COVID-19 fatality in Mexico's indigenous populations

Abstract

Objective: The aim of the study was to explore the factors that could explain the differences in fatality rates among indigenous groups with COVID-19 diagnosis compared with the rest of the population in Mexico.

Study design: We analyzed the public data of COVID-19 surveillance, of the Mexican Ministry of Health, to estimate COVID-19 fatality rates by ethnicity.

Methods: We explored associated factors using Cox proportional hazards models stratified by outpatient and hospital management at diagnosis; analysis was conducted in three scenarios: national level, states with 89% of the indigenous population, and South Pacific region.

Results: A total of 412,017 COVID-19 cases were included, with 1.1% of the indigenous population. The crude fatality rate per 1000 person-weeks was 64.8% higher among indigenous than among non-indigenous people (29.97 vs. 18.18, respectively), and it increased more than twice within outpatients (5.99 vs. 2.64, respectively). Cox analysis revealed that indigenous people who received outpatient management had higher fatality rate than non-indigenous outpatients, at the national level (hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.34-1.98), within the subgroup of 13 states (HR = 1.66; 95% CI = 1.33-2.07), and in the South Pacific region (HR = 2.35; 95% CI = 1.49-3.69). Factors associated with higher fatality rates among non-indigenous and indigenous outpatients were age, sex, and comorbidities.

Conclusions: COVID-19 fatality is higher among indigenous populations, particularly within cases managed as outpatients.

Keywords: COVID-19; Fatality; Hospitalized; Indigenous; Mexico; Outpatients.

Graphical abstract

Fig. 1

COVID-19 fatality hazard ratios based on the type of management and the presence of comorbidities (multivariate model). HR reference: none (hypertension, obesity, diabetes). HR = hazard ratio; CI = confidence interval.

Fig. 2

COVID-19 fatality hazard ratios among indigenous people vs. non-indigenous people based on the type of management, in different regions in Mexico (multivariate model). HR reference: non-indigenous. States with 89% of the indigenous population: Campeche, Chiapas, Mexico City, Guerrero, Hidalgo, Estado de México, Michoacán, Oaxaca, Puebla, Quintana Roo, San Luis Potosí, Veracruz, and Yucatán. Three states in the South Pacific with the highest proportion of indigenous people: Oaxaca, Chiapas, and Guerrero. HR = hazard ratio; CI = confidence interval.