Altitude does not protect against SARS‐CoV‐2 infections and mortality due to COVID‐19

Cárdenas, Laura; Valverde-Bruffau, Valeria Janice; Gonzales, Gustavo F.

doi:10.14814/phy2.14922

Cited by 10 publications

(9 citation statements)

References 10 publications

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“…A closer look on potential confounding factors such as environmental factors others than altitude per se, the availability of services to treat, diagnose, or test for COVID-19, assessing the cause of death, etc., which are mostly less available in high-altitude regions, indicate possible fallacies of a “protective” effect of high-altitude residence [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…While at higher altitudes, extreme environmental conditions like hypobaric hypoxia, increased solar radiation, low ambient temperature, and reduced air pollution, are likely major modulators of COVID-19 mortality [ 8 ], altered prevalence of cardiovascular risk factors and lifestyle behaviors like physical activity and diet may be more important modulators at moderate altitudes [ 5 ]. On the other hand, these ambiguous findings may be explained by potential confounding factors such as differences in the viral load related to population density and/or exposure time to aerosols [ 10 ], the availability of services to treat or diagnose COVID-19 [ 11 ], which are often less available in higher altitude regions [ 12 ]. Such confounders are less relevant in moderate altitude regions of Austria, where access to health care facilities is mostly secured.…”

Section: Introductionmentioning

confidence: 99%

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Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality

Burtscher

Millet

Leitner

et al. 2022

IJERPH

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Moderate altitude (1000–2000 m above sea level) residence is emerging as a protective factor from the mortality of various causes, including of cardiovascular diseases. Conversely, mortality from certain respiratory diseases is higher at these altitudes than in lowlands. These divergent outcomes could indicate either beneficial or detrimental effects of altitude on the mortality of COVID-19 that primarily infects the respiratory tract but results in multi-organ damage. Previous epidemiological data indeed suggest divergent outcomes of moderate to high altitude residence in various countries. Confounding factors, such as variations in the access to clinical facilities or selection biases of investigated populations, may contribute to the equivocation of these observations. We interrogated a dataset of the complete population of an Alpine country in the center of Europe with relatively similar testing and clinical support conditions across altitude-levels of residence (up to around 2000 m) to assess altitude-dependent mortality from COVID-19 throughout 2020. While a reduced all-cause mortality was confirmed for people living higher than 1000 m, no differences in the mortality from COVID-19 between the lowest and the highest altitude regions were observed for the overall population and the population older than 60 years as well. Conversely, COVID-19 mortality seems to have been reduced in the very old (>85 years) women at moderate altitudes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality

Burtscher

Millet

Leitner

et al. 2022

IJERPH

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“…Contrariwise, socio-demographic and environmental factors such as population density, UV radiation, ozone, or cold have been proposed to affect SARS-CoV-2 transmission and viral load; nevertheless, no clinical data is available yet [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU

Simbaña-Rivera

Jaramillo²,

Silva

et al. 2022

PLoS ONE

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Background Multiple studies have attempted to elucidate the relationship between chronic hypoxia and SARS-CoV-2 infection. It seems that high-altitude is associated with lower COVID-19 related mortality and incidence rates; nevertheless, all the data came from observational studies, being this the first one looking into prospectively collected clinical data from severely ill patients residing at two significantly different altitudes. Methods A prospective cohort, a two-center study among COVID-19 confirmed adult patients admitted to a low (sea level) and high-altitude (2,850 m) ICU unit in Ecuador was conducted. Two hundred and thirty confirmed patients were enrolled from March 15th to July 15th, 2020. Results From 230 patients, 149 were men (64.8%) and 81 women (35.2%). The median age of all the patients was 60 years, and at least 105 (45.7%) of patients had at least one underlying comorbidity, including hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale (Score that estimates ICU mortality) at 72 hours was especially higher in the low altitude group with a median of 18 points (IQR: 9.5–24.0), compared to 9 points (IQR: 5.0–22.0) obtained in the high-altitude group. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group. Conclusion There has been a substantial improvement in survival amongst people admitted to the high-altitude ICU. Residing at high-altitudes was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours.

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“…The independent variable was altitude, measured in masl, and was grouped according to the study of Barry & Pollard [ 15 ] and a Previous report in Peru [ 16 ] into three categories: <1500 (low altitude), 1500–2499 (intermediate altitude), and ≥2500 (high altitude). We have also tried different classifications for analysis: 1) Low (<2500) and high (≥2500) altitude, and 2) low (<1500), moderate (1500–2500), high (2500–3500), and very high altitude (≥3500), as reported elsewhere [ 17 ] (see S1 and S2 Tables).…”

Section: Methodsmentioning

confidence: 99%

Disparities in the prevalence of screened depression at different altitudes in Peru: A retrospective analysis of the ENDES 2019

2022

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Introduction Depression is a public health concern, nearing 1.5 million cases and accounting for 9.7% of years lost due to disability. Several factors, including altitude, contribute to its development. Altitude has become a topic for recent research, but its association with depressive symptoms has not been fully clarified. Therefore, this study aimed to determine the association between altitude and depressive symptoms in the Peruvian population. Methods A retrospective, cross-sectional study of the 2019 Demographic and Family Health Survey (ENDES in Spanish) was conducted. The dependent variable, depressive symptoms, was measured using the Patient Health Questionnaire (PHQ-9) and the independent variable, altitude, was categorized into: <1500 meters above sea level (masl), 1500–2499 masl and ≥2500 masl. To evaluate the association between altitude and depressive symptoms, we used Poisson regression model, constructing crude and multiple models. Results Of those living at 1500 to 2499 masl and ≥2500 masl, 7.23% and 7.12% had depressive symptoms, respectively. After adjusting for confounding variables, high altitude was found to be associated with depressive symptoms (prevalence ratio adjusted (aPR): 1.38, 95% confidence interval: 1.04–1.84; aPR 1.41, 95% CI: 1.20–1.66). Conclusions A statistically significant association was found between high altitude and depressive symptoms. This may be attributable to hypobaric hypoxia that occurs at high altitudes and its effects on brain function. This study’s findings should be considered to identify the population at risk and expand the coverage of preventive and therapeutic measures in high-altitude areas of Peru with poor access to health services.

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Altitude does not protect against SARS‐CoV‐2 infections and mortality due to COVID‐19

Cited by 10 publications

References 10 publications

Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality

Health Benefits of Residence at Moderate Altitude Do Not Reduce COVID-19 Mortality

High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU

Disparities in the prevalence of screened depression at different altitudes in Peru: A retrospective analysis of the ENDES 2019

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