Comprehensive Evaluation of the Impact of Sociodemographic Inequalities on Adverse Outcomes and Excess Mortality During the Coronavirus Disease 2019 (COVID-19) Pandemic in Mexico City

Antonio-Villa, Neftalí Eduardo; Fernández‐Chirino, Luisa; Pisanty-Alatorre, Julio; Mancilla-Galindo, Javier; Kammar-García, Ashuin; Vargas‐Vázquez, Arsenio; González-Díaz, Armando; Márquez‐Salinas, Alejandro; Guerra, Enrique C.; Bahena-López, Jessica Paola; Villanueva-Reza, Marco; Márquez-Sánchez, Jessica; Jaramillo-Molina, Máximo Ernesto; Gutiérrez‐Robledo, Luis Miguel; Bello‐Chavolla, Omar Yaxmehen

doi:10.1093/cid/ciab577

Cited by 50 publications

(27 citation statements)

References 29 publications

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“…At the individual level, we confirmed that certain socially vulnerable occupations experienced unequal risks for non-COVID-19 mortality. The role of individual and sociodemographic determinants in the risk for adverse COVID-19 outcomes has been previously explored (36,37). Nevertheless, our findings demonstrate that sociodemographic inequalities impacted individuals with preventable chronic conditions, regardless of public healthcare policies aimed at mitigating the impact of the COVID-19 pandemic in healthcare infrastructure and provision.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Antonio-Villa

Aburto

Fernández‐Chirino

et al. 2022

Preprint

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BACKGROUNDIn 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent to which non-COVID deaths contributed to excess mortality, its regional characterization, and the association between municipal-and individual-level sociodemographic inequality has not been characterized.METHODSWe conducted a retrospective municipal an individual-level study using death certificate data in Mexico from 2016-2020. We analyzed mortality related to COVID-19 and to non-COVID-19 causes using ICD-10 codes to identify cause-specific mortality. Excess mortality was estimated as the increase in deaths in 2020 compared to the average of 2016-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. We evaluated correlates of non-COVID-19 mortality at the individual level using mixed effects logistic regression and correlates of non-COVID-19 excess mortality in 2020 at the municipal level using negative binomial regression.RESULTSWe identified 1,069,174 deaths in 2020 (833.5 per 100,000 inhabitants), which was 49% higher compared to the 2016-2019 average (557.38 per 100,000 inhabitants). Overall excess mortality (276.11 deaths per 100,000 inhabitants) was attributable in 76.1% to COVID-19; however, non-COVID-19 causes comprised one-fifth of excess deaths. COVID-19 deaths occurred primarily in-hospital, while excess non-COVID-19 deaths decreased in this setting and increased out-of-hospital. Excess non-COVID-19 mortality displayed geographical heterogeneity linked to sociodemographic inequalities with clustering in states in southern Mexico. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization, and social marginalization. At the individual level, lower educational attainment, blue collar workers, and lack of medical care assistance were associated with non-COVID-19 mortality during 2020.CONCLUSIONNon-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual-and municipal-level sociodemographic inequalities. These findings should prompt an urgent call to action to improve healthcare coverage and access to reduce health and sociodemographic inequalities in Mexico to reduce preventable mortality in situations which increase the stress of healthcare systems, including the ongoing COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Antonio-Villa

Aburto

Fernández‐Chirino

et al. 2022

Preprint

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“…Based in the “Social Determinants of Health” approach and the ecosocial epidemiology, the cumulative and dynamic interplay processes of exposure, susceptibility, and resistance, which influences health at the singular and general levels, could have been an important factor to understand processes which shape population health—as well as the COVID-19 pandemic [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The association between COVID-19 and some social determinants in Mexico has been studied [ 7 , 29 – 32 ], however, some important questions remain with this topic. Thus, the present study explores the association of living in municipalities with higher rates of crowding conditions and poverty and the risk of mortality from COVID-19 in Mexico.…”

Section: Introductionmentioning

confidence: 99%

Association between living in municipalities with high crowding conditions and poverty and mortality from COVID-19 in Mexico

