1
|
Baquerizo-Sedano L, Goni L, Sayón-Orea C, González-Muniesa P. A U-shaped protection of altitude against mortality and infection of COVID-19 in Peru: an ecological study. BMC Public Health 2023; 23:1054. [PMID: 37264338 DOI: 10.1186/s12889-023-15537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/27/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected the world in multiple ways and has been a challenge for the health systems of each country. From the beginning, risk factors for the severity and mortality of the disease were considered, as the spread of the virus was related to the living conditions of each population. METHODS In this ecological study we have evaluated the role of geography, precisely the altitude above sea level in the incidence and mortality of COVID-19 in Peru. Incidence and mortality data were taken from the open-access database of the government of Peru until March 2021. COVID-19 cases and COVID-19 mortality were treated as cases/density population and 1000 x cases/inhabitants while altitude was treated as continuous and as a categorical variable divided in 7 categories. The relationship between COVID-19 cases or deaths for COVID-19 and altitude as continuous variable was determined using Spearman correlation test. Meanwhile when altitude was considered as a categorical variable, Poisson regression or negative binomial analyses were applied. RESULTS A significant inverse correlation was found between COVID-19 cases by population density and altitude (r=-0.37 p < 0.001). By altitude categories, the lowest risk for infection was observed between 3,000 and 3,500 m (IRR 0.08; 95% CI 0.05,0.12). Moreover, we found an inverse correlation between altitude and COVID-19 mortality (r=-0.39 p < 0.001). Also, the lowest risk for mortality was observed between 3,000 and 3,500 m (IRR 0.12; 95%CI 0.08; 0.18). Similar results were found when analyses were adjusted for inhabitants and stratified by sex. CONCLUSION This study reports an inverse relationship between COVID-19 incidence and mortality with respect to the altitude of residence, particularly, a u-shaped protection is shown, with a highest benefit between 3000 and 3500 m. The possibility of using hypoxia as an alternative treatment requires more complex studies that should allow knowing the physiological and environmental mechanisms of the protective role.
Collapse
Affiliation(s)
- L Baquerizo-Sedano
- Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
- Faculty of Pharmacy and Nutrition, Department of Food Sciences and Physiology, University of Navarra, Pamplona, Spain
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
| | - L Goni
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - C Sayón-Orea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - P González-Muniesa
- Faculty of Pharmacy and Nutrition, Department of Food Sciences and Physiology, University of Navarra, Pamplona, Spain.
- Center for Nutrition Research, University of Navarra, Pamplona, Spain.
- IDISNA - Navarra Institute for Health Research, Pamplona, Spain.
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), Madrid, Spain.
| |
Collapse
|
2
|
Champigneulle B, Stauffer E, Robach P, Doutreleau S, Howe CA, Pina A, Salazar-Granara AA, Hancco I, Guergour D, Brugniaux JV, Connes P, Pichon A, Verges S. Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m. Pulmonology 2023:S2531-0437(23)00095-8. [PMID: 37263861 DOI: 10.1016/j.pulmoe.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes. MATERIALS AND METHODS Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hbmass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days. RESULTS ACZ increased PaO2 by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hbmass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hbmass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively). CONCLUSIONS Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.
Collapse
Affiliation(s)
- B Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France.
| | - E Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - P Robach
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - S Doutreleau
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - C A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, Canada
| | - A Pina
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - A A Salazar-Granara
- Universidad de San Martin de Porres, School of Medicine, Research Centre in Altitude Medicine, Lima, Peru
| | - I Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - D Guergour
- Unité Biochimie Immunoanalyse, Service de Biochimie Biologie Moléculaire et Toxicologie Environnementale, Institut de Biologie et Pathologie, CHU Grenoble Alpes, France
| | - J V Brugniaux
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - P Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - A Pichon
- Laboratoire Move EA 6314, Faculté des Sciences du Sport, Universit. De Poitiers, Poitiers, France
| | - S Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| |
Collapse
|
3
|
Chilipio Chiclla MA, Campos Correa K. Altitud y su relación con la incidencia, letalidad y mortalidad por COVID-19 en Perú: 2020-2021. REVISTA DE LA FACULTAD DE MEDICINA 2022. [DOI: 10.15446/revfacmed.v71n2.101180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introducción. La incidencia, letalidad y mortalidad COVID-19 no ha sido igual en las regiones del Perú, situación que puede estar relacionada con factores pocos estudiados como la altitud; asimismo, características ambientales propias de la altura (presión atmosférica, humedad relativa, etc.) podrían explicar la dinámica de transmisión de la COVID-19.
