COVID-19 Mortality In Colombia Research Articles

Association between the Multidimensional Poverty Measure and COVID-19 mortality in Colombia

Abstract Background Different socioeconomic aspects have been related to mortality from COVID-19. For this reason, the objective of this study was to analyze the association between the Multidimensional Poverty Measure at the municipal level (MPM) and the clinical outcome of mortality in the resident population of Colombia with a diagnosis of COVID-19. Methods Observational, non-concurrent cohort study of confirmed cases of COVID-19 reported in Colombia by August 2021. The main outcome variable was mortality from COVID-19, and the main exposure variable was MPM. The covariates included in the analysis were patient's sex, age, and municipality of residence. Unadjusted and adjusted logistic models were used using balanced random samples of deaths and recovered patients, calculating odds ratios (OR) and 95% confidence interval ranges (CI). Results In total, 4,194,538 cases of COVID-19 were included in the analysis, of which approximately 3% died. According to the adjusted multivariate analysis, it was found that patients who live in municipalities with an MPM between 20 to 40%, 41 to 60%, 61 to 80% and more than 80% had an OR of 1.6 (95% CI 1.4 to 1.8), 1.6 (95% CI 1.3 to 1.9), 1.7 (95% CI 1.2 to 2.5), and 2.2 (95% CI 0.7 to 7.8), respectively, for mortality from COVID-19 compared with an MPM of less than 20%. When analyzing the data according to sex for the MPM from 20 to 40%, 41 to 60%, 61 to 80% and more than 80%, an OR for women of 1.7 (95% CI 1.5 to 2.0), 1.8 (95% CI % 1.5 to 2.1), 1.9 (95% CI 1.3 to 2.6) and 2.8 (CI 0.9 to 10.1) respectively. For men an OR of 1.5 (95% CI 1.3 to 1.7), 1.4 (95% CI 1.2 to 1.7), 1.6 (95% CI 1.1 to 2.3) and 1.9 (95% CI 0.6 to 6.0) respectively compared to a MPM less than 20%. Conclusions The risk of mortality from COVID-19 in Colombia is increased in populations with higher MPM. Social determinants of health have an important effect on the outcomes of COVID-19. Key messages

Health Insurance Scheme: Main Contributor to Inequalities in COVID-19 Mortality in Colombia.

Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies. (Am J Public Health. 2022;112(S6):S586-S590. https://doi.org/10.2105/AJPH.2021.306637).

Chronic exposure to PM2.5 and COVID-19 mortality during the first year of the epidemic in Colombia: an ecological study

BACKGROUND AND AIM: The objective was to determine the association between chronic exposure to fine particulate matter (PM2.5) and COVID-19 mortality in Colombia. METHODS: Ecological study using data at the municipality level, as units of analysis. COVID-19 data were obtained from official reports up to and including March 6th, 2021. PM2.5 long-term exposure was defined as the 2014-2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fit a negative binomial model for the mortality rate adjusting for sociodemographic and health conditions. RESULTS:Estimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in the model. We found that having 10% or more of the population over 65 years of age (MRR=1.16 95%CI 1.00-1.35), and the percentage of urban population (MRR=1.01 95%CI 1.01-1.01) are the main demographic factors associated with death rate at the municipality level. The poverty index and prevalence of chronic diseases, which were associated with COVID-19 mortality during the first months of the epidemic, are no longer statistically significant. CONCLUSIONS:There was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics did have evidence of an ecological effect on COVID-19 mortality. KEYWORDS: Air Pollution, Particulate Matter, Lon-term exposure, Mortality, Other (COVID-19)

Air pollution, sociodemographic and health conditions effects on COVID-19 mortality in Colombia: An ecological study

ObjectiveThe present study aimed to determine the association between chronic exposure to fine particulate matter (PM2.5), sociodemographic aspects, and health conditions with COVID-19 mortality in Colombia. MethodsWe performed an ecological study using data at the municipality level. We used COVID-19 data obtained from government public reports up to and including July 17th, 2020. We defined PM2.5 long-term exposure as the 2014–2018 average of the estimated concentrations at municipalities obtained from the Copernicus Atmospheric Monitoring Service Reanalysis (CAMSRA) model. We fitted a logit-negative binomial hurdle model for the mortality rate adjusting for sociodemographic and health conditions. ResultsEstimated mortality rate ratios (MRR) for long-term average PM2.5 were not statistically significant in either of the two components of the hurdle model (i.e., the likelihood of reporting at least one death or the count of fatal cases). We found that having 10% or more of the population over 65 years of age (MRR = 3.91 95%CI 2.24–6.81), the poverty index (MRR = 1.03 95%CI 1.01–1.05), and the prevalence of hypertension over 6% (MRR = 1.32 95%CI1.03–1.68) are the main factors associated with death rate at the municipality level. Having higher hospital beds capacity is inversely correlated to mortality. ConclusionsThere was no evidence of an association between long-term exposure to PM2.5 and COVID-19 mortality rate at the municipality level in Colombia. Demographics, health system capacity, and social conditions did have evidence of an ecological effect on COVID-19 mortality. The use of model-based estimations of long-term PM2.5 exposure includes an undetermined level of uncertainty in the results, and therefore they should be interpreted as preliminary evidence.