School of Public Health, Georgia State University, Atlanta, GA, USA.
Center for Epidemiology and Health Policies, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile.
BMC Public Health. 2024 Aug 28;24(1):2337. doi: 10.1186/s12889-024-19756-4.
Current literature presents mixed effects of the COVID-19 pandemic on Indigenous communities. We aim to highlight potential disparities and temporal shifts in both the impact of COVID-19 and vaccine uptake among hospitalized Indigenous populations in Chile.
We conducted an observational analysis utilizing 1,598,492 hospitalization records from 2020 to 2021 based on publicly accessible hospital discharge data spanning 65 healthcare facilities of medium and high complexity funded through the Diagnosis-Related Groups (DRG) mechanism in Chile, representing roughly 70% of the country's total hospitalizations. This was supplemented with publicly available municipal data on COVID-19 vaccinations and socio-demographic variables. We performed logistic regression analysis at 0.05 level of significance to assess the bivariate and multivariable association of Indigenous status with COVID-19 diagnosis and COVID-19 deaths among hospitalized populations. We also performed univariate and multiple linear regression to assess the association of COVID-19 vaccination rate and Indigenous status at the municipality level. In addition, we report the distribution of top 10 secondary diagnoses among hospitalized COVID-19 cases and deaths separately for Indigenous and non-Indigenous populations.
Indigenous populations displayed lower adjusted odds for both COVID-19 diagnosis (OR: 0.76, 95% CI: 0.74, 0.77) and death (OR: 0.91, 95% CI: 0.85, 0.97) when compared to non-Indigenous groups. Notably, the adjusted odds ratio for COVID-19 diagnosis in Indigenous populations rose from 0.59 (95% CI: 0.57, 0.61) in 2020 to 1.17 (95% CI: 1.13, 1.21) in 2021. Factors such as the significantly higher median age and greater number of comorbidities in the non-Indigenous hospitalized groups could account for their increased odds of COVID-19 diagnosis and mortality. Additionally, our data indicates a significantly negative adjusted association between COVID-19 vaccination rates and the proportion of Indigenous individuals.
Although Indigenous populations initially showed lower odds of COVID-19 diagnosis and mortality, a marked rise in diagnosis odds among these groups in 2021 underscores the urgency of targeted interventions. The observed negative association between the proportion of Indigenous populations and vaccination rates further underscores the necessity to tackle vaccine access barriers and work towards equitable distribution.
目前的文献对 COVID-19 大流行对原住民社区的影响存在不同的看法。我们旨在强调智利住院原住民人群中 COVID-19 感染和疫苗接种的潜在差异和时间变化。
我们利用智利基于公开可获得的医院出院数据的 2020 年至 2021 年期间的 1598492 例住院记录进行了观察性分析，该数据涵盖了通过诊断相关组（DRG）机制资助的 65 家中等和高复杂度的医疗保健机构，代表了该国约 70%的总住院人数。这一分析还补充了关于 COVID-19 疫苗接种和社会人口统计学变量的公开可得的市县级数据。我们在 0.05 的显著性水平上进行了逻辑回归分析，以评估原住民身份与住院人群中 COVID-19 诊断和 COVID-19 死亡的双变量和多变量关联。我们还进行了单变量和多元线性回归，以评估市县级 COVID-19 疫苗接种率和原住民身份之间的关联。此外，我们还报告了住院 COVID-19 病例和死亡病例中十大次要诊断的分布情况，分别为原住民和非原住民人群。
与非原住民群体相比，原住民群体的 COVID-19 诊断（OR：0.76，95%CI：0.74，0.77）和死亡（OR：0.91，95%CI：0.85，0.97）的调整后比值均较低。值得注意的是，原住民群体 COVID-19 诊断的调整后比值从 2020 年的 0.59（95%CI：0.57，0.61）上升到 2021 年的 1.17（95%CI：1.13，1.21）。非原住民住院人群的中位年龄明显较高，合并症数量较多，这些因素可能导致他们 COVID-19 诊断和死亡的几率增加。此外，我们的数据表明，COVID-19 疫苗接种率与原住民人口比例之间存在显著的负调整关联。
尽管原住民群体最初 COVID-19 诊断和死亡率较低，但 2021 年这些群体 COVID-19 诊断几率的显著上升突显了针对性干预的紧迫性。观察到原住民人口比例与疫苗接种率之间的负相关关系进一步强调了必须解决疫苗获取障碍，并努力实现公平分配。
