{"id":38225,"date":"2021-03-30T11:58:03","date_gmt":"2021-03-30T11:58:03","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=38225"},"modified":"2021-04-09T11:31:16","modified_gmt":"2021-04-09T11:31:16","slug":"effect-of-co-morbidities-on-mortality-from-covid-19-in-mexico-an-ecological-study","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol14no1\/effect-of-co-morbidities-on-mortality-from-covid-19-in-mexico-an-ecological-study\/","title":{"rendered":"Effect of Co-Morbidities on Mortality from COVID-19 in Mexico: an Ecological Study"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

In early December 2019, cases of pneumonia of unknown cause occurred, and affected people worked or went to the local Huanan seafood market in Wuhan, Hubei Province, China1-4<\/sup>; as of December 31th<\/sup>, 2019, a case of unknown pneumonia was reported to the World Health Organization (WHO) office in Whuan, China5<\/sup>.On January 10th<\/sup>, 2020, the\u00a0first death occurred in China due to this infection\u00a06<\/sup>. The outbreak is declared a Public Health emergency of international interest on January 30th<\/sup>, 20206<\/sup>.On February 7th<\/sup>, 2020 it was reported that the cause of idiopathic pneumonia was a new corona virus and the WHO called it 2019-n CoV and later it was called SARS-CoV-27<\/sup> and the disease caused by the\u00a0coronavirus was called COVID -19 on February 11th<\/sup>, 20205<\/sup>.After a month, the virus was isolated, its genome was sequenced and its morphology was described; on January 12th<\/sup>, 2020, the virus genome was shared with WHO by the Chinese Center for Disease Control and Prevention8<\/sup>. Zhou et al.9<\/sup>, reported that the causer of COVID-19 shares 79.5% of the\u00a0SARS-CoV sequence; also, it uses the same cell entry receptor, angiotensin-converting enzyme-2, as SARS-CoV.<\/p>\n

Zhu e t al.10<\/sup>, reported the cytopathic effects and morphology and it is a member of a family of corona viruses that infect humans; grew more in human airway epithelial cells than tissue culture cells, suggesting the potential for increased infectivity. COVID-19 patients who present with a comorbid condition may have an increased risk of deterioration and should therefore be admitted to a designated unit for close monitoring in accordance with the WHO guidelines for screening and triage\u00a011<\/sup>.<\/p>\n

In a series of 41 patients infected with SASR-CoV-2, 32% had some underlying pathology, diabetes 20%, hypertension 15%, cardiovascular disease 15%, chronic obstructive pulmonary disease (COPD) 2%12<\/sup>.<\/p>\n

The objective was to compare deaths from confirmed and discarded cases of COVID-19, as well as to analyze the effect of co-morbidities on deaths of patients with COVID-19.<\/p>\n

Material and methods<\/strong><\/p>\n

A Cross-sectional study in the Mexican population is designed, with data published by the General Directorate of Epidemiology and the National Epidemiological Surveillance System of the Ministry of Health on May 6th<\/sup>, 202013<\/sup>.<\/p>\n

Where analyzed all registries published by Secretary of Health in Mexico, with confirmed and discarded cases of COVID-19.<\/p>\n

Registries with not full data were eliminated from analysis.<\/p>\n

Data were collected on age, gender, symptom onset date, RT-PCR test result, date of death, if applicable, as well as associated factors or diseases (smoking, obesity, pneumonia, cardiovascular disease, asthma, COPD, diabetes, hypertension, chronic kidney disease. Immuno suppression)13<\/sup>.<\/p>\n

A suspected case is a patient who, in the previous 14 days, has presented fever and \/ or cough, headache, myoarthralgia, dyspnea and has had contact with a confirmed case or has traveled to China, Europe or the USA and becomes confirmed when in addition of the\u00a0above, it presents positive RT-PCR test14<\/sup>.To establish whether the case was confirmed or ruled out, it was based on the result of the RT-PCR, recommended by the WHO15<\/sup>.<\/p>\n

For the statistical analysis, variables were crossed with confirmed cases and discarded cases, associated diseases and deaths. Odds Ratios (OR) and 95% confidence intervals were calculated to find an effect between gender, underlying pathologies and the possibility of\u00a0dying.Logistic regression models were designed for death and being a case of COVID-19, as well as death and not being a case for COVID-19, adjusted by age group and sex, for each of the morbidities . Statistical analysis was performed on STATA \u00ae 13.0 (Stata Corp.,\u00a0 College Station, TX, USA).<\/p>\n

Results and discussion<\/strong><\/p>\n

The sample of public records of confirmed and discarded cases of the General Directorate of Epidemiology, of the National System of Epidemiological Surveillance of the Ministry of Health of Mexico, was made up of 134, 663 records of which 45,032 (33.44%) were confirmed cases and 89,631 (66.56%) were negative for the RT-PCR test13<\/sup>.<\/p>\n

For confirmed cases 27,634 (29.57%) the age range was from 0 to 113 years with a mean of 46.72 \u00b1 15.62 years; for 65,807 (70.43%) discarded cases, the age range was from 0 to 110 years with a mean of 39.92 \u00b1 17.62 years (t = 55.63, degrees of freedom 93439, P<\/em> = .00001).<\/p>\n

Table 1 shows the distribution by age group, gender of confirmed cases and discarded cases caused by SARS-CoV-2. For both gender and age groups, there are significant differences between cases with no cases of COVID-19.<\/p>\n

Table 1: Distribution by confirmed and non-cases of COVID-19 in Mexico, until May 6, 2020 (n=93,341).<\/strong><\/p>\n\n\n\n\n\n
Variable<\/strong><\/td>\nConfirmed cases (n=27,634)<\/strong><\/p>\n

n\u00a0\u00a0\u00a0 %<\/strong><\/td>\n

Non-cases (65,807)<\/strong><\/p>\n

\u00a0<\/strong>n (%)<\/strong><\/td>\n<\/tr>\n

\n

Gender<\/strong><\/p>\n

\u00a0\u00a0\u00a0 Female<\/p>\n

\u00a0\u00a0\u00a0 Male<\/p>\n

\u00a0 \u00a0 Total<\/strong><\/p>\n<\/td>\n

 <\/p>\n

11,475 (41.52)<\/p>\n

16,159(58.48)<\/p>\n

27,634(100.0)<\/strong><\/td>\n

 <\/p>\n

34,588 (52.56)<\/p>\n

31,219 (47.44)<\/p>\n

65,807(100.0)<\/strong><\/td>\n<\/tr>\n

\n

Age group (years)<\/strong><\/p>\n

\u00a0\u00a0 0 to 5<\/p>\n

\u00a0\u00a0 6 to 11<\/p>\n

\u00a0\u00a0 12 to 19<\/p>\n

\u00a0\u00a0 20 to 59<\/p>\n

\u00a0\u00a0 60 and higher<\/p>\n

Total<\/strong><\/p>\n<\/td>\n

 <\/p>\n

150 (0.54)<\/p>\n

129(0.47)<\/p>\n

335 (1.21)<\/p>\n

21,247(76.89)<\/p>\n

5,773(20.89)<\/p>\n

27,634 (100.0)<\/strong><\/td>\n

 <\/p>\n

2,361 (3.59)<\/p>\n

1,265 (1.92)<\/p>\n

2,210 (3.36)<\/p>\n

51,195 (77.80)<\/p>\n

8,776 (13.34)<\/p>\n

65,807 (100.0)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Secretary of Health13<\/sup><\/p>\n

Table 2 shows the deaths between confirmed cases and discarded cases; the specific fatality rate for COVID-19 was 9.79%; Among the discarded cases, 1.93% of deaths were registered.<\/p>\n

Table 2: Distribution of deaths among cases and non-cases of COVID-19, until May 6, 2020 (n=93,341).<\/strong><\/p>\n\n\n\n\n
\u00a0Variable<\/strong><\/td>\nConfirmed cases (n=27,634)<\/strong><\/p>\n

n\u00a0\u00a0\u00a0 %<\/strong><\/td>\n

Non-cases (65,807)<\/strong><\/p>\n

\u00a0<\/strong>n (%)<\/strong><\/td>\n

Chi-squared test (df)<\/strong><\/td>\nP<\/em><\/strong>-value<\/strong><\/td>\n<\/tr>\n
\n

Deaths<\/strong><\/p>\n

\u00a0 \u00a0 Yes<\/p>\n

\u00a0\u00a0 No<\/p>\n

Total<\/strong><\/p>\n<\/td>\n

 <\/p>\n

2,704 (9.79)<\/p>\n

24,930(90.21)<\/p>\n

27,634\u00a0 (100.0)<\/td>\n

 <\/p>\n

1,269 (1.93)<\/p>\n

64,538 (98.07)<\/p>\n

65,807\u00a0 (100.0)<\/td>\n

3003 (1)<\/td>\n.0001<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Secretary of Health13<\/sup><\/p>\n

