Background: The mortality rate of coronavirus disease (COVID-19) in the state of São Paulo is highly heterogeneous. This study investigated geographic, economic, social, and health-related factors associated with this discrepancy.
Methods: An ecological study compared COVID-19 mortality rates according to geographic, economic, social, and health-related variables during initial infection of 2.5% of the population in municipalities with more than 30,000 inhabitants.
Results: Mortality was positively associated with demographic density and social inequality (Gini index), and inversely associated with HDI income and longevity of these municipalities, accounting for 33.2% of the variation in mortality.
Conclusions: Social determinants influenced COVID-19 outcomes.