Objetivo. Determinar la relación entre altitud e incidencia, letalidad y mortalidad por COVID-19 en Perú.
Materiales y método. Estudio ecológico de grupos múltiples. Se realizó un análisis secundario de datos oficiales COVID-19 de 1874 distritos del Perú reportados hasta febrero de 2021. La variable altitud se categorizó como baja (0-999 msnm), media (1000-2499 msnm) y elevada (≥2500 msnm). Las tasas de incidencia acumulada, letalidad y mortalidad por COVID-19 se calcularon como el número de casos entre la población total de cada distrito multiplicada por 10000, el número de defunciones entre el número de casos multiplicado por 100, y el número de defunciones entre la población total de cada distrito multiplicado por 100000, respectivamente. Para el análisis de los datos se empleó estadística bivariada (coeficiente de correlación de Spearman y prueba de Kruskal-Wallis) y multivariada (regresión lineal múltiple), con un nivel de confianza del 95%.
Resultados. Se observó una correlación inversa entre la tasa de incidencia acumulada (1823 distritos) y altitud (Rho:-0.355; p<0.001), es decir, se redujo a mayor altitud, y una correlación directa entre la tasa de letalidad (1526 distritos) y altitud (Rho: 0.131; p<0.001), es decir, aumentó a mayor altitud. Aunque la tasa de mortalidad mostró una correlación inversa con la altitud (Rho:-0.310; p<0.000), esta varía heterogéneamente según niveles altitudinales. En el análisis multivariado, luego de ajustar el modelo por pobreza y densidad poblacional, la altitud se asoció con las tasas de incidencia (p<0.001) y de letalidad (p=0.009), pero no con la de mortalidad (p=0.179).
Conclusión. Se observó una correlación inversa entre altitud y la tasa de incidencia de COVID-19 y una correlación directa entre altitud y la tasa de letalidad en Perú durante el periodo de estudio. Finalmente, no se encontró una correlación entre altitud y tasa de mortalidad.
Collapse
|
4
|
Revisiting the COVID-19 fatality rate and altitude association through a comprehensive analysis. Sci Rep 2022; 12:18048. [PMID: 36302862 PMCID: PMC9610325 DOI: 10.1038/s41598-022-21787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
The emergence of COVID-19 virus has led to a pandemic with staggering morbidity and mortality. There is evidence showing that pre-existing conditions and environmental factors are associated with worse COVID-19 outcomes. Among these conditions, altitude is of particular interest. Altitude has been shown to influence the morbidity and mortality of multiple chronic pathologies such as cardiovascular disease, chronic obstructive pulmonary disease and lung cancer. COVID-19 fatality rate has been associated with as altitude as well, but findings are disputed. Therefore, we revisit this assessment with a comprehensive analysis of the relationship between COVID-19 fatality rates and altitude for the Mountain region of the United States while considering the effect of additional comorbidities and sociodemographic factors. A Generalized Additive Model (GAM) approach using one year of county data adjusted by population density was performed to evaluate associations within states and for the whole region. Our analysis revealed a consistent effect where COVID-19 case-fatality rate is decreased with higher altitude, even when controlling for pre-existing conditions and certain demographic variables. In summary, the work presented provides evidence that suggests that the protective effects of high altitude are likely to be influenced by physiologic factors but demographic trends that are associated with life at high altitude must also be considered.
