Department of Clinical Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
Centre for Research in Emerging Diseases, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
Front Public Health. 2021 Jul 27;9:660114. doi: 10.3389/fpubh.2021.660114. eCollection 2021.
The pandemic caused by the new coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently affecting more than 200 countries. The most lethal clinical presentation is respiratory insufficiency, requiring attention in intensive care units (ICU). The most susceptible people are over 60 years old with comorbidities. The health systems organization may represent a transcendental role in survival. To analyze the correlation of sociodemographic factors, comorbidities and health system organization variables with survival in cases infected by SARS-CoV-2 during the first 7 months of the pandemic in Mexico. The cohort study was performed in a health system public basis from March 1st to September 30th, 2020. The included subjects were positive for the SARS-CoV-2 test, and the target variable was mortality in 60 days. The risk variables studied were: age, sex, geographic distribution, comorbidities, health system, hospitalization, and access to ICU. Bivariate statistics (-test), calculation of fatality rates, survival analyses and adjustment of confusing variables with Cox proportional-hazards were performed. A total of 753,090 subjects were analyzed, of which the 52% were men. There were 78,492 deaths (10.3% of general fatality and 43% inpatient). The variables associated with a higher risk of hospital mortality were age (from 60 years onwards), care in public sectors, geographic areas with higher numbers of infection and endotracheal intubation without management in the ICU. The variables associated with a lower survival in cases affected by SARS-CoV-2 were age, comorbidities, and respiratory insufficiency (with endotracheal intubation without care in the ICU). Additionally, an interaction was observed between the geographic location and health sector where they were treated.
由新型冠状病毒严重急性呼吸综合征冠状病毒 2 型(SARS-CoV-2)引起的大流行目前正在影响 200 多个国家。最致命的临床表现是呼吸功能不全,需要在重症监护病房(ICU)中进行治疗。最易感染的人群是 60 岁以上合并有并发症的人群。卫生系统的组织可能在生存方面起着至关重要的作用。
为了分析社会人口统计学因素、合并症和卫生系统组织变量与墨西哥大流行期间前 7 个月感染 SARS-CoV-2 的病例的生存情况之间的相关性。
该队列研究是在 2020 年 3 月 1 日至 9 月 30 日期间在一个基于公共卫生系统的基础上进行的。纳入的研究对象是 SARS-CoV-2 检测呈阳性的患者,目标变量是 60 天内的死亡率。研究的风险变量有:年龄、性别、地理分布、合并症、卫生系统、住院和 ICU 入住。进行了单变量统计分析(-检验)、病死率计算、生存分析和 Cox 比例风险混杂变量调整。
共分析了 753090 名患者,其中 52%为男性。共有 78492 人死亡(一般病死率为 10.3%,住院患者病死率为 43%)。与住院死亡率较高相关的变量有年龄(60 岁以上)、在公共部门接受治疗、感染人数较多的地理区域以及在 ICU 中没有管理的气管插管。
与 SARS-CoV-2 感染病例生存情况较差相关的变量有年龄、合并症和呼吸功能不全(伴有气管插管但没有在 ICU 中进行治疗)。此外,还观察到地理位置和治疗所在的卫生部门之间存在交互作用。
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