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- Title
Comprehensive Evaluation of the Impact of Sociodemographic Inequalities on Adverse Outcomes and Excess Mortality During the Coronavirus Disease 2019 (COVID-19) Pandemic in Mexico City.
- Authors
Antonio-Villa, Neftali Eduardo; Fernandez-Chirino, Luisa; Pisanty-Alatorre, Julio; Mancilla-Galindo, Javier; Kammar-García, Ashuin; Vargas-Vázquez, Arsenio; González-Díaz, Armando; Fermín-Martínez, Carlos A; Márquez-Salinas, Alejandro; Guerra, Enrique C; Bahena-López, Jessica Paola; Villanueva-Reza, Marco; Márquez-Sánchez, Jessica; Jaramillo-Molina, Máximo Ernesto; Gutiérrez-Robledo, Luis Miguel; Bello-Chavolla, Omar Yaxmehen
- Abstract
Background The impact of the coronavirus disease 2019 (COVID-19) pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City. Methods We analyzed suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, from the Mexico City Epidemiological Surveillance System from 24 February 2020 to 31 March 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the general civil registry. Results We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater risk for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic. Conclusions Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City.
- Subjects
MEXICO; POPULATION density; COVID-19; PSYCHOLOGICAL vulnerability; SEVERITY of illness index; ARTIFICIAL respiration; RISK assessment; SOCIOECONOMIC factors; HOSPITAL care; GOVERNMENT policy; EMPLOYMENT; SOCIODEMOGRAPHIC factors; HEALTH equity; COVID-19 pandemic
- Publication
Clinical Infectious Diseases, 2022, Vol 74, Issue 5, p785
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab577