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. 2022 Jun;23(2):146-158.
doi: 10.1089/ham.2021.0149. Epub 2022 Apr 27.

Living at High Altitude and COVID-19 Mortality in Peru

Laura Nicolaou  1   2 , Anne Steinberg  3 , Rodrigo M Carrillo-Larco  4 , Stella Hartinger  5   6 , Andres G Lescano  6   7 , William Checkley  1   2   3
Affiliations

Living at High Altitude and COVID-19 Mortality in Peru

Laura Nicolaou et al. High Alt Med Biol. 2022 Jun.

Abstract

Nicolaou, Laura, Anne Steinberg, Rodrigo M. Carrillo-Larco, Stella Hartinger, Andres G. Lescano, and William Checkley. Living at high altitude and COVID-19 mortality in Peru. High Alt Med Biol. 23:146-158, 2022. Background: Previous studies have reported a lower severity of COVID-19 infections at higher altitudes; however, this association may be confounded by various factors. We examined the association between living at altitude and COVID-19 mortality in Peru adjusting for population density, prevalence of comorbidities, indicators of socioeconomic status, and health care access. Methods: Utilizing administrative data across 196 provinces located at varying altitudes (sea level to 4,373 m), we conducted a two-stage analysis of COVID-19 deaths between March 19 and December 31, 2020, Peru's first wave. We first calculated cumulative daily mortality rate for each province and fit lognormal cumulative distribution functions to estimate total mortality rate, and start, peak, and duration of the first wave. We then regressed province-level total mortality rate, start, peak, and duration of the first wave as a function of altitude adjusted for confounders. Results: There were 93,528 recorded deaths from COVID-19 (mean age 66.5 years, 64.5% male) for a cumulative mortality of 272.5 per 100,000 population between March 19 and December 31, 2020. We did not find a consistent monotonic trend between living at higher altitudes and estimated total mortality rate for provinces at 500 - 1,000 m (-12.1 deaths per 100,000 population per 100 m, 95% familywise confidence interval -27.7 to 3.5) or > 1,000 m (-0.3, -2.7 to 2.0). We also did not find consistent monotonic trends for the start, peak, and duration of the first wave beyond the first 500 m. Conclusions: Our findings suggest that living at high altitude may not confer a lower risk of death from COVID-19.

Keywords: COVID-19; high altitude; mortality.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Altitude by province. (A) Map of departments (labeled) and provinces; (B) population density cartogram by province.
FIG. 2.
FIG. 2.
2020 total COVID-19 deaths per 100,000 inhabitants in all provinces and mean and standard deviation by department ordered by ascending altitude.
FIG. 3.
FIG. 3.
CDMR and DMR by department showing predicted start, end and peak of first wave, and sorted by altitude. CDMR, cumulative daily mortality rate; DMR, daily mortality rate.
FIG. 4.
FIG. 4.
Maps by province: (A) 2020 COVID-19 deaths per 100,000 population; (B) start of first wave; (C) peak of first wave; (D) duration of first wave.
FIG. 5.
FIG. 5.
Variables as a function of altitude: (A) 2020 COVID-19 deaths per 100,000 population; (B) start of first wave; (C) peak of first wave; (D) duration of first wave. Multivariable adjusted models showing mean and 95% familywise CIs. CI, confidence interval.
See this image and copyright information in PMC

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