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

被引:59
作者
Bello-Chavolla, Omar Yaxmehen [1 ,2 ]
Gonzalez-Diaz, Armando [3 ]
Antonio-Villa, Neftali Eduardo [1 ,4 ]
Fermin-Martinez, Carlos A. [2 ,4 ]
Marquez-Salinas, Alejandro [1 ,4 ]
Vargas-Vazquez, Arsenio [2 ,4 ]
Bahena-Lopez, Jessica Paola [4 ]
Garcia-Pena, Carmen [1 ]
Aguilar-Salinas, Carlos A. [2 ,5 ,6 ]
Gutierrez-Robledo, Luis Miguel [1 ]
机构
[1] Inst Nacl Geriatria, Div Res, Anillo Perif 2767, Mexico City 10200, DF, Mexico
[2] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Unidad Invest Enfermedades Metab, Mexico City, DF, Mexico
[3] Univ Nacl Autonoma Mexico, Mexico City, DF, Mexico
[4] Univ Nacl Autonoma Mexico, Fac Med, MD PhD PECEM, Mexico City, DF, Mexico
[5] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Endocrinol & Metab, Mexico City, DF, Mexico
[6] Tecnol Monterrey, Escuela Med & Ciencias Salud, Monterrey, Nuevo Leon, Mexico
来源
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES | 2021年 / 76卷 / 03期
关键词
COVID-19; Human Aging; Inequality; Mortality; Mexico; SARS-CoV-2; SELF-PERCEPTIONS; DISEASE;
D O I
10.1093/gerona/glaa163
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
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.
引用
收藏
页码:E52 / E59
页数:8
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