Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Center for Gerontology and Healthcare Research, Providence, Rhode Island, USA.
J Gerontol B Psychol Sci Soc Sci. 2021 Aug 13;76(7):e268-e274. doi: 10.1093/geronb/gbaa227.
Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities.
We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator.
Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7).
Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.
墨西哥是拉丁美洲受 2019 年冠状病毒病（COVID-19）打击最严重的国家之一。墨西哥的很大一部分老年人患有多种疾病，生活在贫困中，获得医疗保健服务的机会有限。在居住在农村地区的成年人中，这些统计数据甚至更高，这表明农村社区的老年人可能更容易感染 COVID-19。本文的目的是按年龄组比较诊断为 COVID-19 的人群的临床和人口统计学特征，并描述农村和城市社区的病例和死亡率。
我们将墨西哥卫生部和人口普查局提供的公开数据进行了关联。根据人口将市镇分为农村（<2500 人）、半农村（≥2500 人且<15000 人）、半城市（≥15000 人且<100000 人）和城市（≥100000 人）。使用每个市镇的人口作为分母，使用零膨胀负二项式模型计算 COVID-19 病例总数和每百万人死亡人数。
老年人更有可能住院并报告严重病例，死亡率更高。此外，农村市镇每百万人口 COVID-19 病例和与 COVID-19 相关的死亡人数均高于城市市镇。COVID-19 病例的调整绝对差异为 912.7 例/百万（95%置信区间[CI]：79.0-1746.4），与 COVID-19 相关的死亡率为 390.6 例/百万（95%CI：204.5-576.7）。
需要采取紧急政策措施，要求农村地区的墨西哥人使用口罩、鼓励洗手并改善专业护理。