Collapse
|
5
|
Ortiz-Saavedra B, Montes-Madariaga ES, Zafra-Tanaka JH, Moreno-Loaiza O. Re: "High-Altitude Environment and COVID-19: SARS-CoV-2 Seropositivity in the Highest City in the World," by Champigneulle et al. High Alt Med Biol 2021; 22:431-433. [PMID: 34905393 DOI: 10.1089/ham.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brando Ortiz-Saavedra
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Perú
| | | | - Jessica Hanae Zafra-Tanaka
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia (UPCH), Lima, Perú
| | - Oscar Moreno-Loaiza
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
6
|
Tomas-Grau RH, Ploper D, Ávila CL, Vera Pingitore E, Maldonado Galdeano C, Chaves S, Socias SB, Stagnetto A, Navarro SA, Chahla RE, Aguilar López M, Llapur CJ, Aznar P, Alcorta ME, Costas D, Flores I, Heinze D, Apfelbaum G, Mostoslavsky R, Mostoslavsky G, Cazorla SI, Perdigón GDV, Chehín R. Elevated Humoral Immune Response to SARS-CoV-2 at High Altitudes Revealed by an Anti-RBD " In-House" ELISA. Front Med (Lausanne) 2021; 8:720988. [PMID: 34722566 PMCID: PMC8551828 DOI: 10.3389/fmed.2021.720988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/21/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a global pandemic with dramatic health and socioeconomic consequences. The Coronavirus Disease 2019 (COVID-19) challenges health systems to quickly respond by developing new diagnostic strategies that contribute to identify infected individuals, monitor infections, perform contact-tracing, and limit the spread of the virus. In this brief report, we developed a highly sensitive, specific, and precise “In-House” ELISA to correctly discriminate previously SARS-CoV-2-infected and non-infected individuals and study population seroprevalence. Among 758 individuals evaluated for anti-SARS-CoV-2 serology in the province of Tucumán, Argentina, we found a weak correlation between antibodies elicited against the RBD, the receptor-binding domain of the Spike protein, and the nucleocapsid (N) antigens of this virus. Additionally, we detected mild levels of anti-RBD IgG antibodies in 33.6% of individuals diagnosed with COVID-19, while only 19% showed sufficient antibody titers to be considered as plasma donors. No differences in IgG anti-RBD titers were found between women and men, neither in between different age groups ranging from 18 to 60. Surprisingly, individuals from a high altitude village displayed elevated and longer lasting anti-RBD titers compared to those from a lower altitude city. To our knowledge, this is the first report correlating altitude with increased humoral immune response against SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Rodrigo Hernán Tomas-Grau
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Diego Ploper
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - César Luis Ávila
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Esteban Vera Pingitore
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Carolina Maldonado Galdeano
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Silvina Chaves
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Sergio Benjamín Socias
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Agustín Stagnetto
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | - Silvia Adriana Navarro
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| | | | - Mónica Aguilar López
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Conrado Juan Llapur
- Departamento de Residencias, Dirección General de Recursos Humanos (DGRRHH), Ministerio de Salud, Tucumán, Argentina
| | - Patricia Aznar
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - María Elena Alcorta
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Dardo Costas
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Isolina Flores
- Laboratorio de Salud Pública, Sistema Provincial de Salud, Hospital Néstor Kirchner, Tucumán, Argentina
| | - Dar Heinze
- Section of Gastroenterology, Department of Medicine, Center for Regenerative Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Gabriela Apfelbaum
- Facultad de Medicina, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Raul Mostoslavsky
- The Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, United States
| | - Gustavo Mostoslavsky
- Section of Gastroenterology, Department of Medicine, Center for Regenerative Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Silvia Inés Cazorla
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Gabriela Del Valle Perdigón
- Centro de Referencia para Lactobacilos, Consejo Nacional de Investigación Científicas y Técnicas (CONICET), Tucumán, Argentina
| | - Rosana Chehín
- Instituto de Medicina Molecular y Celular Aplicada, Universidad Nacional de Tucumán-Consejo Nacional de Investigación Científicas y Técnicas- Sistema Provincial de Salud (UNT-CONICET-SIPROSA), Tucumán, Argentina
| |
Collapse
|