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Salas-Ortiz A. Socioeconomic Inequalities and Ethnic Discrimination in COVID-19 Outcomes: the Case of Mexico. J Racial Ethn Health Disparities 2024; 11:900-912. [PMID: 37041406 PMCID: PMC10089566 DOI: 10.1007/s40615-023-01571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
In Mexico, Indigenous people were hospitalised and killed by COVID-19 at a disproportionate rate compared to the non-Indigenous population. The main factors contributing to this were poor health conditions and impoverished social and economic circumstances within the country. The objective of this study is to examine the extent to which ethnic disparities are attributable to processes of structural discrimination and further explore the factors that exacerbate or mitigate them. Using administrative public data on COVID-19 and Census information, this study uses the Oaxaca-Blinder decomposition method to examine the extent to which disparities are illegitimate and signal discrimination against Indigenous people. The results show that although ethnic disparities were mainly attributable to observable differences in individual and contextual characteristics, 22.8% (p < 0.001) of the ethnic gap in hospitalisations, 17.5% in early deaths and 16.4% in overall deaths remained unexplained and could potentially indicate systemic discrimination. These findings highlight that pre-existing and longstanding illegitimate disparities against Indigenous people jeopardise the capacity of multi-ethnic countries to achieve social justice in health.
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Affiliation(s)
- Andrea Salas-Ortiz
- Centre for Health Economics, University of York, Alcuin Block A, York, YO105DD, North Yorkshire, England, UK.
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2
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Abascal Miguel L, Mendez-Lizarraga CA, Rojo EM, Sepúlveda J. COVID-19 vaccine uptake and barriers among Indigenous language speakers in Mexico: Results from a nationally representative survey. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002921. [PMID: 38547235 PMCID: PMC10977884 DOI: 10.1371/journal.pgph.0002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/06/2024] [Indexed: 04/01/2024]
Abstract
Mexico faced a significant burden from the COVID-19 pandemic. Since the pandemic's onset in 2020, numerous studies have underscored the substantial risk of COVID-19 death among Indigenous individuals. This study aims to assess COVID-19 vaccine uptake among Indigenous language speakers in Mexico, focusing on understanding the barriers they face in obtaining access to vaccines. We used Encuesta Nacional de Salud y Nutrición Continua (ENSANUT) 2022, a nationally representative health survey in Mexico to analyze data on self-reported COVID-19 vaccine status, reasons for not getting vaccinated, and other relevant covariates. We employed logistic regression to estimate odds ratios (ORs) for vaccine uptake and uptake barriers, all models were adjusted for potential confounders. Among 34,051 participants, 1793 individuals (5.23%) reported speaking an Indigenous language. Indigenous language speakers were found to have a lower vaccination rate (63%) compared to non-Indigenous language speakers (81%) (p <0.005). They were also 59% less likely to be vaccinated against COVID-19 (OR 0.41, 95% CI 0.27-0.62), even when adjusted for confounders. Among unvaccinated individuals, Indigenous language speakers were more likely to cite negative beliefs about the vaccine or fear as reasons for not being vaccinated (OR 1.82, 95% CI 1.11-3.00) while being less likely to report access barriers (OR 0.62, CI 95% 0.42-0.91). This study highlights disparities in COVID-19 vaccine uptake among Indigenous language speakers in Mexico. The findings underscore the urgent need for targeted, culturally appropriate public health interventions and the consideration of social and ethnic vulnerability in prioritizing vaccinations.
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Affiliation(s)
- Lucía Abascal Miguel
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Cesar A. Mendez-Lizarraga
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Elizabeth M. Rojo
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
| | - Jaime Sepúlveda
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
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Kraft TS, Seabright E, Alami S, Jenness SM, Hooper P, Beheim B, Davis H, Cummings DK, Rodriguez DE, Cayuba MG, Miner E, de Lamballerie X, Inchauste L, Priet S, Trumble BC, Stieglitz J, Kaplan H, Gurven MD. Metapopulation dynamics of SARS-CoV-2 transmission in a small-scale Amazonian society. PLoS Biol 2023; 21:e3002108. [PMID: 37607188 PMCID: PMC10443873 DOI: 10.1371/journal.pbio.3002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
The severity of infectious disease outbreaks is governed by patterns of human contact, which vary by geography, social organization, mobility, access to technology and healthcare, economic development, and culture. Whereas globalized societies and urban centers exhibit characteristics that can heighten vulnerability to pandemics, small-scale subsistence societies occupying remote, rural areas may be buffered. Accordingly, voluntary collective isolation has been proposed as one strategy to mitigate the impacts of COVID-19 and other pandemics on small-scale Indigenous populations with minimal access to healthcare infrastructure. To assess the vulnerability of such populations and the viability of interventions such as voluntary collective isolation, we simulate and analyze the dynamics of SARS-CoV-2 infection among Amazonian forager-horticulturalists in Bolivia using a stochastic network metapopulation model parameterized with high-resolution empirical data on population structure, mobility, and contact networks. Our model suggests that relative isolation offers little protection at the population level (expected approximately 80% cumulative incidence), and more remote communities are not conferred protection via greater distance from outside sources of infection, due to common features of small-scale societies that promote rapid disease transmission such as high rates of travel and dense social networks. Neighborhood density, central household location in villages, and household size greatly increase the individual risk of infection. Simulated interventions further demonstrate that without implausibly high levels of centralized control, collective isolation is unlikely to be effective, especially if it is difficult to restrict visitation between communities as well as travel to outside areas. Finally, comparison of model results to empirical COVID-19 outcomes measured via seroassay suggest that our theoretical model is successful at predicting outbreak severity at both the population and community levels. Taken together, these findings suggest that the social organization and relative isolation from urban centers of many rural Indigenous communities offer little protection from pandemics and that standard control measures, including vaccination, are required to counteract effects of tight-knit social structures characteristic of small-scale populations.
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Affiliation(s)
- Thomas S. Kraft
- Department of Anthropology, University of Utah, Salt Lake City, Utah, United States of America
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Edmond Seabright
- School of Collective Intelligence, Mohammed VI Polytechnic University, Rabat, Morocco
- University of New Mexico, Department of Anthropology, Albuquerque, New Mexico, United States of America
| | - Sarah Alami
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
- School of Collective Intelligence, Mohammed VI Polytechnic University, Rabat, Morocco
| | - Samuel M. Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
| | - Paul Hooper
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | - Bret Beheim
- Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Helen Davis
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Daniel K. Cummings
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | | | | | - Emily Miner
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Lucia Inchauste
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Stéphane Priet
- Unité des Virus Émergents (UVE: Aix-Marseille Univ–IRD 190 –Inserm 1207 –IHU Méditerranée Infection), Marseille, France
| | - Benjamin C. Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
- Center for Evolution and Medicine, Arizona State University, Tempe, Arizona, United States of America
| | | | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California, United States of America
| | - Michael D. Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, California, United States of America
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Little BB, Shakib S, Pena Reyes ME, Karimi S, Vu GT, Dupré N, McKinney WP, Mitra R. COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation. J Glob Health 2023; 13:06030. [PMID: 37506193 PMCID: PMC10386760 DOI: 10.7189/jogh.13.06030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Background Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico. Methods We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation. Results Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous. Conclusions Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.
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Affiliation(s)
- Bert B Little
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
| | - Shaminul Shakib
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
| | - Maria E Pena Reyes
- Escuela de Nacional Antroplogia e Historia and Instituto de Nacional Antroplogia e Historia Mexico City, Mexico
| | - Seyed Karimi
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
| | - Giang T Vu
- School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, USA
| | - Natalie Dupré
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
| | - W Paul McKinney
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
| | - Riten Mitra
- School of Public Health and Information Sciences, University of Louisville, Kentucky, USA
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Weber G, Cabras I, Peredo AM, Yanguas-Parra P, Prime K. Exploring resilience in public services within marginalised communities during COVID-19: The case of coal mining regions in Colombia. JOURNAL OF CLEANER PRODUCTION 2023; 415:137880. [PMID: 37362962 PMCID: PMC10285674 DOI: 10.1016/j.jclepro.2023.137880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
This paper examines the impact of COVID-19 on marginalised communities and its effects on the provision of public services. Focusing on two coal mining regions in Colombia during the pandemic crisis, and examining Indigenous and Afro-Colombian communities, we analyze the provision of public services at a local level, identifying both shortcomings and resilience. Findings show that the lack of resilient public services amplified the effects of COVID-19 and its containment measures, exacerbating existing structural inequalities within local marginalised communities. It also reinforced the control exercised by coal mining companies within local economies. However, the substantial lack of public service provision also provided space for the development and strengthening of several resilience strategies among local communities, such as solidarity networks and schemes and the revitalization of local environmental knowledge. The study identifies multiple shortcomings in how the national and local administrations handled the COVID-19 outbreak and highlights the potential of enhancing resilience in public services to support marginalised communities in times of crisis.
