Association of urban inequality and income segregation with COVID-19 mortality in Brazil

J. Firmino de Sousa Filho; Uriel M. Silva; Larissa L. Lima; Aureliano S. S. Paiva; Gervásio F. Santos; Roberto F. S. Andrade; Nelson Gouveia; Ismael H. Silveira; Amélia A. de Lima Friche; Maurício L. Barreto; Waleska Teixeira Caiaffa

doi:10.1371/journal.pone.0277441

Peer Review History

Original SubmissionJune 17, 2022
19 Aug 2022 Decision Letter - Maria Elisabeth Johanna Zalm, Editor PONE-D-22-17397Association of urban inequality and income segregation with COVID-19 mortality in BrazilPLOS ONE Dear Dr. Sousa Filho, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Your manuscript has been assessed by one peer-reviewer, and their comments are appended below. The reviewer has asked for some additional clarification regarding the methodology of the study, for example regarding the variables used and the justification of the sample selection. In addition, the reviewer states that the manuscript requires a more in-depth discussion of the limitations to this study. 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Currently, your Funding Statement reads as follows: “The Salud Urbana en América Latina (SALURBAL)/Urban Health in Latin America project is funded by the Wellcome Trust [205177/Z/16/Z]. JFSF, UMS, LLL, ASSP, GFS, AALF, NG, WTC are supported by Wellcome Trust [205177/Z/16/Z]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://wellcome.org/” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study documented that more unequal Brazilian cities suffered higher mortality from covid-19. The theme is relevant to global public health; findings reported here can instruct health policy and planning. This reviewer agrees with the main methodological options and shares some specific concerns. 1. Using 2010 data on socioeconomic status (income, education, etc.) is the most relevant unacknowledged study limitation. I understand that Brazil may not have performed a more recent census, which limits the current study and must be discussed. 2. The study outcome variable is weekly covid-19 death rates. The pandemic took a higher toll on specific gender and age groups; furthermore, city-level socioeconomic status may be a function of its proportion of older people. This observation account for the importance of adjusting death rates for age and gender. Please inform the reader if it was done; please justify if it was not. 3. I also missed explaining or justifying the sample of 152 Brazilian cities. I understood that a previous study gathered the database. However, the reader should be able to understand the study without having to search for previous publications. Please inform the reader what criteria guided the selection of these cities. 4. Except for the primary exposures (income inequality and income segregation), the remaining covariates did not associate with the outcome in Table 3’s models. This finding was not discussed. 5. In the Abstract, the authors concluded (and emphasized) that “socioeconomic inequalities can be reduced permanently through consistent long-term policies.” As it stands, this statement is just wishful thinking. This study has not assessed the effectiveness of “consistent long-term policies” permanently reducing socioeconomic inequalities. It is curious to observe that, in the main text, the conclusion did not repeat this argument. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Jose Leopoldo Ferreira Antunes ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0277441.r001
Revision 1
2 Sep 2022 Author Response Dear reviewer, we thank you for your valuable comments and hope that we have answered all of them concisely. The changes are highlighted in red in the “manuscript with tracked changes” document. Review Comments to the Author Reviewer #1: This study documented that more unequal Brazilian cities suffered higher mortality from covid-19. The theme is relevant to global public health; findings reported here can instruct health policy and planning. This reviewer agrees with the main methodological options and shares some specific concerns. 1. Using 2010 data on socioeconomic status (income, education, etc.) is the most relevant unacknowledged study limitation. I understand that Brazil may not have performed a more recent census, which limits the current study and must be discussed. Thank you for your comment. We have inserted this paragraph in the “strengths and limitations” section to clarify this fragility. “Another limitation is that income data by census tract level used to compute the dissimilarity index were collected by the Brazilian Bureau of statistics in 2010 (the last nationwide census; the 2020 demographic census has been postponed to 2022 because of the COVID-19 pandemic). Thus, these socioeconomic data may not reflect the current reality of the population.” 2. The study outcome variable is weekly covid-19 death rates. The pandemic took a higher toll on specific gender and age groups; furthermore, city-level socioeconomic status may be a function of its proportion of older people. This observation account for the importance of adjusting death rates for age and gender. Please inform the reader if it was done; please justify if it was not. Thank you for your comment. We have inserted this sentence in the first paragraph of the “Data sources” subsection: “(only aggregate records for each city were available; the dataset does not have individual data)”. To further clarify the issue, we have also inserted this sentence in the “Statistical analysis” subsection: “Since our source of COVID-19 mortality only included aggregate deaths, we cannot adjust for individual sex and age”. Finally, we acknowledge this properly in the “Strengths and limitations” subsection, with the sentence “The lack of individual-level death records also meant that we cannot account for individual age and sex-specific effects on mortality rates, having to rely on contextual effects instead (e.g., the proportion of the population aged 65 years old or higher in each city)”. 3. I also missed explaining or justifying the sample of 152 Brazilian cities. I understood that a previous study gathered the database. However, the reader should be able to understand the study without having to search for previous publications. Please inform the reader what criteria guided the selection of these cities. Thank you for your comment, we have complemented the following sentence at the end of the “materials and methods” section: “The selection criterion for cities is that they should have at least 100,000 inhabitants within a contiguous built-up urban area, identified using satellite imagery [22].” “In addition, 121 million people live in these urban agglomerations in Brazil or approximately 63% of the total population in 2010.” 4. Except for the primary exposures (income inequality and income segregation), the remaining covariates did not associate with the outcome in Table 3’s models. This finding was not discussed. Thank you for this suggestion. We have inserted the following in the talk section to address this comment: “The relationship between COVID-19 mortality rates and the covariates used in our study, on the other hand, was not significant for any of the estimated models. However, since the association between COVID-19 with inequality and segregation is influenced by different social aspects and families' living conditions and well-being (here captured by overall income, education, and access to essential health services), these are still theoretically relevant features to control the associations.” 5. In the Abstract, the authors concluded (and emphasized) that “socioeconomic inequalities can be reduced permanently through consistent long-term policies.” As it stands, this statement is just wishful thinking. This study has not assessed the effectiveness of “consistent long-term policies” permanently reducing socioeconomic inequalities. It is curious to observe that, in the main text, the conclusion did not repeat this argument. Thank you for this comment. We agree with the reviewer and we decided to exclude this sentence from the abstract. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0277441.r002
27 Oct 2022 Decision Letter - Raphael Mendonça Guimaraes, Editor Association of urban inequality and income segregation with COVID-19 mortality in Brazil PONE-D-22-17397R1 Dear Dr. Susa Filho We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Raphael Mendonça Guimaraes, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Jose Leopoldo Ferreira Antunes ******** https://doi.org/10.1371/journal.pone.0277441.r003
Formally Accepted
2 Nov 2022 Acceptance Letter - Raphael Mendonça Guimaraes, Editor PONE-D-22-17397R1 Association of urban inequality and income segregation with COVID-19 mortality in Brazil Dear Dr. Sousa Filho: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Raphael Mendonça Guimaraes Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0277441.r004

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