Inequity in Inequity: Disproportional Mortality Risk from SARS in Cancer Patients with COVID-19 in Brazil: A Call to Action

Background: Cancer was one of the biggest global challenges in public health before COVID-19 pandemic and even higher challenge in low- and middle-developed countries. Confronting both conditions reveal inequalities. We determined lethality and factors associated with mortality in cancer patients who developed severe acute respiratory syndrome (SARS) due to COVID-19 in a northeast region of Brazil.Methods: Cross-sectional study developed from secondary data of a Brazilian state. We selected cases of cancer patients aged 20 years or older, who developed SARS due to COVID-19 (confirmed by reverse transcription-polymerase chain reaction) and were notified between March 07, 2020, and May 08, 2021. Logistic regression analyzed the effects of different variables on lethality.Findings: We identified 756 cancer patients aged 66·3±15·3 years (51·9% males). Global lethality was 75·8% and progressively increased with age. Tumor type was not described in 25·5% (193) of patients, 3·2% had history of cancer, 11·6% had hematologic cancer, and 59·7% had solid tumors. However, different types or topography of tumors did not influence mortality risk. Adjusted multivariate analyses showed age (adjusted odds ratio [aOR] 1·02; 95%CI 1.01-1·03; p < 0·001) and previous chronic pulmonary disease (aOR 2·02; 95%CI 0·96-4·28; p = 0·064) as risk factors for mortality, and overweight (aOR 0·50; 95%CI 0·23-1·10; p = 0·087) and cough (aOR 0·57; 95% I 0·40-0·83; p = 0·003) as protective factors.Interpretation: Cancer patients who developed SARS due to COVID-19 presented a highly disproportional mortality risk. Death was high in the study population, age increased by 2% the chance of death for each year of life, and lethality was higher in patients older than 80 years. Coordinated proactive strategies are needed to reduce the probability of infection and increase safety and early detection in cancer patients.Funding: This work was supported by grants from the National Key Research and Development Program of China (2018YFC1004701, LD), the National Nature Science Foundation of China (82001629 for XS; 81871128, 81571391 and 81401166 for LD; 82030040 for HS), the Jiangsu Province Social Development Project (BE2018602, HS), Jiangsu Provincial Medical Youth Talent (QNRC2016006, LD), the Youth Program of Natural Science Foundation of Jiangsu Province (BK20200116, XS) and Jiangsu Province Postdoctoral Research Funding (2021K277B, XS).Declaration of Interest: The authors have declared that no conflicts of interest exist.Ethical Approval: The human studies were approved by the Ethics Review Board of the Center for Reproductive Medicine, Shandong University (IRB No. 2021-45), and all samples were donated voluntarily for scientific research after informed consent was obtained.