Unequal Impact of Structural Health Determinants and Comorbidity on COVID-19 Severity and Lethality in Older Mexican Adults: Considerations Beyond Chronological Aging

  1. Omar Yaxmehen Bello-Chavolla
  2. Armando González-Díaz
  3. Neftali Eduardo Antonio-Villa
  4. Carlos A Fermín-Martínez
  5. Alejandro Márquez-Salinas
  6. Arsenio Vargas-Vázquez
  7. Jessica Paola Bahena-López
  8. Carmen García-Peña
  9. Carlos A Aguilar-Salinas
  10. Luis Miguel Gutiérrez-Robledo

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Abstract

Background

COVID-19 has had a disproportionate impact on older adults. Mexico’s population is younger, yet COVID-19’s impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging.

Methods

We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction.

Results

We analyzed 20 804 confirmed SARS-CoV-2 cases in adults aged 60 and older. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization, and intensive care unit (ICU) admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas.

Conclusions

Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.

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  1. Version published to 10.1093/gerona/glaa163
  2. ScreenIT

    SciScore for 10.1101/2020.05.12.20098699: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A potential limitation of our study is the lack of symptom-specific data which could be helpful to characterize atypical presentations of COVID-19 in older adults and identify early predictors of disease severity and potential recovery as has been seen in some series, and which remains to be addressed in future studies to better characterize the course of COVID-19 in older adults [36]. Finally, an additional limitation of our work could be related to underreporting of mild cases in marginalized areas due to a lack of widespread testing, which might inflate mortality estimates for those regions, but which also would indicate a significant challenge for handling the COVID-19 epidemic in marginalized communities moving forward. Our findings could inform public policy related to ethical decision making for older adults by prompting consideration of factors beyond chronological age and promote further studies in older populations, which remains imperative to address aging in populations undergoing an epidemiological transition with increased morbidity burden, such as Mexico. In conclusion, we characterized predictors of COVID-19 outcomes in older Mexican adults, including potential predictors related to structural inequalities which increase COVID-19 severity and lethality risk. We demonstrated that comorbidity profiles and structural factors are better predictors of COVID-19 severity and mortality compared to chronological age. Overall, baseline COVID-19 mortality hazards are une...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.05.12.20098699v1 on medRxiv