Survival analysis and mortality predictors of COVID-19 in a pediatric cohort in Mexico

Abstract

BackgroundThe new coronavirus SARS-CoV-2 pandemic has been relatively less lethal in children; however, poor prognosis and mortality has been associated with factors such as access to health services. Mexico remained on the list of the ten countries with the highest case fatality rate (CFR) in adults. It is of interest to know the behavior of COVID-19 in the pediatric population. The aim of this study was to identify clinical and sociodemographic variables associated with mortality due to COVID-19 in pediatric patients.ObjectiveUsing National open data and information from the Ministry of Health, Mexico, this cohort study aimed to identify clinical and sociodemographic variables associated with COVID-19 mortality in pediatric patients.MethodA cohort study was designed based on National open data from the Ministry of Health, Mexico, for the period April 2020 to January 2022, and included patients under 18 years of age with confirmed SARS-CoV-2 infection. Variables analyzed were age, health services used, and comorbidities (obesity, diabetes, asthma, cardiovascular disease, immunosuppression, high blood pressure, and chronic kidney disease). Follow-up duration was 60 days, and primary outcomes were death, hospitalization, and requirement of intensive care. Statistical analysis included survival analysis, prediction models created using the Cox proportional hazards model, and Kaplan-Meier estimation curves.ResultsThe cohort included 261,099 cases with a mean age of 11.2 ± 4 years, and of these, 11,569 (4.43%) were hospitalized and 1,028 (0.39%) died. Variables associated with risk of mortality were age under 12 months, the presence of comorbidities, health sector where they were treated, and first wave of infection.ConclusionBased on data in the National database, we show that the pediatric fatality rate due to SARS-CoV-2 is similar to that seen in other countries. Access to health services and distribution of mortality were heterogeneous. Vulnerable groups were patients younger than 12 months and those with comorbidities.

Risk factors for severe disease and mortality in children with COVID-19

“…We found that diabetes was associated with hospital admission, invasive mechanical ventilation, and death. Similar results have been recorded in pediatric populations younger than 12 months, and those with comorbidities have a worse prognosis [ 19 , 20 ]. Consistent with other studies, adult patients with diabetes had higher hospital admission rates and a higher risk of dying [ 12 ].…”

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

“…Numerous studies have demonstrated that COVID‐19 patients who also have conditions like hypertension, diabetes, and obesity typically experience worse outcomes 55,57,58 . The body's capacity to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the immune system's normal function 59,60 …”

“… 55 , 57 , 58 The body's capacity to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the immune system's normal function. 59 , 60 …”