Padilla-Raygoza N, Vega-Jimenez O. U, Juárez A. G, Gallardo-Luna M. D. J, Navarro-Olivos E, León-Verdin M. G, Magos-Vázquez F. J, Díaz-Martínez D. A. Effect of Co-Morbidities on Mortality from COVID-19 in Mexico: an Ecological Study. Biomed Pharmacol J 2021;14(1).
Manuscript received on :04-06-2020
Manuscript accepted on :07-12-2020
Published online on: 30-03-2021
Plagiarism Check: Yes
Reviewed by: Dr. Chinnu Sugavanam Senthilkumar  
Second Review by: Dr. Suganya Kannan  
Final Approval by: Dr. em. Hans-Joachim Freisleben  

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Nicolás Padilla-Raygoza1*, Oscar Ulises Vega-Jimenez1, Andrea García Juárez1, María de Jesús Gallardo-Luna2, Efraín Navarro-Olivos2, Ma Guadalupe León-Verdin2, Francisco J. Magos-Vázquez2 and Daniel Alberto Díaz-Martínez2

1School of Medicine, University of Celaya, México 38080.

2Secretary of Health from Guanajuato State, México, 36000.

Corresponding Author E mail: npadilla@udec.edu.mx

DOI : https://dx.doi.org/10.13005/bpj/2095

Abstract

With the emergence of a SARS-CoV-2 infection pandemic in China and its spread to other countries, mortality was shown to be high and to a greater extent if there were underlying pathologies. It is said {or an ecological analytical cross-sectional study, of the open records of confirmed and discarded cases for COVID-19 of the General Directorate of Epidemiology of the Secretary of Health of Mexico. A specific mortality of 9.79% is reported; being higher in men between the ages of 20 to 59 and over 60 years. Mortality rates from underlying diseases were higher than those reported in the USA in early May 2020. Asthma was found to be a protective factor for COVID-19 mortality. It is concluded that mortality was higher in the presence of comorbidities.

Keywords

COVID-19; Co-Morbidities; Mortality; SARS-CoV-2

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Padilla-Raygoza N, Vega-Jimenez O. U, Juárez A. G, Gallardo-Luna M. D. J, Navarro-Olivos E, León-Verdin M. G, Magos-Vázquez F. J, Díaz-Martínez D. A. Effect of Co-Morbidities on Mortality from COVID-19 in Mexico: an Ecological Study. Biomed Pharmacol J 2021;14(1).

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Padilla-Raygoza N, Vega-Jimenez O. U, Juárez A. G, Gallardo-Luna M. D. J, Navarro-Olivos E, León-Verdin M. G, Magos-Vázquez F. J, Díaz-Martínez D. A. Effect of Co-Morbidities on Mortality from COVID-19 in Mexico: an Ecological Study. Biomed Pharmacol J 2021;14(1). Available from: https://bit.ly/2Okl3R1

Introduction

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; as of December 31th, 2019, a case of unknown pneumonia was reported to the World Health Organization (WHO) office in Whuan, China5.On January 10th, 2020, the first death occurred in China due to this infection 6. The outbreak is declared a Public Health emergency of international interest on January 30th, 20206.On February 7th, 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 and the disease caused by the coronavirus was called COVID -19 on February 11th, 20205.After a month, the virus was isolated, its genome was sequenced and its morphology was described; on January 12th, 2020, the virus genome was shared with WHO by the Chinese Center for Disease Control and Prevention8. Zhou et al.9, reported that the causer of COVID-19 shares 79.5% of the SARS-CoV sequence; also, it uses the same cell entry receptor, angiotensin-converting enzyme-2, as SARS-CoV.

Zhu e t al.10, 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 11.

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.

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.

Material and methods

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, 202013.

Where analyzed all registries published by Secretary of Health in Mexico, with confirmed and discarded cases of COVID-19.

Registries with not full data were eliminated from analysis.

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.

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 above, it presents positive RT-PCR test14.To establish whether the case was confirmed or ruled out, it was based on the result of the RT-PCR, recommended by the WHO15.

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 dying.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 ® 13.0 (Stata Corp.,  College Station, TX, USA).

Results and discussion

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.

For confirmed cases 27,634 (29.57%) the age range was from 0 to 113 years with a mean of 46.72 ± 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 ± 17.62 years (t = 55.63, degrees of freedom 93439, P = .00001).

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.

Table 1: Distribution by confirmed and non-cases of COVID-19 in Mexico, until May 6, 2020 (n=93,341).

Variable Confirmed cases (n=27,634)

n    %

Non-cases (65,807)

 n (%)

Gender

    Female

    Male

    Total

 

11,475 (41.52)

16,159(58.48)

27,634(100.0)

 

34,588 (52.56)

31,219 (47.44)

65,807(100.0)

Age group (years)

   0 to 5

   6 to 11

   12 to 19

   20 to 59

   60 and higher

Total

 

150 (0.54)

129(0.47)

335 (1.21)

21,247(76.89)

5,773(20.89)

27,634 (100.0)

 

2,361 (3.59)

1,265 (1.92)

2,210 (3.36)

51,195 (77.80)

8,776 (13.34)

65,807 (100.0)

Source: Secretary of Health13

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.

