Rehospitalization due to COVID-19 reinfection in Rio de Janeiro, 2020–2022: Associations with vaccination status, sociodemographic and clinical factors
4 affiliations
- 1National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- 2Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- 3School of Applied Mathematics, Getulio Vargas Foundation, Rio de Janeiro, Brazil
- 4Institute of Social Medicine/UERJ, Rio de Janeiro, Brazil
Abstract
The COVID-19 pandemic posed significant challenges, including rehospitalization of patients due to SARS-CoV-2 reinfection, particularly in the context of variants of concern and Brazil’s COVID-19 vaccination campaign. This study aimed to estimate the rate of rehospitalizations due to reinfection in the municipality of Rio de Janeiro (2020–2022), assess the impact of individual vaccination status, and identify factors associated with this outcome. Cohort study including individuals aged 18 years or older who were hospitalized with Severe Acute Respiratory Illness (SARI) resulting from SARS-CoV-2 infection in Rio de Janeiro. Data from four administrative databases (SIPNI, e-SUS Notifica, SIVEP-Gripe, and SIM) were integrated through record linkage. Rehospitalizations due to reinfection were defined as those occurring ≥90 days after the initial hospitalization. Annual rehospitalization rates were calculated per 100 person-years. The analysis included demographics, hospital discharge disposition, and vaccination-related variables. Cox proportional hazards models with deaths considered as competing risks were used. Of the 59,001 individuals included, 1,957 (3.3%) experienced rehospitalization. The main finding was that a complete vaccination regimen with a booster (≥3 doses) was associated with a 39% reduction in the risk of rehospitalization (sHR: 0.61; 95% CI: 0.52–0.73), while older age, multimorbidity, and Black race/skin color emerged as significant risk factors. Full vaccination with booster doses offered protection against COVID-19-related rehospitalization; however, racial inequities, advanced age, and comorbidities remain important risk factors. Public health policies that expand periodic booster vaccination, strengthen health education, and address social vulnerabilities are urgently needed as a fundamental strategy for preventing future pandemics.
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BibTeX
@article{neves2026rehospitalization,
title = {{Rehospitalization due to COVID-19 reinfection in Rio de Janeiro, 2020–2022: Associations with vaccination status, sociodemographic and clinical factors}},
author = {Ranna Kíssia Alves das Neves and Leonardo Soares Bastos and Daniel Antunes Maciel Villela and Valeria Saraceni and Débora Medeiros de Oliveira Cruz and Luiz Max Carvalho and Antonio Guilherme Pacheco},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0332281},
url = {https://doi.org/10.1371/journal.pone.0332281},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Rehospitalization due to COVID-19 reinfection in Rio de Janeiro, 2020–2022: Associations with vaccination status, sociodemographic and clinical factors
AU - Ranna Kíssia Alves das Neves
AU - Leonardo Soares Bastos
AU - Daniel Antunes Maciel Villela
AU - Valeria Saraceni
AU - Débora Medeiros de Oliveira Cruz
AU - Luiz Max Carvalho
AU - Antonio Guilherme Pacheco
PY - 2026
DA - 2026/10/01
JO - PLOS One
DO - 10.1371/journal.pone.0332281
UR - https://doi.org/10.1371/journal.pone.0332281
AB - The COVID-19 pandemic posed significant challenges, including rehospitalization of patients due to SARS-CoV-2 reinfection, particularly in the context of variants of concern and Brazil’s COVID-19 vaccination campaign. This study aimed to estimate the rate of rehospitalizations due to reinfection in the municipality of Rio de Janeiro (2020–2022), assess the impact of individual vaccination status, and identify factors associated with this outcome. Cohort study including individuals aged 18 years or older who were hospitalized with Severe Acute Respiratory Illness (SARI) resulting from SARS-CoV-2 infection in Rio de Janeiro. Data from four administrative databases (SIPNI, e-SUS Notifica, SIVEP-Gripe, and SIM) were integrated through record linkage. Rehospitalizations due to reinfection were defined as those occurring ≥90 days after the initial hospitalization. Annual rehospitalization rates were calculated per 100 person-years. The analysis included demographics, hospital discharge disposition, and vaccination-related variables. Cox proportional hazards models with deaths considered as competing risks were used. Of the 59,001 individuals included, 1,957 (3.3%) experienced rehospitalization. The main finding was that a complete vaccination regimen with a booster (≥3 doses) was associated with a 39% reduction in the risk of rehospitalization (sHR: 0.61; 95% CI: 0.52–0.73), while older age, multimorbidity, and Black race/skin color emerged as significant risk factors. Full vaccination with booster doses offered protection against COVID-19-related rehospitalization; however, racial inequities, advanced age, and comorbidities remain important risk factors. Public health policies that expand periodic booster vaccination, strengthen health education, and address social vulnerabilities are urgently needed as a fundamental strategy for preventing future pandemics.
SN - 1932-6203
ER -