Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico

Abstract

COVID-19 is a respiratory disease caused by SARS-CoV-2, which has significantly impacted economic and public healthcare systems worldwide. SARS-CoV-2 is highly lethal in older adults (>65 years old) and in cases with underlying medical conditions, including chronic respiratory diseases, immunosuppression, and cardio-metabolic diseases, including severe obesity, diabetes, and hypertension. The course of the COVID-19 pandemic in Mexico has led to many fatal cases in younger patients attributable to cardio-metabolic conditions. Thus, in the present study, we aimed to perform an early spatial epidemiological analysis for the COVID-19 outbreak in Mexico. Firstly, to evaluate how mortality risk from COVID-19 among tested individuals (MRt) is geographically distributed and secondly, to analyze the association of spatial predictors of MRt across different states in Mexico, controlling for the severity of the disease. Among health-related variables, diabetes and obesity were positively associated with COVID-19 fatality. When analyzing Mexico as a whole, we identified that both the percentages of external and internal migration had positive associations with early COVID-19 mortality risk with external migration having the second-highest positive association. As an indirect measure of urbanicity, population density, and overcrowding in households, the physicians-to-population ratio has the highest positive association with MRt. In contrast, the percentage of individuals in the age group between 10 to 39 years had a negative association with MRt. Geographically, Quintana Roo, Baja California, Chihuahua, and Tabasco (until April 2020) had higher MRt and standardized mortality ratios, suggesting that risks in these states were above what was nationally expected. Additionally, the strength of the association between some spatial predictors and the COVID-19 fatality risk varied by zone.

Serum Vitamin D levels are associated with increased COVID-19 severity and mortality independent of whole-body and visceral adiposity

“…SARS-CoV-2 infects cells using the angiotensin converting enzyme-2 (ACE-2) receptor; infection can produce an interstitial pneumonia that may progress to acute respiratory distress syndrome (ARDS) and death (7,8). COVID-19 severity has been shown to be modified by the presence of cardio-metabolic comorbidities as well as inflammatory markers which may reflect vascular or respiratory deterioration (9)(10)(11)(12).…”

Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review

“… Sigler et al (2021) discussed that HDI is a significant predictor at the beginning but after countries impose restrictions, globalization factors became a significant factor. On the state scale , Gargiulo et al (2020) and Ramírez-Aldana et al (2021) both found that GDP is positively and significantly associated with the number of cases in Italy and Mexico, respectively. On the county scale , Xiong et al (2020) revealed that GDP was positively and significantly associated with the number of COVID-19 cases in China.…”

“…Internal and external mobility of population on state, county, and urban scales is another common variable to analyze the spread of COVID-19. The result of studies in Iran, France, and Mexico shows that population mobility, internally and externally, plays a significant role in a higher number of cases on the state scale ( Ahmadi et al, 2020 ; Ramírez-Aldana et al, 2021 ; Pilkington et al, 2021 ). As was expected, the higher rate of mobility is a significant predictor of COVID-19 cases on the County scale ( Jamshidi et al, 2020 ; Niu et al, 2020 ; Tokey, 2021 ).…”

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

“…Similarly, we examined whether socio-demographic inequalities as proxied by DISLI, and COVID-19 indicators were associated with age-adjusted diabetes-related excess mortality. Bivariate correlations between epidemiological indicators and age-adjusted diabetes-related excess mortality were evaluated with Lee’s L test for spatial autocorrelation using spatial weights matrix within the spdep R package 18 . We also assessed the correlation of these epidemiological indicators with the out-of-hospital to in-hospital death ratio, as a proxy of their impact in access to medical care.…”