Table 2: Distribution of deaths among cases and non-cases of COVID-19, until May 6, 2020 (n=93,341).

 Variable Confirmed cases (n=27,634)

n    %

Non-cases (65,807)

 n (%)

Chi-squared test (df) P-value

Deaths

    Yes

   No

Total

 

2,704 (9.79)

24,930(90.21)

27,634  (100.0)

 

1,269 (1.93)

64,538 (98.07)

65,807  (100.0)

3003 (1) .0001

Source: Secretary of Health13

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).

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.

  Confirmed cases COVID-19 (n=27,634) Non-cases COVID-19 (65,807)
Variable  Deaths

n%

Non-deaths

n%

Deaths

n%

Non- deaths

n%

Gender

Females

Male

Total

 

857 31.69

1,847 68.31

2,704  100.0

 

10,61842.59

14,31257.41

24,930  100.0

 

54142.63

72857.37

1,269100.0

 

34,04752.67

30,49147.33

64,538 100.0

OR (CI95%) 0.63 (0.57 to 0.68) 0.67 (0.59 to 0.74)
Age group (years)

0 – 5

6-11

12-19

20-59

60 or higher

Total

 

8 0.30

0  0

10.04

1,367 50.55

1,328 49.11

2,704100.0

 

1420.57

1290.52

3341.34

19,88079.74

4,44517.83

24,930 100.0

 

49 3.86

120.95

25 1.97

492 38.77

691 54.45

1,269 100.0

 

2,3123.58

1,2531.94

2,1853.39

50,70378.56

8,085  12.53

64,538  100.0

Source: Secretary of Health13

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.

Table 4: Missing data in co-morbidities and whether confirmed COVID-19 patients in Mexican Sample from the start until May 6th, 2020.

  Variable

Confirmed COVID-19

patients

 

Non-confirmed COVID-19

patients

Diabetes 262 135
Hypertension 257 123
COPD 259 125
Asthma 267 119
Cardiovascular disease 265 125
Immunosuppression 263 140
Chronic kidney disease 270 112
Smoking 257 125
Obesity, 247 99
Pneumonia 2 7

Source: Secretary of Health13

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  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).

Asthma prevented death in confirmed cases (18%)  and non-cases (47%) (Table 5).

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).

Table 5: Distribution of deaths by cases and non-cases of COVID-19, by co-morbidities in Mexico.

  Confirmed cases COVID-19 (n=27,634) Non-cases COVID-19 (65,807)
  Deaths

n  %

Non-deaths

n  %

Deaths

n  %

Non- deaths

n  %

Diabetes

Yes

No

 

1,075  40.07

1,608  59.93

 

4,116 16.67

20,57383.33

 

511  49.78

742  50.22

 

6,737  10.46

57,682  89.54

OR (CI95%) 3.34 (IC95%3.07 to 3.63) 5.90 (5.25 to 6.62)
Hypertension

Yes

No

 

1,173  45.70

1,511  54.30

 

4,896    10.83

19,797  89.17

 

548  20.48

708  79.52

 

9,672    15.01

54,756  84.99

OR (CI95%) 3.14 (2.89 to 3.41) 4.38 (3.91 to 4.91)
COPD

Yes

No

 

1825.67

2,501  94.33

 

499         2.02

24,193  97.98

 

163     13.02

1,089  86.98

 

1,558      2.42

62,872  97.58

OR (CI95) 3.53 (2.96 to 4.20) 6.04 (5.09 to 7.17)
Asthma

Yes

No

 

75         2.80

2,606  97.20

 

841         3.41

23,845  96.59

 

166       6.20

2,513  93.80

 

1,948      3.02

62,479  96.98

OR (CI95%) 0.82 (0.64 to 1.03) 0.53 (0.38 to 0.74)
Cardiovascular disease

Yes

No

 

166      6.20

2,513  93.80

 

6272.54

24,063  97.46

 

164     13.07

1,091  86.93

 

1,948      3.02

62,479  96.98

OR (CI95%) 2.54 (2.13 to 3.02) 4.82 (4.07 to 5.72
Pneumonia

Yes

No

 

2,008  74.26

696     25.74

 

6,374    25.57

18,554  74.43

 

879   69.27

390  30.73

 

7,676    11.90

56,855  88.10

OR (CI95%) 8.67 (7.92 to 9.50) 16.69 (14.78 to 18.85)
Immunopression

Yes

No

 

100       3.73

2,581  96.27

 

387         1.63

23,303  98.37

 

122       9.76

1,128  90.24

 

1,666     2.59

62,751  97.41

OR (CI95%) 2.43 (1.95 to 3.04) 7.13 (6.02 to 8.46)
Chronic kidney disease

Yes

No

 

196  7.31

2,484  92.69

 

514  2.08

24,170  97.92

 

170  13.50

1,089 86.50

 

