Increased Risk of Hospitalization and Death in Patients with COVID-19 and Pre-existing Noncommunicable Diseases and Modifiable Risk Factors in Mexico

Abstract

Background The population in Mexico has high prevalence rates of noncommunicable diseases (NCDs). Hospitalization and death of COVID-19 patients in the countries most affected by the pandemic has been associated to chronic comorbidities. Objective To describe the prevalence of NCDs in patients with COVID-19 in Mexico and analyze the increased risk due to comorbidities and risk factors on hospitalization, utilization of intensive care units and death. Methods A cross-sectional study was performed from 212,802 confirmed COVID-19 cases reported by the Ministry of Health up to June 27, 2020. Odds ratios were performed using logistic regression model. Results Up to 47.40% of patients with COVID-19 diagnosis were also reported with a comorbidity, with hypertension being the most frequent (20.12%). The report of at least one NCD significantly increased the risk of death with respect to patients without such diagnoses. Chronic kidney disease increased the risk of death the most (OR 2.31), followed by diabetes (OR 1.69), immunosuppression (OR 1.62), obesity (OR 1.42), hypertension (OR 1.24), chronic obstructive pulmonary disease (OR 1.20). The comorbidities that most increased the risk of ICU and of intubation were diabetes, immunosuppression and obesity. Conclusion NCD comorbidities increase the severity of COVID-19 infection. Given high NCD prevalence rates among the Mexican population, the pandemic poses a special threat to the health system and to society. Special prevention measures need to be strengthened for persons with NCD diagnoses in the short-term. In the mid-term, disease control strategies need to be improved to protect these patients against COVID-19 severity.

Health and Institutional Risk Factors of COVID-19 Mortality in Mexico, 2020

“…The study aimed to examine, after adjusting by different individual-level characteristics, how non-communicable disease interactions affect mortality risk by COVID-19 in Mexico, and how death risk varies across institutions for different comorbidity profiles. The findings of this study suggest that obesity, diabetes, hypertension, and CKD increase the mortality risk of COVID-19, in line with previous published research in Mexico 27 and internationally. 13,[18][19][20][21] When examining how death risk varies for different combinations (interactions) of comorbid diseases, it doubles when obesity interacts with diabetes, CKD, or hypertension.…”

“…Obesity is a major health problem in the Mexican population, and the models show that COVID-19 mortality increases in line with this metric. The increased risk of death among obese patients is consistent with other studies in Mexico 26,27 and 1 in the U.S.A., 18 which is expected considering that these 2 countries have the highest prevalence of obesity worldwide. 38 For the case of Mexico, the results herein raise questions about the specific mechanisms through which the Mexican obesity epidemic interacts with the current pandemic.…”

“…In Mexico, recent studies have examined risk factors associated with risk of infection, 25 severity, and mortality. [26][27][28][29] This literature is consistent with the international research, but uses data that do not include the approximately 250,000 new cases that occurred during the peak of the pandemic in July-August. Furthermore, Mexico's epidemiological profile includes a high prevalence of obesity (36.1% in adults in 2018 30 ) CVD, and diabetes-the 3 leading causes of mortality, combined with high levels of institutional inequality.…”

COVID-19 associated with diabetes and other noncommunicable diseases led to a global health crisis

“…Diabetes, cardiovascular diseases (CVD) and other NCDs were recognized as major risk factors to hospitalization, intensive care needs and death due to the novel 2019 coronavirus [4,5,6,7,8,9,10,11,12,13]. Data from different parts of the world, included both in the news and scientific reports, pointed out that the overall SARS-CoV-2 case-fatality rate of 2.3%, was actually more than three times higher (7.3%) when diabetes was present [4].…”

“…Early measures seemed to be extremely limited in different parts of the world [16,30,31]. Among the countries the experienced high COVID-19 burden, Brazil was alerted that 34-54.5% of its adults were at risk of severe COVID-19 [32], and in Mexico, verified associations between severe COVID-19 and premature death with NCDs prompted researchers to recommend early protection of these high-risk populations [10]. In the South and Central America (IDF SACA region), policies were put into place to protect individuals with diabetes only in 37% of the region, through either delivering medicines at home (16%) or providing enough medical supplies for 2-3 months at once (21%) [30].…”