Among the deceased with a confirmed diagnosis of SARS-CoV-2, men predominated (68.31%) and in both groups, being a woman was a preventive factor of death in up to 37% (Table 3). By age group, deaths between 20-59 years (50.55%) and 60 or older (49.11%) predominated; in the discarded cases, deaths predominated in men (67.37%) with ages 60 or older (57.37%). (Table 3).<\/p>\n

Table 3: Distribution of deaths by confirmed cases and non-cases of COVID-19, by gender and age group on Mexico, until May 6, 2020.<\/strong><\/p>\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\nConfirmed cases COVID-19 (n=27,634)<\/strong><\/td>\nNon-cases COVID-19 (65,807)<\/strong><\/td>\n<\/tr>\n
Variable\u00a0<\/strong><\/td>\nDeaths<\/strong><\/p>\n

n%<\/strong><\/td>\n

Non-deaths<\/strong><\/p>\n

n%<\/strong><\/td>\n

Deaths<\/strong><\/p>\n

n%<\/strong><\/td>\n

Non- deaths<\/strong><\/p>\n

n%<\/strong><\/td>\n<\/tr>\n

Gender<\/strong><\/p>\n

Females<\/p>\n

Male<\/p>\n

Total<\/strong><\/td>\n

 <\/p>\n

857 31.69<\/p>\n

1,847 68.31<\/p>\n

2,704\u00a0 100.0<\/td>\n

 <\/p>\n

10,61842.59<\/p>\n

14,31257.41<\/p>\n

24,930\u00a0 100.0<\/td>\n

 <\/p>\n

54142.63<\/p>\n

72857.37<\/p>\n

1,269100.0<\/td>\n

 <\/p>\n

34,04752.67<\/p>\n

30,49147.33<\/p>\n

64,538 100.0<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n0.63 (0.57 to 0.68)<\/td>\n0.67 (0.59 to 0.74)<\/td>\n<\/tr>\n
Age group (years)<\/strong><\/p>\n

0 \u2013 5<\/p>\n

6-11<\/p>\n

12-19<\/p>\n

20-59<\/p>\n

60 or higher<\/p>\n

Total<\/strong><\/td>\n

 <\/p>\n

8 0.30<\/p>\n

0\u00a0 0<\/p>\n

10.04<\/p>\n

1,367 50.55<\/p>\n

1,328 49.11<\/p>\n

2,704100.0<\/td>\n

 <\/p>\n

1420.57<\/p>\n

1290.52<\/p>\n

3341.34<\/p>\n

19,88079.74<\/p>\n

4,44517.83<\/p>\n

24,930 100.0<\/td>\n

 <\/p>\n

49 3.86<\/p>\n

120.95<\/p>\n

25 1.97<\/p>\n

492 38.77<\/p>\n

691 54.45<\/p>\n

1,269 100.0<\/td>\n

 <\/p>\n

2,3123.58<\/p>\n

1,2531.94<\/p>\n

2,1853.39<\/p>\n

50,70378.56<\/p>\n

8,085\u00a0 12.53<\/p>\n

64,538\u00a0 100.0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Secretary of Health13<\/sup><\/p>\n

When analyzing the co-morbidities, the records were eliminated because they did not know if they suffered from the associated diseases: Table 4 summarized the number of patients with missing data for each disease analyzed in this study.<\/p>\n

Table 4: Missing data in co-morbidities and whether confirmed COVID-19 patients in Mexican Sample from the start until May 6th<\/sup>, 2020.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

\u00a0\u00a0Variable<\/strong><\/p>\n<\/td>\n

Confirmed COVID-19<\/strong><\/p>\n

patients <\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Non-confirmed COVID-19<\/strong><\/p>\n

patients <\/strong><\/td>\n<\/tr>\n

Diabetes<\/td>\n262<\/td>\n135<\/td>\n<\/tr>\n
Hypertension<\/td>\n257<\/td>\n123<\/td>\n<\/tr>\n
COPD<\/td>\n259<\/td>\n125<\/td>\n<\/tr>\n
Asthma<\/td>\n267<\/td>\n119<\/td>\n<\/tr>\n
Cardiovascular disease<\/td>\n265<\/td>\n125<\/td>\n<\/tr>\n
Immunosuppression<\/td>\n263<\/td>\n140<\/td>\n<\/tr>\n
Chronic kidney disease<\/td>\n270<\/td>\n112<\/td>\n<\/tr>\n
Smoking<\/td>\n257<\/td>\n125<\/td>\n<\/tr>\n
Obesity,<\/td>\n247<\/td>\n99<\/td>\n<\/tr>\n
Pneumonia<\/td>\n2<\/td>\n7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Secretary of Health13<\/sup><\/p>\n

