Comprehensive evaluation of the impact of sociodemographic inequalities on adverse outcomes and excess mortality during the 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:10.1101/2021.03.11.21253402

Cited by 16 publications

(18 citation statements)

References 42 publications

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“…Variables for adjustment in our study included age, sex, time from symptom onset to medical care, smoking and socio-demographic variables since these have been associated with the risk of developing severe disease and mortality in patients with COVID-19 [10, 20–23]. These covariates have been used in other studies, too [24, 25].…”

Section: Discussionmentioning

confidence: 99%

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Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

et al. 2021

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Conflicting results have been obtained through meta-analyses for the role of obesity as a risk factor for adverse outcomes in patients with coronavirus disease-2019 (COVID-19), possibly due to the inclusion of predominantly multimorbid patients with severe COVID-19. Here, we aimed to study obesity alone or in combination with other comorbidities as a risk factor for short-term all-cause mortality and other adverse outcomes in Mexican patients evaluated for suspected COVID-19 in ambulatory units and hospitals in Mexico. We performed a retrospective observational analysis in a national cohort of 71 103 patients from all 32 states of Mexico from the National COVID-19 Epidemiological Surveillance Study. Two statistical models were applied through Cox regression to create survival models and logistic regression models to determine risk of death, hospitalisation, invasive mechanical ventilation, pneumonia and admission to an intensive care unit, conferred by obesity and other comorbidities (diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, immunosuppression, hypertension, cardiovascular disease and chronic kidney disease). Models were adjusted for other risk factors. From 24 February to 26 April 2020, 71 103 patients were evaluated for suspected COVID-19; 15 529 (21.8%) had a positive test for SARS-CoV-2; 46 960 (66.1%), negative and 8614 (12.1%), pending results. Obesity alone increased adjusted mortality risk in positive patients (hazard ratio (HR) = 2.7, 95% confidence interval (CI) 2.04–2.98), but not in negative and pending-result patients. Obesity combined with other comorbidities further increased risk of death (DM: HR = 2.79, 95% CI 2.04–3.80; immunosuppression: HR = 5.06, 95% CI 2.26–11.41; hypertension: HR = 2.30, 95% CI 1.77–3.01) and other adverse outcomes. In conclusion, obesity is a strong risk factor for short-term mortality and critical illness in Mexican patients with COVID-19; risk increases when obesity is present with other comorbidities.

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Section: Discussionmentioning

confidence: 99%

“…Models for each group were adjusted for sex, age, smoker and time from symptom onset to medical care according to a o value <0.1 in the crude model. To control the confounding effect of socio-demographic variables for severe COVID-19 cases [20], all models were adjusted for the previously described socio-demographic variables.…”

Section: Methodsmentioning

confidence: 99%

Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

et al. 2021

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“…Although local authorities have promoted the use of Rapid-Ag T around all the country since November 2020, our results show that there is an unequal testing capacity for each state in Mexico. This inequality in testing could be related to unequal socioeconomic and demographic factors reported during the COVID-19 pandemic rather than individual conditions related to testing performance [ 23 ]. Special caution should be taken when evaluating and communicating negative results of rapid antigen tests for SARS-CoV-2, which if misinterpreted could be misleading and reduce adherence for self-isolation of asymptomatic cases identified via contact tracing [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance and clinical implications of rapid SARS-CoV-2 antigen testing in Mexico using real-world nationwide COVID-19 registry data