1,380  2.14

63,056  97.86

OR (CI95%) 3.71 (3.13 to 4.40) 1.29 (1.09 to 1.52)
Obesity

Yes

No

 

801     29.82

1,885  70.18

 

5,019    20.32

19,682  79.68

 

241 19.13

1,019  80.87

 

9,141    14.18

55,307  85.82

OR (CI95%) 1.67 (1.53 to 1.82) 1.43 (1.24 to 1.65)
Smoking

Yes

No

 

245       9.14

2,435  90.86

 

2,186     8.85

22,511  91.15

 

159     12,69

1,094  87.31

 

6,535    10.14

57,894  89.86

OR (CI95%) 1.04 (0.90 to 1.19) 1.29 (1.09 to 1.52)

Source: Secretary of Health13

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 cases.Similar results for hypertension, chronic obstructive pulmonary disease, cardiovascular disease, pneumonia, immuno suppression, chronic kidney disease. Obesity had a slight effect on mortality in confirmed cases and discarded cases; Smoking had virtually no effect on deaths (Table 6).

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.

Co-morbilities OR crude

(CI95%)

OR

adjusted by agegroup

(CI95%)

OR

adjusted by gender

(CI95%)

Diabetes

Cases COVID-19

Non-cases

 

3.34 (3.07 to 3.63)

5.89 (5.25 to 6.62)

 

2.39 (2.18 to 2.61)

3.78 (3.33 to 4.29)

 

3.34 (3.07 to 3.63)

5.89 (5.25 to 6.62)

Hypertension

Cases COVID-19

Non-cases

 

3.14 (2,89 to 3.41)

4.38 (3.91 to 4.91)

 

2.09 (1.91 to 2.28)

2.68 (2.36 to 3.04)

 

3.17 (2.92 to 3.44)

4.35 ( 3.89 to 4.88)

COPD

Cases COVID-19

Non-cases

 

3.53 (2.96 to 4.20)

6.04 (5.09 to 7.57

 

1.92 (1.60 to 2.31)

2.71 (2.25 to 3.27)

 

3.65 (3.06 to 4.35)

5.97 (5.03 to 7.10)

Asthma

Cases COVID-19

Non-cases

 

0.53 (0.38 to 0.74)

0.82(0.64 to 1.04)

 

0.57 (0.40 to 0.80)

0.92 (0.72 to 1.18)

 

0.55 (0.39 to 0.77)

0.88 (0.69 to 1.12)

Cradiovascular disease

Cases COVID-19

Non-cases

 

 

2.54 (2.13 to 3.02)

4.82 (4.07 to 5.72)

 

 

1.52 (1.26 to 1.82)

2.73 (2.28 to 3.26)

 

 

2.53 (2.12 to 3.02)

4.74 (4.00 to 5.63)

Pneumonia

Cases COVID-19

Non-cases

 

8.40 (7.67 to 9.20)

16.69 (14.78 to 18.85)

 

6.68 (6.17 to 7.44)

14.24 (12.56 to 16.15)

 

8.18 (7.47 to 8.96)

16.40 (14.51 to 18.52)

Immunosuppression

Cases COVID-19

Non-cases

 

2.43 (1.95 to 3.04)

4.07 (3.36 to 4.94)

 

2.15 (1.70 to 2.72)

3.32 (2.73 to 4.05)

 

2.49 (1.99 to 3.12)

4.09 (3.37 to 4.96)

Chronic kidney disease

Cases COVID-19

Non-cases

 

 

3.71 (3.13 to 3.13)

7.13 (6.02 to 8.46)

 

 

2.72 (2.27 to 3.25)

4.38 (3.67 to 5.24)

 

 

3.67 (3.10 to 4.36)

Obesity

Cases COVID-19

Non-cases

 

1.67 (1.53 to 1.82)

1.43 (1.24 to 1.65)

 

1.72 (1.57 to 1.88)

1.27 (1.10 to 1.47)

 

1.69 (1.55 to 1.85)

1.46 (1.26 to 1.68)

Smoking

Cases COVID-19

Non-cases

 

1.04 (0.90 to 1.19)

1.29 (1.09 to 1.52)

 

0.99 (0.86 to 1.48)

1.13 (0.95 to 1.34)

 

0.96 (0.83 to 1.10)

1.20 (1.02 to 1.42)

Source: Analysis of data of Secretary of Health13

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.

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.

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

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. In Mexico, mortality was higher in men (68.31%) than in women (Table 2 and 3).

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 of age or older and with comorbidities represent severe cases that may present coinfections 19. 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).

In the United States, the National Center for Health Statistics, until May 9th, 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 obesity and 20.22% for hypertension20. 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 cardiovascular 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.

Of the discarded cases of COVID-19 they had an overall mortality of 1.93%13. One explanation for the higher OR’s 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 them consider themselves suspected of being infected with SARS-CoV-2.

Conclusion

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 diabetes but not confirmed for COVID-19. same for other pathologies except asthma.

Conflict of interest.

Nothing to declare

Funding source

No one

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