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Affiliation(s)
- Gabriel Weber
- ESSCA, School of Management, Angers, Bordeaux, France
| | - Ignazio Cabras
- ESSCA, School of Management, Angers, Bordeaux, France
- Newcastle Business School, Northumbria University, Newcastle, UK
| | - Ana Maria Peredo
- Telfer School of Management, University of Ottawa (Canada) and School of Environmental Studies, University of Victoria, Canada
| | | | - Karla Prime
- Newcastle Business School, Northumbria University, Newcastle, UK
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Galappaththi EK, Perera CD, Dharmasiri IP, Ford JD, Kodithuwakku SS, Chicmana-Zapata V, Zavaleta-Cortijo C, Pickering K, van Bavel B, Hyams K, Arotoma-Rojas I, Akugre FA, Nkalubo J, Namanya DB, Mensah A, Hangula MM. Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples. ENVIRONMENTAL SCIENCE & POLICY 2023; 144:110-123. [PMID: 36949900 PMCID: PMC10011033 DOI: 10.1016/j.envsci.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.
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Affiliation(s)
- Eranga K Galappaththi
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | - Chrishma D Perera
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
- University of Colombo, Colombo, Sri Lanka
| | - Indunil P Dharmasiri
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, United States
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Sarath S Kodithuwakku
- Department of Agricultural Economics & Business Management, University of Peradeniya, Sri Lanka
| | - Victoria Chicmana-Zapata
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carol Zavaleta-Cortijo
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Bianca van Bavel
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Keith Hyams
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - Ingrid Arotoma-Rojas
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | | | - Jonathan Nkalubo
- Uganda National Health Research Organization & Mulago National Referral Hospital, Uganda
| | - Didacus Bambaiha Namanya
- Ministry of Health-Uganda National Health Research Organisation, & Uganda Martyrs, University, Uganda
| | - Adelina Mensah
- Institute for Environment and Sanitation Studies, University of Ghana, Accra, Ghana
| | - Martha M Hangula
- Department of Animal Production, Agribusiness and Economics, University of Namibia, Namibia
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Cárdenas-Rojas MI, Guzmán-Esquivel J, Murillo-Zamora E. Predictors of ICU Admission in Children with COVID-19: Analysis of a Large Mexican Population Dataset. J Clin Med 2023; 12:jcm12103593. [PMID: 37240699 DOI: 10.3390/jcm12103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Children, although mostly affected mildly or asymptomatically, have also developed severe coronavirus disease 2019 (COVID-19). This study aims to assess potential predictors of intensive care unit (ICU) admission in a large population (n = 21,121) of children aged 0-9 years with laboratory-confirmed disease. We performed a cross-sectional analysis of a publicly available dataset derived from the normative epidemiological surveillance of COVID-19 in Mexico. The primary binary outcome of interest was admission to the ICU due to respiratory failure. Results showed that immunosuppressed children and those with a personal history of cardiovascular disease had a higher likelihood of being admitted to the ICU, while increasing age and the pandemic duration were associated with a lower likelihood of admission. The study's results have the potential to inform clinical decision-making and enhance management and outcomes for children affected by COVID-19 in Mexico.