OR for the association between deaths and co-morbidities, it is reported that those who died from COVID-19 were three times more likely to have had diabetes, hypertension, COPD and chronic kidney disease; for cardiovascular disease, immuno suppression and obesity, the\u00a0 OR were less than 3, but continue to show an effect of these pathologies on death. For smoking, the effect was almost null on death (Table 5).<\/p>\n

Asthma prevented death in confirmed cases (18%)\u00a0 and non-cases (47%) (Table 5).<\/p>\n

Regarding the discarded cases of COVID-19, the OR between diabetes, hypertension, COPD, cardiovascular disease, pneumonia, immuno suppression, chronic kidney disease, obesity and smoking, in all cases an effect of pathologies on the possibility is detected. of death and much higher the OR than those obtained in the cases (Table 5).<\/p>\n

Table 5: Distribution of deaths by cases and non-cases of COVID-19, by co-morbidities in Mexico.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\nConfirmed cases COVID-19 (n=27,634)<\/strong><\/td>\nNon-cases COVID-19 (65,807)<\/strong><\/td>\n<\/tr>\n
\u00a0<\/strong><\/td>\nDeaths<\/strong><\/p>\n

n\u00a0 %<\/strong><\/td>\n

Non-deaths<\/strong><\/p>\n

n\u00a0 %<\/strong><\/td>\n

Deaths<\/strong><\/p>\n

n\u00a0 %<\/strong><\/td>\n

Non- deaths<\/strong><\/p>\n

n\u00a0 %<\/strong><\/td>\n<\/tr>\n

Diabetes<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

1,075\u00a0 40.07<\/p>\n

1,608\u00a0 59.93<\/td>\n

 <\/p>\n

4,116 16.67<\/p>\n

20,57383.33<\/td>\n

 <\/p>\n

511\u00a0 49.78<\/p>\n

742\u00a0 50.22<\/td>\n

 <\/p>\n

6,737\u00a0 10.46<\/p>\n

57,682\u00a0 89.54<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n3.34 (IC95%3.07 to 3.63)<\/td>\n5.90 (5.25 to 6.62)<\/td>\n<\/tr>\n
Hypertension<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

1,173\u00a0 45.70<\/p>\n

1,511\u00a0 54.30<\/td>\n

 <\/p>\n

4,896\u00a0\u00a0\u00a0 10.83<\/p>\n

19,797\u00a0 89.17<\/td>\n

 <\/p>\n

548\u00a0 20.48<\/p>\n

708\u00a0 79.52<\/td>\n

 <\/p>\n

9,672\u00a0\u00a0\u00a0 15.01<\/p>\n

54,756\u00a0 84.99<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n3.14 (2.89 to 3.41)<\/td>\n4.38 (3.91 to 4.91)<\/td>\n<\/tr>\n
COPD<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

1825.67<\/p>\n

2,501\u00a0 94.33<\/td>\n

 <\/p>\n

499\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2.02<\/p>\n

24,193\u00a0 97.98<\/td>\n

 <\/p>\n

163\u00a0\u00a0\u00a0\u00a0 13.02<\/p>\n

1,089\u00a0 86.98<\/td>\n

 <\/p>\n

1,558\u00a0\u00a0\u00a0\u00a0\u00a0 2.42<\/p>\n

62,872\u00a0 97.58<\/td>\n<\/tr>\n

OR (CI95)<\/td>\n3.53 (2.96 to 4.20)<\/td>\n6.04 (5.09 to 7.17)<\/td>\n<\/tr>\n
Asthma<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

75\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 2.80<\/p>\n

2,606\u00a0 97.20<\/td>\n

 <\/p>\n

841\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.41<\/p>\n

23,845\u00a0 96.59<\/td>\n

 <\/p>\n

166\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a06.20<\/p>\n

2,513\u00a0 93.80<\/td>\n

 <\/p>\n

1,948\u00a0\u00a0\u00a0\u00a0\u00a0 3.02<\/p>\n

62,479\u00a0 96.98<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n0.82 (0.64 to 1.03)<\/td>\n0.53 (0.38 to 0.74)<\/td>\n<\/tr>\n
Cardiovascular disease<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

