Spatial epemiological study of the distribution, clustering, and risk factors associated with early COV-19 mortality in Mexico

Abstract

COV-19 is a respiratory disease caused by SARS-CoV-2, which has significantly impacted economic and public healthcare systems worldwe. SARS-CoV-2 is highly lethal in older adults (>65 years old) and in cases with underlying medical conditions, including chronic respiratory diseases, immunosuppression, and cardio-metabolic diseases, including severe obesity, diabetes, and hypertension. The course of the COV-19 pandemic in Mexico has led to many fatal cases in younger patients attributable to cardio-metabolic conditions. Thus, in the present study, we aimed to perform an early spatial epemiological analysis for the COV-19 outbreak in Mexico. Firstly, to evaluate how mortality risk from COV-19 among tested indivuals (MRt) is geographically distributed and secondly, to analyze the association of spatial predictors of MRt across different states in Mexico, controlling for the severity of the disease. Among health-related variables, diabetes and obesity were positively associated with COV-19 fatality. When analyzing Mexico as a whole, we entified that both the percentages of external and internal migration had positive associations with early COV-19 mortality risk with external migration having the second-highest positive association. As an indirect measure of urbanicity, population density, and overcrowding in households, the physicians-to-population ratio has the highest positive association with MRt. In contrast, the percentage of indivuals in the age group between 10 to 39 years had a negative association with MRt. Geographically, Quintana Roo, Baja California, Chihuahua, and Tabasco (until April 2020) had higher MRt and standardized mortality ratios, suggesting that risks in these states were above what was nationally expected. Additionally, the strength of the association between some spatial predictors and the COV-19 fatality risk varied by zone.