19 associada a condi\u00e7\u00f5es cr\u00f4nicas, servi\u00e7os de sa\u00fade e iniquidades: Evid\u00eancias de sindemia","volume":"46","author":"Barbosa","year":"2022","journal-title":"Rev. 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