166\u00a0\u00a0\u00a0\u00a0\u00a0 6.20<\/p>\n

2,513\u00a0 93.80<\/td>\n

 <\/p>\n

6272.54<\/p>\n

24,063\u00a0 97.46<\/td>\n

 <\/p>\n

164\u00a0\u00a0\u00a0\u00a0 13.07<\/p>\n

1,091\u00a0 86.93<\/td>\n

 <\/p>\n

1,948\u00a0\u00a0\u00a0\u00a0\u00a0 3.02<\/p>\n

62,479\u00a0 96.98<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n2.54 (2.13 to 3.02)<\/td>\n4.82 (4.07 to 5.72<\/td>\n<\/tr>\n
Pneumonia<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

2,008\u00a0 74.26<\/p>\n

696\u00a0\u00a0\u00a0\u00a0 25.74<\/td>\n

 <\/p>\n

6,374\u00a0\u00a0\u00a0 25.57<\/p>\n

18,554\u00a0 74.43<\/td>\n

 <\/p>\n

879\u00a0\u00a0 69.27<\/p>\n

390\u00a0 30.73<\/td>\n

 <\/p>\n

7,676\u00a0\u00a0\u00a0 11.90<\/p>\n

56,855\u00a0 88.10<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n8.67 (7.92 to 9.50)<\/td>\n16.69 (14.78 to 18.85)<\/td>\n<\/tr>\n
Immunopression<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

100\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 3.73<\/p>\n

2,581\u00a0 96.27<\/td>\n

 <\/p>\n

387\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 1.63<\/p>\n

23,303\u00a0 98.37<\/td>\n

 <\/p>\n

122\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 9.76<\/p>\n

1,128\u00a0 90.24<\/td>\n

 <\/p>\n

1,666\u00a0\u00a0\u00a0\u00a0 2.59<\/p>\n

62,751\u00a0 97.41<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n2.43 (1.95 to 3.04)<\/td>\n7.13 (6.02 to 8.46)<\/td>\n<\/tr>\n
Chronic kidney disease<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

196\u00a0 7.31<\/p>\n

2,484\u00a0 92.69<\/td>\n

 <\/p>\n

514\u00a0 2.08<\/p>\n

24,170\u00a0 97.92<\/td>\n

 <\/p>\n

170\u00a0 13.50<\/p>\n

1,089 86.50<\/td>\n

 <\/p>\n

1,380\u00a0 2.14<\/p>\n

63,056\u00a0 97.86<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n3.71 (3.13 to 4.40)<\/td>\n1.29 (1.09 to 1.52)<\/td>\n<\/tr>\n
Obesity<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

801\u00a0\u00a0\u00a0\u00a0 29.82<\/p>\n

1,885\u00a0 70.18<\/td>\n

 <\/p>\n

5,019\u00a0\u00a0\u00a0 20.32<\/p>\n

19,682\u00a0 79.68<\/td>\n

 <\/p>\n

241 19.13<\/p>\n

1,019\u00a0 80.87<\/td>\n

 <\/p>\n

9,141\u00a0\u00a0\u00a0 14.18<\/p>\n

55,307\u00a0 85.82<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n1.67 (1.53 to 1.82)<\/td>\n1.43 (1.24 to 1.65)<\/td>\n<\/tr>\n
Smoking<\/p>\n

Yes<\/p>\n

No<\/td>\n

 <\/p>\n

245\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 9.14<\/p>\n

2,435\u00a0 90.86<\/td>\n

 <\/p>\n

2,186\u00a0\u00a0\u00a0\u00a0 8.85<\/p>\n

22,511\u00a0 91.15<\/td>\n

 <\/p>\n

159\u00a0\u00a0\u00a0\u00a0 12,69<\/p>\n

1,094\u00a0 87.31<\/td>\n

 <\/p>\n

6,535\u00a0\u00a0\u00a0 10.14<\/p>\n

57,894\u00a0 89.86<\/td>\n<\/tr>\n

OR (CI95%)<\/td>\n1.04 (0.90 to 1.19)<\/td>\n1.29 (1.09 to 1.52)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Secretary of Health13<\/sup><\/p>\n

With the logistic regression model, for confirmed cases with diabetes, the age group acted as a confounder, an effect that was not found for gender, a similar result for the discarded\u00a0cases.Similar results for hypertension, chronic obstructive pulmonary disease, cardiovascular disease, pneumonia, immuno suppression, chronic kidney disease. Obesity\u00a0had a slight effect on mortality in confirmed cases and discarded cases; Smoking had virtually no effect on deaths (Table 6).<\/p>\n

Table 6: OR crude and adjusted of mortality and co-morbidities, by age group and gender among cases COVID-19 and non-cases in Mexico.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Co-morbilities<\/td>\nOR crude<\/p>\n

