Abstract
Local characteristics of populations have been associated with coronavirus disease 2019 (COVID-19) outcomes. We analyze the municipality-level factors associated with a high COVID-19 mortality rate (MR) of in Mexico. We retrieved information from cumulative confirmed symptomatic cases and deaths from COVID-19 as of June 20, 2020, and data from most recent census and surveys of Mexico. A negative binomial regression model was adjusted, the dependent variable was the number of COVID-19 deaths, and the independent variables were the quintiles of the distribution of sociodemographic and health characteristics among the 2457 municipalities of Mexico. Factors associated with high MRs from COVID-19, relative to quintile 1, were diabetes and obesity prevalence, diabetes mortality rate, indigenous population, economically active population, density of economic units that operate essential activities, and population density. Among factors inversely associated with lower MRs from COVID-19 were high hypertension prevalence and houses without sewage drainage. We identified 1351 municipalities without confirmed COVID-19 deaths, of which, 202 had high and 82 very high expected COVID-19 mortality (mean = 8 and 13.8 deaths per 100,000, respectively). This study identified municipalities of Mexico that could lead to a high mortality scenario later in the epidemic and warns against premature easing of mobility restrictions and to reinforce strategies of prevention and control of outbreaks in communities vulnerable to COVID-19.
Highlights
The first case of the new coronavirus disease 2019 (COVID-19) in Mexico was confirmed on February 28, 2020.1 Since the Government of Mexico has launched a series of preventive measures that adhere to the World Health Organization (WHO) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strategic preparedness and response plan aimed at limiting the spread of the virus.[2]
A confirmed case of COVID-19 is defined as a person with a diagnosis given by the National Network of Public Health Laboratories recognized by the Institute of Epidemiological Diagnosis and Reference (InDRE) who met the criteria of a suspected case.[15]
We identified 1351 municipality levels without COVID-19 deaths reported in symptomatic cases, which according to its characteristics, 202 had high and 82 very high Expected MRs (EMRs) from COVID-19
Summary
Coronavirus pandemic surveillance in Mexico has been carried out using the Sentinel model proposed by the Pan American Health Organization (PAHO),[13] implemented in the country in 2019 for the H1N1 pandemic. This model works with 475 nationally representative health facilities that monitor coronavirus cases through testing for SARS-CoV-2, conducted in 10% of suspected cases and 100% of those suspected with SARS and signs of breathing difficulty, or in deaths of those hospitalized suspected to be COVID-19 cases.
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