Abstract
BACKGROUND: Population-based data on COVID-19's impact are essential for informing public health policies, particularly in low- and middle-income countries. Here, we investigated the history of COVID-19 diagnoses across the Brazilian population, considering factors such as sex, age, skin colour/ethnicity, comorbidity, schooling, and socioeconomic level. METHODS: In this nationwide study, EPICOVID 2.0, we surveyed 133 cities in all Brazilian states between March and June 2024. We randomly selected 250 households per city and one individual from each household. Crude and adjusted prevalence ratios were calculated to examine the association between covariates and self-reports of prior COVID-19 diagnoses and hospitalizations, and odds ratios to assess the factors associated with the higher number of COVID-19 episodes. RESULTS: Our analysis of 33 250 individuals revealed that 28.6% [95% confidence interval (CI), 27.3-29.9] of the study population had a previous COVID-19 diagnosis, with most of those reported presenting one episode (77.7%), followed by two (17.3%) and three episodes (5.0%). We observed a positive association between higher educational attainment and wealth quintiles and self-reported COVID-19 diagnoses. We also found that women presented a higher COVID-19 prevalence. About 4.5% (95% CI, 3.8-5.2) of participants who reported previous COVID-19 were hospitalized, with an average length of stay of 10.4 days. We did not find a difference in the prevalence of hospitalizations between socioeconomic strata. We observed that those who experienced two or more COVID-19 episodes had three times higher odds of being hospitalized. CONCLUSION: These findings highlight significant disparities in the COVID-19 impact across socioeconomic and demographic groups in Brazil, underscoring the need for targeted public health interventions to address vulnerabilities and reduce the COVID-19 burden in Brazil.