(CI95%)<\/td>\n

OR<\/p>\n

adjusted by agegroup<\/p>\n

(CI95%)<\/td>\n

OR<\/p>\n

adjusted by gender<\/p>\n

(CI95%)<\/td>\n<\/tr>\n

Diabetes<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

3.34 (3.07 to 3.63)<\/p>\n

5.89 (5.25 to 6.62)<\/td>\n

 <\/p>\n

2.39 (2.18 to 2.61)<\/p>\n

3.78 (3.33 to 4.29)<\/td>\n

 <\/p>\n

3.34 (3.07 to 3.63)<\/p>\n

5.89 (5.25 to 6.62)<\/td>\n<\/tr>\n

Hypertension<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

3.14 (2,89 to 3.41)<\/p>\n

4.38 (3.91 to 4.91)<\/td>\n

 <\/p>\n

2.09 (1.91 to 2.28)<\/p>\n

2.68 (2.36 to 3.04)<\/td>\n

 <\/p>\n

3.17 (2.92 to 3.44)<\/p>\n

4.35 ( 3.89 to 4.88)<\/td>\n<\/tr>\n

COPD<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

3.53 (2.96 to 4.20)<\/p>\n

6.04 (5.09 to 7.57<\/td>\n

 <\/p>\n

1.92 (1.60 to 2.31)<\/p>\n

2.71 (2.25 to 3.27)<\/td>\n

 <\/p>\n

3.65 (3.06 to 4.35)<\/p>\n

5.97 (5.03 to 7.10)<\/td>\n<\/tr>\n

Asthma<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

0.53 (0.38 to 0.74)<\/p>\n

0.82(0.64 to 1.04)<\/td>\n

 <\/p>\n

0.57 (0.40 to 0.80)<\/p>\n

0.92 (0.72 to 1.18)<\/td>\n

 <\/p>\n

0.55 (0.39 to 0.77)<\/p>\n

0.88 (0.69 to 1.12)<\/td>\n<\/tr>\n

Cradiovascular disease<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

 <\/p>\n

2.54 (2.13 to 3.02)<\/p>\n

4.82 (4.07 to 5.72)<\/td>\n

 <\/p>\n

 <\/p>\n

1.52 (1.26 to 1.82)<\/p>\n

2.73 (2.28 to 3.26)<\/td>\n

 <\/p>\n

 <\/p>\n

2.53 (2.12 to 3.02)<\/p>\n

4.74 (4.00 to 5.63)<\/td>\n<\/tr>\n

Pneumonia<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

8.40 (7.67 to 9.20)<\/p>\n

16.69 (14.78 to 18.85)<\/td>\n

 <\/p>\n

6.68 (6.17 to 7.44)<\/p>\n

14.24 (12.56 to 16.15)<\/td>\n

 <\/p>\n

8.18 (7.47 to 8.96)<\/p>\n

16.40 (14.51 to 18.52)<\/td>\n<\/tr>\n

Immunosuppression<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

2.43 (1.95 to 3.04)<\/p>\n

4.07 (3.36 to 4.94)<\/td>\n

 <\/p>\n

2.15 (1.70 to 2.72)<\/p>\n

3.32 (2.73 to 4.05)<\/td>\n

 <\/p>\n

2.49 (1.99 to 3.12)<\/p>\n

4.09 (3.37 to 4.96)<\/td>\n<\/tr>\n

Chronic kidney disease<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

 <\/p>\n

3.71 (3.13 to 3.13)<\/p>\n

7.13 (6.02 to 8.46)<\/td>\n

 <\/p>\n

 <\/p>\n

2.72 (2.27 to 3.25)<\/p>\n

4.38 (3.67 to 5.24)<\/td>\n

 <\/p>\n

 <\/p>\n

3.67 (3.10 to 4.36)<\/td>\n<\/tr>\n

Obesity<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

1.67 (1.53 to 1.82)<\/p>\n

1.43 (1.24 to 1.65)<\/td>\n

 <\/p>\n

1.72 (1.57 to 1.88)<\/p>\n

1.27 (1.10 to 1.47)<\/td>\n

 <\/p>\n

1.69 (1.55 to 1.85)<\/p>\n

1.46 (1.26 to 1.68)<\/td>\n<\/tr>\n

Smoking<\/p>\n

Cases COVID-19<\/p>\n

Non-cases<\/td>\n

 <\/p>\n

1.04 (0.90 to 1.19)<\/p>\n

1.29 (1.09 to 1.52)<\/td>\n

 <\/p>\n

0.99 (0.86 to 1.48)<\/p>\n

1.13 (0.95 to 1.34)<\/td>\n

 <\/p>\n

0.96 (0.83 to 1.10)<\/p>\n

1.20 (1.02 to 1.42)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Source: Analysis of data of Secretary of Health13<\/sup><\/p>\n

