Comprehensive Evaluation of the Impact of Sociodemographic Inequalities on Adverse Outcomes and Excess Mortality During the Coronavirus Disease 2019 (COVID-19) Pandemic in Mexico City
Por:
Antonio-Villa N.E., Fernandez-Chirino L., Pisanty-Alatorre J., Mancilla-Galindo J., Kammar-García A., Vargas-Vázquez A., González-Díaz A., Fermín-Martínez C.A., Márquez-Salinas A., Guerra E.C., Bahena-López J.P., Villanueva-Reza M., Márquez-Sánchez J., Jaramillo-Molina M.E., Gutiérrez-Robledo L.M., Bello-Chavolla O.Y.
Publicada:
1 ene 2022
Resumen:
BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City. METHODS: We analyzed suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, from the Mexico City Epidemiological Surveillance System from 24 February 2020 to 31 March 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the general civil registry. RESULTS: We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater risk for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic. CONCLUSIONS: Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City. © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Filiaciones:
Antonio-Villa N.E.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Fernandez-Chirino L.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Pisanty-Alatorre J.:
Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM)Mexico City, Mexico
Instituto Mexicano del Seguro SocialMexico City, Mexico
Mancilla-Galindo J.:
Instituto Nacional de Cardiología Ignacio Chávez, Unidad de Investigación UNAM-INCMexico City, Mexico
Kammar-García A.:
Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City, Mexico
Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico NacionalMexico City, Mexico
Vargas-Vázquez A.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
González-Díaz A.:
Facultad de Ciencias Politicas Sociales y Sociales, National Autonomous University of MexicoMexico City, Mexico
Fermín-Martínez C.A.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Márquez-Salinas A.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Guerra E.C.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Bahena-López J.P.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
MD/PhD (PECEM) Program, National Autonomous University of MexicoMexico City, Mexico
Villanueva-Reza M.:
Departamento de Infectologia. Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City, Mexico
Márquez-Sánchez J.:
Departamento de Infectología, Instituto Nacional de PediatríaMexico City, Mexico
Jaramillo-Molina M.E.:
International Inequalities Institute, London School of Economics, London, United Kingdom
Gutiérrez-Robledo L.M.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
Bello-Chavolla O.Y.:
Division de Investigación, Instituto Nacional de GeriatríaMexico City, Mexico
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