Higher COVID-19 mortality among certain groups in Colombia linked to structural inequalities

Since the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes the coronavirus disease 2019 (COVID-19), has spread to 191 countries and regions. To date, there are more than 75 million cases and over 1.66 million deaths.

One of the hardest-hit countries is Colombia, reporting at least 1.46 million cases and more than 39,000 deaths.

Researchers at the Ministry of Health and Social Protection in Bogotá, Colombia, provided evidence of socioeconomic inequalities in COVID-19 deaths in terms of age, sex, ethnicity, type of health insurance regime, and socioeconomic status.

The team has found that males, the elderly, indigenous people, those with subsidized health insurance regime, and those living in very low socioeconomic strata are more likely to die from COVID-19.

The study

To arrive at the study findings, which were published on the medRxiv* preprint server, the researchers conducted a survival analysis in a national retrospective cohort study of COVID-19 confirmed cases in Colombia between March and October 2020.

The team used individual data obtained from the national public health surveillance system. In the country, symptomatic and asymptomatic cases were conformed using Reverse transcription-polymerase chain reaction (RT-PCR). Furthermore, beginning July 23, 2020, symptomatic cases were also confirmed using antigen-based validated tests.

The researchers also calculated the time to death or recovery for each patient in the study. They utilized an extended multivariable time-dependent Co regression model to estimate the hazard risk ratio (HR) by the factors mentioned.

Study findings

In the study, most conformed COVID-19 cases were male, older than 60, living in urban areas, with the contributory regime of health insurance, and living in residents that belong to the two lower levels of socioeconomic strata.

Moreover, the results showed that seven of the 30,565 cases that end up in deaths were asymptomatic or had no symptoms of COVID-19. Of the more than 914,000 confirmed cases that have recovered, 11.2% had no symptoms.

Our results provide evidence of socioeconomic and demographic inequalities in COVID-19 mortality in Colombia," the team explained.

"In addition to the well-documented differential risk of mortality related to older age groups and male sex, this study provides evidence of socioeconomic and ethnicity inequalities in COVID-19 mortality," they added.

The team explained that the findings support past reports that older people and males are at a higher risk of dying from COVID-19. The most plausible reason for this is the age-related response to sepsis in older people with a decline in immune cell function, uncontrolled production of inflammatory cytokines, and reduced humoral immune function.

Males are at a higher risk of COVID-19-related death, which can be explained by the increased expression of the angiotensin-converting enzyme (ACE2) receptors in men, the cellular gateways of SARS-CoV-2 into cells.

In other countries, ethnic disparities have also been reported concerning COVID-19 deaths. For instance, in the United States, African Americans and Hispanics are at a heightened risk of dying from COVID-19. In Brazil, after age, Pardo ethnicity was the second most important risk factor for death.

Apart from these, the team also revealed that poor living and sanitary conditions, accompanied by the burden of prior infectious diseases and malnutrition, impose a higher risk on people and the community's health.

With the study findings, public health interventions and infection control measures are crucial for the prevention and early detection of COVID-19. Detecting those infected and isolating them immediately should be prioritized for more susceptible groups according to the unequal death risks.

Colombia is not the only country grappling with COVID-19. The United States reports the highest number of infections, with more than 17.21 million cases and over 310,000 deaths.

India, Brazil, and Russia follow with a staggering 9.97 million, 7.11 million, and 2.76 million cases, respectively.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Angela Betsaida B. Laguipo

Written by

Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She is currently completing her Master's Degree where she specialized in Maternal and Child Nursing and worked as a clinical instructor and educator in the School of Nursing at the University of Baguio.


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