Unequal Impact of Structural Health Determinants and Comorbidity on COVID-19 Severity and Lethality in Older Mexican Adults: Considerations Beyond Chronological Aging
Unequal Impact of Structural Health Determinants and Comorbidity on COVID-19 Severity and Lethality in Older Mexican Adults: Considerations Beyond Chronological Aging
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DOI：
10.1093/gerona/glaa163
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发表时间：
2021-03-01
影响因子：
5.1
通讯作者：
Gutierrez-Robledo, Luis Miguel
中科院分区：
文献类型：
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作者：
Bello-Chavolla, Omar Yaxmehen;Gonzalez-Diaz, Armando;Gutierrez-Robledo, Luis Miguel
背景：新冠肺炎对老年人的影响不成比例。墨西哥人口较年轻，但新冠肺炎对老年人的影响可与人口结构较老的国家相提并论。在这里，我们的目标是确定健康和结构性决定因素，增加墨西哥老年人新冠肺炎的易感性超过时间顺序。方法：我们使用墨西哥卫生部流行病学总局的数据分析了老年人确诊的新冠肺炎病例。我们对新冠肺炎严重程度和死亡率增加的风险因素进行了建模，使用混合模型纳入了有关医疗保健获取和边缘化的多水平数据。我们还评估了新冠肺炎死亡风险预测的结构性因素和共病情况，并将其与按时间顺序排列的年龄进行了比较。结果：我们分析了20 804例60岁及以上成年人中确诊的SARS-CoV-2病例。在老年人中，男性、吸烟、糖尿病和肥胖与肺炎、住院和重症监护病房(ICU)入院有关，CKD和COPD与住院有关。高社交滞后指数和获得私人护理是新冠肺炎严重程度和死亡率的预测因素。在无合并症的个体中，年龄不是新冠肺炎严重程度的预测因素，与单独按时间顺序年龄相比，结构性因素和共病因素的组合是新冠肺炎死亡率和严重程度的更好预测因素。新冠肺炎基线致死风险在墨西哥各城市中分布不均，特别是在比较城市和农村地区时。结论：结构性因素和共病解释了墨西哥老年人新冠肺炎严重程度和死亡率随年龄增长的超额风险。与新冠肺炎相关的临床决策应该从按时间顺序老化转向更全面的老年护理方法。
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.