Faculty of Medicine, University of Colima, Colima, Col, 28040, Mexico.
Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Colima, Col, 28000, Mexico.
J Public Health (Oxf). 2021 Sep 22;43(3):437-444. doi: 10.1093/pubmed/fdaa228.
Recent evidence points to the relevance of poverty and inequality as factors affecting the spread and mortality of the COVID-19 pandemic in Latin America. This study aimed to determine whether COVID-19 patients living in Mexican municipalities with high levels of poverty have a lower survival compared with those living in municipalities with low levels.
Retrospective cohort study. Secondary data was used to define the exposure (multidimensional poverty level) and outcome (survival time) among patients diagnosed with COVID-19 between 27 February and 1 July 2020. Crude and adjusted hazard ratios (HR) from Cox regression were computed.
Nearly 250 000 COVID-19 patients were included. Mortality was 12.3% reaching 59.3% in patients with ≥1 comorbidities. Multivariate survival analyses revealed that individuals living in municipalities with extreme poverty had 9% higher risk of dying at any given time proportionally to those living in municipalities classified as not poor (HR 1.09; 95% CI 1.06-1.12). The survival gap widened with the follow-up time up to the third to fourth weeks after diagnosis.
Evidence suggests that the poorest population groups have a lower survival from COVID-19. Thus, combating extreme poverty should be a central preventive strategy.
最近的证据表明，贫困和不平等是影响拉丁美洲 COVID-19 疫情传播和死亡率的因素。本研究旨在确定生活在墨西哥贫困程度较高的城市的 COVID-19 患者的存活率是否低于生活在贫困程度较低的城市的患者。
回顾性队列研究。使用二级数据来定义 2020 年 2 月 27 日至 7 月 1 日期间被诊断患有 COVID-19 的患者的暴露（多维贫困水平）和结局（生存时间）。计算 Cox 回归的粗和调整后的风险比（HR）。
纳入了近 250000 名 COVID-19 患者。死亡率为 12.3%，有≥1 种合并症的患者死亡率达到 59.3%。多变量生存分析显示，与生活在非贫困城市的患者相比，生活在极端贫困城市的患者在任何特定时间死亡的风险高 9%（HR 1.09；95%CI 1.06-1.12）。随着随访时间的延长，这种生存差距在诊断后的第三至第四周扩大。
有证据表明，最贫困的人群 COVID-19 的存活率较低。因此，消除极端贫困应成为一项核心的预防策略。