The samples reported as confirmed cases of COVID-19 were 27,634 with 2,704 deaths, with a specific rate of 9.79%. COVID-19 deaths predominated in men ages 20 to 59 and those aged 60 or older. Globally, the WHO reported a mortality from COVID-19 of 6.34%16<\/sup>.<\/p>\n

According to the same WHO report, Italy had a specific mortality rate of 12-80%, the United Kingdom of 12.78%, Spain 10.3%, the United States of America, 3.97% and Brazil of 2.96%16<\/sup>.<\/p>\n

The case-specific mortality in Mexico was 9.79% and according to the WHO report of May 6th<\/sup>, 2020, overall the case-specific mortality was 6.9%, for the Americas region it was 5.38% and for Europe 9.3 %17<\/sup>.<\/p>\n

There is currently evidence that mortality rates are higher in men than in women, as indicated by the Italian Institute of Health in one of its reports, where of 23,188 deaths, approximately 70% of these were men, as well as in China and South Korea18<\/sup>. In Mexico, mortality was higher in men (68.31%) than in women (Table 2 and 3).<\/p>\n

The incidence of SARS-CoV-2 infection has been seen to be more frequent in adult male patients between the ages of 34 and 59, and it has also been observed that people 60 years\u00a0of age or older and with comorbidities represent severe cases that may present coinfections\u00a019<\/sup>. Among the confirmed cases in Mexico, mortality between 20 and 59 years was 50.55% and 49,115 in those over 60 years of age (Table 3).<\/p>\n

In the United States, the National Center for Health Statistics, until May 9th<\/sup>, 2020 reports that patients with comorbidities of all ages are 49,770; stratifying each comorbidity and reporting a specific mortality of 14.27% in people with diabetes, 7.34% for kidney failure, 43.41% for pneumonia, 3.45% for cardiovascular disease, 7.72% for COPD, 2.65% for\u00a0obesity and 20.22% for hypertension20<\/sup>. In Mexico, among the confirmed cases of diabetes, mortality was 40.07; 45.70% among those with hypertension, 74.26% in those with pneumonia, 29.82% in those with obesity, 9.14% among smokers 6.20% among those with\u00a0cardiovascular disease, 7.31% among those who reported chronic kidney disease, 5.67% among those with COPD 3.73% among those with some type of immuno suppression and 2.80% among those with asthma (Table 5). In general, the specific death rate from co-morbidities was higher than that reported in the USA.<\/p>\n

Of the discarded cases of COVID-19 they had an overall mortality of 1.93%13<\/sup>. One explanation for the higher OR\u2019s for the pathologies included in this analysis, among the discarded cases of having COVID-19, is that they all had a respiratory condition that made\u00a0them consider themselves suspected of being infected with SARS-CoV-2.<\/p>\n

Conclusion<\/strong><\/p>\n

Mortality in Mexico among confirmed cases of COVID-19 is higher for adult men, over 20 years and older adults. Regarding the underlying pathologies, mortality was higher in Mexico than in other affected countries.In this population it was three times more likely to die having diabetes and confirmed COVID 19 and six times more likely to die by having\u00a0diabetes but not confirmed for COVID-19. same for other pathologies except asthma.<\/p>\n

