Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study

  1. Myriam Patricia Cifuentes
  2. Laura Andrea Rodriguez-Villamizar
  3. Maylen Liseth Rojas-Botero
  4. Carlos Arturo Alvarez-Moreno
  5. Julián Alfredo Fernández-Niño

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Abstract

After 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia.

Methods

We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata.

Results

There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68).

Conclusion

Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.

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  1. Version published to 10.1136/jech-2020-216275
  2. ScreenIT

    SciScore for 10.1101/2020.12.14.20248203: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent was not required due to the nature of the study and use of anonymized data from publicly available data sources.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableHalf of the population are women (51.2%), 77.1% of people live in urban areas and 68.2% of Colombians are between 15 and 64 years old.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We performed the statistical analysis using SPSS software® version 26.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, conclusions should be carefully interpreted considering the limitations of the study. This study relies on data reported to SIVIGILA and it is possible that despite its national coverage, some degree of underreporting might be present. The probability of underreporting is higher in the sparse rural areas where most disadvantaged people live and therefore underreporting, if present, would have an attenuating effect of the effect measures. Colombia does not conduct COVID-19 mass testing and underreporting of cases and deaths might be influencing the confirmed cases captured by SIVIGILA and our results. Finally, our results are not controlled for the presence of chronic morbidities in confirmed cases so the effect of specific chronic diseases on COVID-19 mortality was not estimated and socioeconomic variables are not controlled for them. In conclusion, our study provides evidence of demographic and socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regime, and socioeconomic strata. Confirmed COVID-19 cases who are male, over 60 years old, indigenous, holding a government subsidized health insurance, and those living in areas classified in the lower socioeconomic strata have a higher risk of dying faster from COVID-19. Public health interventions for prevention and early detection of COVID-19 cases should be prioritized for more vulnerable groups according to the unequal mortality risks.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.14.20248203 on medRxiv