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. 2020 Sep 25:44:e106.
doi: 10.26633/RPSP.2020.106. eCollection 2020.

[Social inequalities in the progression of COVID-19 in the Mexican population]

[Article in Spanish]
Luis Ortiz-Hernández  1 , Miguel A Pérez-Sastré  2
Affiliations

[Social inequalities in the progression of COVID-19 in the Mexican population]

[Article in Spanish]
Luis Ortiz-Hernández et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish

Objective: To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2.

Method: We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models.

Results: People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45).

Conclusions: The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.

Objetivo.: Determinar si existen disparidades asociadas a la estratificación socioeconómica, la etnicidad, los servicios médicos y la región geográfica en la progresión de la enfermedad por coronavirus (COVID-19) en adultos mexicanos infectados por SARS-CoV-2.

Método.: Se analizaron los datos registrados por la Dirección General de Epidemiología de la Secretaría de Salud del Gobierno Federal de México respecto de los casos confirmados de infección por SARS-CoV-2. El análisis se limitó a los datos de adultos de 20 años o más registrados hasta el 10 de julio del 2020 (n=234 870). Los indicadores de severidad de la COVID-19 fueron hospitalización, desarrollo de neumonía, requerimiento de intubación o ingreso a la unidad de cuidados intensivos, y muerte. Se estimaron diferencias de acuerdo con el nivel de marginación municipal, la pertenencia a un grupo indígena, la región geográfica y el sector de los servicios. A partir de modelos de regresión multinivel se estimaron razones de prevalencias (RP).

Resultados.: Las personas que residían en municipios con mayor marginación tuvieron mayor riesgo de presentar los cuatro indicadores de formas severas de COVID-19 (RP=1,05 o 1,06). Las personas indígenas tuvieron mayor riesgo de neumonía (RP=1,22), hospitalización (RP=1,14) y muerte (RP=1,23). Entre los casos atendidos en servicios privados fue menor el riesgo de muerte (RP=0,40), pero mayor el uso de intubación o ingreso a la unidad de cuidados intensivos (RP=4,45).

Conclusiones.: Las tendencias observadas indican que los efectos de la COVID-19 no solo se deben a las características biológicas del SARS-CoV-2, sino también a los recursos (o falta de ellos) para enfrentarlo, los cuales están distribuidos por procesos sociales.

Keywords: Mexico; Social inequity; coronavirus infections; ethnic groups; health status disparities; socioeconomic factors.

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