Ethnic disparities in COVID-19 mortality in Mexico: A cross-sectional study based on national data

  1. Ismael Ibarra-Nava
  2. Kathia G. Flores-Rodriguez
  3. Violeta Ruiz-Herrera
  4. Hilda C. Ochoa-Bayona
  5. Alfonso Salinas-Zertuche
  6. Magaly Padilla-Orozco
  7. Raul G. Salazar-Montalvo

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Abstract

Across the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico.

Methods

We used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders.

Results

From February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92).

Discussion

In this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.

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  1. Version published to 10.1371/journal.pone.0239168
  2. ScreenIT

    SciScore for 10.1101/2020.08.26.20182543: (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: 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:
    (12) Our study had some limitations. Selection bias could be present as Mexico is mainly using a sentinel surveillance system to identify and report COVID-19 cases. This system mainly identifies people seeking care. Thus, asymptomatic and mild cases might be missed. This could be particularly problematic for our sample of patients who did not require hospitalization and, thus, our whole sample as well. Ethnicity was also missing in 12562 (2.9%) of 432501 adult patients with COVID-19. However, this percentage is much lower than previous studies conducted in the UK and Brazil. (4, 5) Ethnicity was determined in this data set by asking the patient if they spoke an Indigenous language. According to a recent national survey, 21.5% of Mexicans consider themselves Indigenous, but only 6.5% of the population actually spoke an Indigenous language. (22) Only 4178 (1.0%) patients spoke an Indigenous language in our sample, which suggests Indigenous peoples lack access to adequate testing and are, therefore, underrepresented in our sample. Finally, our models were not able to be adjusted for socioeconomic status. For this reason, we included health care sector as a variable in our model unlike previous studies in Mexico, as income is associated with insurance type. Mexico is a racially and ethnically diverse country. However, most Mexicans are considered mestizos, or people of mixed European, African and Indian ancestry. This has resulted in the erasure of racial identities and it poses ...

    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

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  3. Version published to 10.1101/2020.08.26.20182543v1 on medRxiv