Conflict of interest.<\/strong><\/p>\n

Nothing to declare<\/p>\n

Funding source<\/strong><\/p>\n

No one<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol<\/em>. 2020;92(4):401-402. Doi: https:\/\/doi.org\/10.1002\/jmv.25678.
    \nCrossRef<\/a><\/li>\n
  2. Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al.The continuing 2019-nCoV epidemic threatof novel coronaviruses to global health \u2013 the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis.<\/em> 2020; 91: 264-66 Doi: https:\/\/doi.org\/10.1016\/j.ijid.2020.01.009
    \n    CrossRef<\/a><\/li>\n
  3. Huang C, Wang Y, Li X, Ren L, Zhao J, Yi Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet<\/em>. 2020;395(10223):497-506\u00a0\u00a0\u00a0 Doi: https:\/\/doi.org\/10.1016\/S0140-6736(20)30183-5
    \n    CrossRef<\/a><\/li>\n
  4. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet<\/em>. 2020;395(10223):507-13 https:\/\/doi.org\/10.1016\/S0140-6736(20)30211-7
    \n    CrossRef<\/a><\/li>\n
  5. World Health Organization. Rolling updates on coronavirus disease (COVID-19). Updated 7 May 2020. Available in: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/events-as-they-happen<\/li>\n
  6. Yoo JH, Hong ST. The outbreak caseswith the novel coronavirus suggest upgraded quarantine and isolation in Korea. J Korean Med Sci.<\/em> 2020;35(5): e62 Doi: https:\/\/doi.org\/10.3346\/jkms.2020.35.e62
    \n    CrossRef<\/a><\/li>\n
  7. Carlos WG, Dela Cruz C, Cao B, Pasnick S, Jamil S, Novel Wuhan (2019-CoV) coronavirus. Am J RespiCrit Care Med<\/em> 2020;201(4):7-8 Doi: https:\/\/doi.org\/10.1164\/rccm.2014P7
    \n    CrossRef<\/a><\/li>\n
  8. Zhang Y, Ku J, Li H, Cao B. A novel coronavirus (COVID-19) outbreak. A call for action. Chest.<\/em> 2020;157<\/strong>(4):e99-e101. Doi: https:\/\/doi.org\/10.1016\/j.chest.2020.02.014
    \n    CrossRef<\/a><\/li>\n
  9. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature<\/em>. 2020;579:270-3. https:\/\/doi.org\/10.1038\/s41586-020-2012-7
    \n    CrossRef<\/a><\/li>\n
  10. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med<\/em> 2020; 382:727:37. Doi: https:\/\/doi.org\/10.1056\/NEJMoa2001017
    \n    CrossRef<\/a><\/li>\n
  11. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected. Interim guidannce, 2020. Available in: https:\/\/www.who.int\/publications-detail\/clinical-management-ofsevere-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
    \n    CrossRef<\/a><\/li>\n
  12. Huang C, WuangY, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Whuan, China. The Lancet.<\/em> 2020; 395(10223):497-506 Doi: https:\/\/doi.org\/10.1016\/S0140-6736(20)30183-5
    \n    CrossRef<\/a><\/li>\n
  13. Secretar\u00eda de Salud. Datos-Abiertos Bases hist\u00f3ricas. 6 mayo 2020. Available in:https:\/\/www.gob.mx\/salud\/documentos\/datos-abiertos-bases-historicas-direccion-general-de-epidemiologia<\/li>\n
  14. Direcci\u00f3n General de Epidemiolog\u00eda. Secretar\u00eda de Salud. AE-Enfermedad COVID-19_SARS-CoV-2, 20200317. Available in: https:\/\/www.gob.mx\/cms\/uploads\/attachment\/file\/541794\/AE_Enfermedad_COVID-19_SARS-CoV-2_2020.03.17.pdf<\/li>\n
  15. World Health Organization. Advice on the use of point-of-care immunodiagnostic tests for COVID-19. Scientific Brief. 2020. Available in: https:\/\/www.who.int\/news-room\/commentaries\/detail\/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19<\/li>\n
  16. World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report \u2013 85, April 14, 2020. Available in: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4<\/li>\n
  17. World Health Organization. Situation Report-107. Situation Report Coronavirus disease (COVID-19). 2020 may 6. Available in: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/situation-reports<\/li>\n
  18. Spagnolo PA, Manson JE, Joffe H. Sex and gender differences in health: What the COVID-19 pandemic can teach us. Annals of Internal Medicine<\/em>. 2020; 173(5):385-386. Doi: https:\/\/doi.org\/10.7326\/M20-1941
    \n    CrossRef<\/a><\/li>\n
  19. Harapan H, Itoh N, Yufka A, Winardi W, Keam S, Te H, et al. Coronavirus disease 2019 (COVID-19): A literature review. Journal of Infection and Public Health<\/em>. 2020;13(2020): 1-9. Doi: https:\/\/doi.org \/10.1016\/j.jiph.2020.03.019
    \n    CrossRef<\/a><\/li>\n
  20. National Center for Health Statistics. Centers for Disease Control and Prevention. 2020. Available from: https:\/\/www. cdc.gov\/nchs \/nvss\/vsrr\/covid_weekly\/#Comorbidities.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction In early December 2019, cases of pneumonia of unknown […]<\/p>\n","protected":false},"author":14,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[88],"tags":[],"class_list":["post-38225","post","type-post","status-publish","format-standard","hentry","category-vol14no1"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/38225","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=38225"}],"version-history":[{"count":6,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/38225\/revisions"}],"predecessor-version":[{"id":38517,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/38225\/revisions\/38517"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=38225"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=38225"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=38225"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}