Variability in case fatality rate risk due to Covid-19 according to health services provider in Mexico City hospitals

Abstract

Objective. To describe differences in Case Fatality Rate (CFR) for Covid-19 among healthcare subsystems in Mexico City between March and December 2020. Materials and methods. This is a retrospective secondary data analysis from the National Epidemiological Surveillance System data of Covid-19 cases. Information about health provider institutions was retrieved from the Catalogue of Health Establishments (CLUES). Logistic regressions were fitted to determine the association between health subsystems and mortality associated to Covid-19. The analyses were divided between hospitalized and ambulatory patients. Results. The probability of dying from Covid-19 was higher among those treated at Instituto Mexicano del Seguro Social (IMSS) (Hospitalized:OR=5.11, Ambulatory:OR=36.57), Instituto de Se­guridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Hospitalized:OR=2.10, Ambulatory:OR=9.19), Secretaría de Salud (SS) (Hospitalized:OR=1.94, Ambulatory:OR=5.29) or other public institutions (Hospitalized: OR=1.70, Ambulatory:OR=9.56) than in those treated in private in­stitutions. Conclusions. Differences in healthcare quality and access between health subsystems are profound. It is imperative to increase the capacity and quality of the different health subsystems to improve health outcomes.

Socioeconomic Inequalities and Ethnic Discrimination in COVID-19 Outcomes: the Case of Mexico

“…If the levels of marginalisation across municipalities were equalised, the ethnic gap would decrease by 58% in hospitalisations, 36% in early deaths and 31% in deaths (general). These results are consistent with a prior study about the higher probability to die due to COVID-19 among people treated in the Mexican Social Security Institute [ 37 ] compared to other health provider institutions. Despite this latter study showing unconditional probabilities, it offers insights into the existence of structural differences in the hospital infrastructure, equipment availability and training of the staff as well as the use of care protocols and that the pandemic only exhibited these deep-rooted inequalities [ 36 ].…”

“…The six public health provider institutions were divided into social security institutions (IMSS, ISSSTE, PEMEX, SEDENA, and SEMAR) and health secretariat institutions (Federal and State Ministry of Health-owned hospitals). The inclusion of these variables is based on previous evidence about COVID-19 treatment differences across public health institutions [ 36 , 37 ].…”

Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study

“…It also showed the way to establish appropriate strategies and improve communication with the population. Major modifications to customary organizational processes will need to be analyzed in search of specific opportunities for well-designed programs that help raise the level of resilience of health services and staff, as well as deal with the consequences of unforeseen changes in care outcomes (García et al, 2022; Haldane et al, 2021; Kruk et al, 2015; PAHO, 2020a; PAHO, 2020b). As a result, it can be assumed that the experience of what has been achieved in the local response to state health services, mainly in governance/stewardship, represents a chance to redirect public health policies toward integration of health services, which, like those of Mexico, continue to be segmented, with consequences in terms of disparity in access and lack of universal coverage (Armenta et al, 2022; Eyawo & Viens, 2020; Frenk et al, 2010; González et al, 2020; Kumpunen et al, 2022; Schneider et al, 2019).…”

Risk Factors for Mortality of Adult Patients With COVID-19: A Two-Year Cohort Study in a Private Tertiary Care Center in Mexico

“…Mexican health system's highly heterogeneous organization and quality of care have allowed discrepancies in healthcare to persist to date. The system of care is divided into four main subsystems (private health care providers, as well as Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE), and Secretaría de Salud (SS) as public institutions), all of which remain fragmented and incapable of delivering universal care [32][33][34]38,54]. Public institutions represent the health services with the highest demand, as they are more affordable, which puts them at a higher risk of exceeding their capacity, causing health services saturation and increasing mortality [49].…”

“…Despite not having the highest mortality rate of LAC, Mexico currently stands as the fifth country with the most deaths worldwide [35]. The alarming mortality, correlated with the aforementioned risk factors [5,7,36,37], can also be associated with the differences among healthcare institutions; evidence suggests that the lack of homogeneity among available resources, infrastructure, quality of care, and standardized protocols may have resulted in a higher probability of dying from COVID-19 for patients treated in a public healthcare facility, than those treated in a private institution [5,[38][39][40]. Considering this, it becomes necessary to have an understanding of the statistical behavior of the pandemic in public and private institutions separately, which would in turn present a complete overview of its interaction within two different healthcare environments, as well as the corresponding socioeconomic implications, such as inequalities in healthcare access and possible cultural disparities for marginalized groups, which continue to impact the evolution of the pandemic in Mexico.…”