Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: A cohort nation-wide study

Abstract

Background: After eight months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia. Methods: We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from March 2nd to October 26th, 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the hazard risk ratio (HR) by age groups, sex, ethnicity, type of health insurance, area of residence, and socioeconomic strata. Results: There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between March 2nd and October 26th. The risk of dying for COVID-19 among confirmed cases was higher in males (HR=1.68 95% CI: 1.64-1.72), in people older than 60 years (HR=296.58 95% CI: 199.22-441.51), in indigenous people (HR=1.20 95% CI: 1.08-1.33), in people with subsidized health insurance regime (HR=1.89 95% CI: 1.83-1.96), and in people living in the very low socioeconomic strata (HR=1.44 95% CI: 1.24-1.68). Conclusion: Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regime, and socioeconomic status.

Social inequities in the impact of COVID-19 lockdown measures on the mental health of a large sample of the Colombian population (PSY-COVID study)

“…According to previous research, these findings highlight the unequal distribution of resources as a structural factor with a high impact on mental health (Calderón-Larrañaga et al, 2020;Cifuentes et al, 2020;Friedman et al, 2020). In Colombia, there is evidence that mental health was precarious before the pandemic (Ministerio de Salud y Protección Social, 2015).…”

“…The scientific evidence collected so far indicates that the virus spreads and causes higher mortality rates among the most vulnerable communities, which, in turn, are victims of pre-existing social and economic inequities. This is the case of Colombia, where higher mortality rates for COVID-19 are associated with socioeconomic inequality in terms of low income, sex, ethnicity, and type of health insurance (Cifuentes et al, 2020). Even in developed countries with more robust health systems, social determinants have been identified in which the most vulnerable groups were most affected (Calderón-Larrañaga et al, 2020;Friedman et al, 2020).…”

Social Inequities in the Impact of COVID-19 Lockdown Measures on the Mental Health of a Large Sample of the Colombian Population (PSY-COVID Study)

“…According to previous research, these findings highlight the unequal distribution of resources as a structural factor with a high impact on mental health [37][38][39]. In Colombia, there is evidence that mental health was precarious before the pandemic [31].…”

“…The information collected so far indicates that the virus spreads and causes higher mortality rates among the most vulnerable communities, which, in turn, are victims of pre-existing social and economic inequities. This is the case of Colombia, where higher mortality rates for COVID-19 are associated with socioeconomic inequality in terms of low income, gender, ethnicity, and type of health insurance [37]. Even in developed countries with more robust health systems, social determinants have been identified in which the most vulnerable groups were most affected [38,39].…”