Balboa-Castillo Teresa, Andrade-Mayorga Omar, Marzuca-Nassr Gabriel Nasri, Morales Illanes Gladys, Ortiz Manuel, Schiferlli Ingrid, Aguilar-Farias Nicolas, Soto Álvaro, Sapunar Jorge
Centro de Investigación en Epidemiología Cardiometabólica y Nutricional (EPICYN); Faculty of Medicine, Universidad de La Frontera, Temuco, Chile. Email:
Centro de Investigación en Epidemiología Cardiometabólica y Nutricional (EPICYN), Faculty of Medicine, Universidad de La Frontera, Temuco, Chile; Department of Preclinical Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile. ORCID: 0000-0003-3359-4100.
Medwave. 2021 May 4;21(4):e8181. doi: 10.5867/medwave.2021.04.8180.
The coronavirus disease 2019 (COVID-19) pandemic, produced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly throughout the world. Latin American and the Caribbean countries have been harshly affected by the pandemic mainly due to less prepared healthcare systems and fragmented social safety nets. In the region, health status population-based indicators are worse than compared to the Organization for Economic Cooperation and Development. Recent evidence suggests that the progression and severity of COVID-19 are associated with the prior health status of individuals, and studies have shown that the case fatality rate is highly stratified among different populations. This narrative review aims to describe factors associated with adverse outcomes of COVID-19 in the context of social determinants of health in Latin American and Caribbean countries. In this review, we state that genetic and biological factors interact in a sophisticated way with social determinants of health, impacting the rapid spread of COVID-19 in Latin American and Caribbean countries. Behavioral factors, such as physical inactivity, smoking, and unhealthy diets, are related to chronic systemic inflammation. Also, air pollution can prolong inflammation and the hyper-activation of the immune system. Air pollutants could facilitate the spread of the virus. Finally, frailty and comorbidities can be associated with COVID-19 severity through increasing vulnerability to stressors and leading to more severe symptoms of COVID-19 disease, including a higher mortality risk. All these factors contribute to increasing the impact of COVID-19 in Latin American and Caribbean countries. We highlight the relevance of considering social determinants of health in Latin American and the Caribbean countries, not only in controlling the likelihood of getting the disease but also its progression and severity. All these social determinants can guide the design and implementation of tailored interventions promoting healthy lifestyle behaviors, which should lower the spread of the disease, its severity, and lethality.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引发的2019冠状病毒病（COVID-19）大流行已在全球迅速蔓延。拉丁美洲和加勒比国家受到这场大流行的严重影响，主要原因是医疗保健系统准备不足以及社会安全网碎片化。在该地区，基于人群的健康状况指标比经济合作与发展组织国家的情况更差。最近的证据表明，COVID-19的进展和严重程度与个体先前的健康状况相关，并且研究表明，不同人群的病死率差异很大。本叙述性综述旨在描述在拉丁美洲和加勒比国家健康的社会决定因素背景下，与COVID-19不良结局相关的因素。在本综述中，我们指出遗传和生物学因素与健康的社会决定因素以复杂的方式相互作用，影响了COVID-19在拉丁美洲和加勒比国家的快速传播。行为因素，如身体活动不足、吸烟和不健康饮食，与慢性全身炎症有关。此外，空气污染会延长炎症并导致免疫系统过度激活。空气污染物可能会促进病毒传播。最后，身体虚弱和合并症可能通过增加对压力源的易感性以及导致COVID-19疾病更严重的症状，包括更高的死亡风险，而与COVID-19的严重程度相关。所有这些因素都加剧了COVID-19在拉丁美洲和加勒比国家的影响。我们强调在拉丁美洲和加勒比国家考虑健康的社会决定因素的相关性，这不仅关乎控制感染疾病的可能性，还关乎疾病的进展和严重程度。所有这些社会决定因素可以指导设计和实施针对性的干预措施，以促进健康的生活方式行为，从而降低疾病的传播、严重程度和致死率。