2022

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Background The World Health Organization stated a pandemic by severe acute respiratory syndrome coronavirus SARS-Cov2 (COVID-19) on March, 2020 with devastating implications for populations, healthcare systems, and economies globally. Objective The present study explores the association between patients living in municipalities with crowding conditions and poverty and mortality from COVID-19 in Mexico; specifically evaluating the socioeconomic characteristics of the municipality in which the patients reside and some individual characteristics. Methods In the present study, we examined public information collected from the National Epidemiological Surveillance System informing all persons tested for SARS-CoV-2 and published by the Ministry of Health. The present analysis was restricted to those with the date of registration to October 12, 2021. The association between the main exposures (overcrowded conditions and poverty) and the outcomes of interest (death by COVID-19) was explored using Cox proportional hazard regression models, including frailty penalties to accommodate multilevel data and random effects for the municipality of case occurrence. Results A total of 9619917 subjects were included in the Epidemiological Surveillance System for viral respiratory disease platform. Of those for which results were available, 6141403 were negative for COVID-19 and 3478514 were positive for COVID-19; with a total of 273216 deaths in those who tested positive. Among those positive to COVID-19 mean age was 46.9. Patients living in municipalities with high rates of crowding conditions increased the risk of dying from COVID-19 by 8% (95% CI: 1.03, 1.14). Individuals living in municipalities with indigenous background was associated with an increased risk of dying from COVID-19 (HR = 1.10; 95% CI: 1.04, 1.17). Individuals living in municipalities with illiteracy (HR = 1.09; 95% CI: 1.03, 1.11), poverty (HR = 1.17; 95% CI: 1.14, 1.19), food insecurity (HR = 1.094; 95% CI 1.02, 1.06), limited access to social security (HR = 1.10; 95% CI: 1.08, 1.13) and health services (HR = 1.06; 95% CI: 1.04, 1.08) had a higher risk of mortality from COVID-19. Conclusion Our data suggest that patients living in municipalities with higher rates of crowding conditions and higher rates of poverty had elevated risk of mortality from COVID-19. In Mexico, the COVID-19 pandemic is a systemic crisis linked to human development since we have seen that it affects less developed and more vulnerable municipalities. Policies to reduce vulnerabilities and develop strategies to deal with health crises like the current one needs to be considered.

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“…Although an important increase in testing capacity occurred with the introduction of antigen tests in Mexico City after 28 October 2020 [ 18 ], this pattern of testing rates by age category did not change, which suggests that low availability of testing may not determine whether younger people and older adults seek testing or not. Rather, lower testing rates in older adults, children and adolescents could be explained by the tendency to stay at home during the pandemic [ 19 ], as well as lower contacts with other people, and lower mobility indexes than young adults and middle-aged adults [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 patients with increasing age experience differential time to initial medical care and severity of symptoms

et al. 2021

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We conducted a retrospective observational study in patients with laboratory-confirmed coronavirus disease (COVID-19) who received medical care in 688 COVID-19 ambulatory units and hospitals in Mexico City between 24 February 2020 and 24 December 2020, to study if the elderly seek medical care later than younger patients and their severity of symptoms at initial medical evaluation. Patients were categorised into eight groups (<20, 20–29, 30–39, 40–49, 50–59, 60–69, 70–79 and ≥80 years). Symptoms at initial evaluation were classified according to a previously validated classification into respiratory and non-respiratory symptoms. Comparisons between time from symptom onset to medical care for every age category were performed through variance analyses. Logistic regression models were applied to determine the risk of presenting symptoms of severity according to age, and mortality risk according to delays in medical care. In total, 286 020 patients were included (mean age: 42.8, s.d.: 16.8 years; 50.4% were women). Mean time from symptom onset to medical care was 4.04 (s.d.: 3.6) days and increased with older age categories (P < 0.0001). Mortality risk increased by 6.4% for each day of delay in medical care from symptom onset. The risk of presenting with the symptoms of severity was greater with increasing age categories. In conclusion, COVID-19 patients with increasing ages tend to seek medical care later, with higher rates of symptoms of severity at initial presentation in both ambulatory units and hospitals.

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Comprehensive Evaluation of the Impact of Sociodemographic Inequalities on Adverse Outcomes and Excess Mortality During the Coronavirus Disease 2019 (COVID-19) Pandemic in Mexico City

Cited by 50 publications

References 29 publications

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Association between living in municipalities with high crowding conditions and poverty and mortality from COVID-19 in Mexico

COVID-19 patients with increasing age experience differential time to initial medical care and severity of symptoms

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