et al. 2021

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Background SARS-CoV-2 testing capacity is important to monitor epidemic dynamics and as a mitigation strategy. Given difficulties of large-scale quantitative reverse transcription polymerase chain reaction (qRT-PCR) implementation, rapid antigen tests (Rapid Ag-T) have been proposed as alternatives in settings like Mexico. Here, we evaluated diagnostic performance of Rapid Ag-T for SARS-CoV-2 infection and its associated clinical implications compared to qRT-PCR testing in Mexico. Methods We analyzed data from the COVID-19 registry of the Mexican General Directorate of Epidemiology up to April 30th, 2021 (n = 6,632,938) and cases with both qRT-PCR and Rapid Ag-T (n = 216,388). We evaluated diagnostic performance using accuracy measures and assessed time-dependent changes in the Area Under the Receiver Operating Characteristic curve (AUROC). We also explored test discordances as predictors of hospitalization, intubation, severe COVID-19 and mortality. Results Rapid Ag-T is primarily used in Mexico City. Rapid Ag-T have low sensitivity 37.6% (95%CI 36.6–38.7), high specificity 95.5% (95%CI 95.1–95.8) and acceptable positive 86.1% (95%CI 85.0–86.6) and negative predictive values 67.2% (95%CI 66.2–69.2). Rapid Ag-T has optimal diagnostic performance up to days 3 after symptom onset, and its performance is modified by testing location, comorbidity, and age. qRT-PCR (-) / Rapid Ag-T (+) cases had higher risk of adverse COVID-19 outcomes (HR 1.54 95% CI 1.41–1.68) and were older, qRT-PCR (+)/ Rapid Ag-T(-) cases had slightly higher risk or adverse outcomes and ≥7 days from symptom onset (HR 1.53 95% CI 1.48–1.59). Cases detected with rapid Ag-T were younger, without comorbidities, and milder COVID-19 course. Conclusions Rapid Ag-T could be used as an alternative to qRT-PCR for large scale SARS-CoV-2 testing in Mexico. Interpretation of Rapid Ag-T results should be done with caution to minimize the risk associated with false negative results.

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“…Regarding the rate mortality of COVID‐19 in this cohort of patients (5.75%), it is lower than that reported in the general Mexican population (13.55%‐11.28%), 23 which is higher than the worldwide mortality (4.98%‐2.95%) in the studied period (for details, see Table 3 ). Antonio‐Villa et al 30 evaluated the COVID‐19 pandemic in Mexico City and reported that the mortality rate is higher in people in active economically active sectors and of marginalised municipalities with a high population density. This reinforces the reports that sustain that socioeconomic conditions are a determining factor for mortality and the outcome of COVID‐19 worldwide.…”

Section: Discussionmentioning

confidence: 99%

Patients with schizophrenia have decreased COVID‐19 prevalence among hospitalised patients with psychiatric and neurological diseases: A retrospective analysis in Mexican population

Rivas-Ramírez¹,

Tendilla-Beltrán

Gómez-Mendoza³

et al. 2021

Int J Clin Pract

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Background Increased coronavirus disease 2019 (COVID‐19) incidence and mortality in hospitalised patients with psychiatric and neurologic disorders have been reported. Methods The clinical records of 198 patients with psychiatric and neurological disorders hospitalised in the Dr Rafael Serrano Psychiatric Hospital in Puebla during the peak of the first wave of the COVID‐19 pandemic in Mexico were analysed for psychiatric or neurologic diagnosis, gender, age, medical diagnosis, and COVID‐19 prevalence. For patients with COVID‐19, the effects of gender, and medical diagnosis were explored. Results There was an increased COVID‐19 prevalence in the studied population (43.94%), compared with the national Mexican (~0.21% to 0.63%) and worldwide average in the general population (~0.13% to 4.28%). However, the mortality rate (5.75%) was lower than that reported in Mexico (11.28%‐13.55%), which was higher than the worldwide average (2.95%‐4.98%). We detected increased COVID‐19 prevalence in patients with comorbidities (odds ratios [OR] 0.4; 95% CI: 0.2‐1, P = .0447). Moreover, patients with schizophrenia spectrum disorders have a decreased predisposition to COVID‐19 (OR 0.4, 95% CI: 0.2‐0.8; P = .0250), as opposed to patients with intellectual disability that are predisposed to COVID‐19 (OR 2.2, 95% CI: 0.2‐0.8; P = .0434), in comparison with the rest of the hospital population. Conclusion The prevalence of COVID‐19 in hospitalised patients with psychiatric disorders is increased compared with that of the general population; however, a lower mortality rate was detected. Also, an increased risk of COVID‐19 was detected in patients with comorbidities. Interestingly, the observed variation in COVID‐19 prevalence in patients with schizophrenia and intellectual disability was not associated with age or other specific medical diagnoses.

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Comprehensive evaluation of the impact of sociodemographic inequalities on adverse outcomes and excess mortality during the COVID-19 pandemic in Mexico City

Cited by 16 publications

References 42 publications

Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

Diagnostic performance and clinical implications of rapid SARS-CoV-2 antigen testing in Mexico using real-world nationwide COVID-19 registry data

Patients with schizophrenia have decreased COVID‐19 prevalence among hospitalised patients with psychiatric and neurological diseases: A retrospective analysis in Mexican population

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