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Affiliation(s)
- Martha I Cárdenas-Rojas
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico
| | - Efrén Murillo-Zamora
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli 250, Col. El Haya, Villa de Álvarez 28984, Mexico
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Irizar P, Pan D, Kapadia D, Bécares L, Sze S, Taylor H, Amele S, Kibuchi E, Divall P, Gray LJ, Nellums LB, Katikireddi SV, Pareek M. Ethnic inequalities in COVID-19 infection, hospitalisation, intensive care admission, and death: a global systematic review and meta-analysis of over 200 million study participants. EClinicalMedicine 2023; 57:101877. [PMID: 36969795 PMCID: PMC9986034 DOI: 10.1016/j.eclinm.2023.101877] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background COVID-19 has exacerbated existing ethnic inequalities in health. Little is known about whether inequalities in severe disease and deaths, observed globally among minoritised ethnic groups, relates to greater infection risk, poorer prognosis, or both. We analysed global data on COVID-19 clinical outcomes examining inequalities between people from minoritised ethnic groups compared to the ethnic majority group. Methods Databases (MEDLINE, EMBASE, EMCARE, CINAHL, Cochrane Library) were searched from 1st December 2019 to 3rd October 2022, for studies reporting original clinical data for COVID-19 outcomes disaggregated by ethnicity: infection, hospitalisation, intensive care unit (ICU) admission, and mortality. We assessed inequalities in incidence and prognosis using random-effects meta-analyses, with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) use to assess certainty of findings. Meta-regressions explored the impact of region and time-frame (vaccine roll-out) on heterogeneity. PROSPERO: CRD42021284981. Findings 77 studies comprising over 200,000,000 participants were included. Compared with White majority populations, we observed an increased risk of testing positive for infection for people from Black (adjusted Risk Ratio [aRR]:1.78, 95% CI:1.59-1.99, I2 = 99.1), South Asian (aRR:3.00, 95% CI:1.59-5.66, I2 = 99.1), Mixed (aRR:1.64, 95% CI:1.02-1.67, I2 = 93.2) and Other ethnic groups (aRR:1.36, 95% CI:1.01-1.82, I2 = 85.6). Black, Hispanic, and South Asian people were more likely to be seropositive. Among population-based studies, Black and Hispanic ethnic groups and Indigenous peoples had an increased risk of hospitalisation; Black, Hispanic, South Asian, East Asian and Mixed ethnic groups and Indigenous peoples had an increased risk of ICU admission. Mortality risk was increased for Hispanic, Mixed, and Indigenous groups. Smaller differences were seen for prognosis following infection. Following hospitalisation, South Asian, East Asian, Black and Mixed ethnic groups had an increased risk of ICU admission, and mortality risk was greater in Mixed ethnic groups. Certainty of evidence ranged from very low to moderate. Interpretation Our study suggests that systematic ethnic inequalities in COVID-19 health outcomes exist, with large differences in exposure risk and some differences in prognosis following hospitalisation. Response and recovery interventions must focus on tackling drivers of ethnic inequalities which increase exposure risk and vulnerabilities to severe disease, including structural racism and racial discrimination. Funding ESRC:ES/W000849/1.
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Affiliation(s)
- Patricia Irizar
- School of Social Sciences, University of Manchester, United Kingdom
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
| | - Dharmi Kapadia
- School of Social Sciences, University of Manchester, United Kingdom
| | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Harry Taylor
- School of Social Sciences, University of Manchester, United Kingdom
| | - Sarah Amele
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Eliud Kibuchi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Pip Divall
- University Hospitals of Leicester, Education Centre Library, Glenfield Hospital and Leicester Royal Infirmary, United Kingdom
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, United Kingdom
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, United Kingdom
- Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, United Kingdom
- NIHR Leicester Biomedical Research Centre, United Kingdom
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dos Santos M, Oliveira Penteado J, de Lima Brum R, da Silva Bonifácio A, Florêncio Ramires P, de Franceschi Gariboti D, Santos Cardoso RM, da Silva Júnior FMR. Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil. SPATIAL DEMOGRAPHY 2023; 11:1-17. [PMID: 36685786 PMCID: PMC9841953 DOI: 10.1007/s40980-022-00112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 01/18/2023]
Abstract
The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.
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Affiliation(s)
- Marina dos Santos
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Júlia Oliveira Penteado
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Rodrigo de Lima Brum
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Alicia da Silva Bonifácio
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Paula Florêncio Ramires
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Diuster de Franceschi Gariboti
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Ruana Michela Santos Cardoso
- grid.411252.10000 0001 2285 6801Universidade Federal de Sergipe – UFS, Av. Marechal Rondon, S/N - Jardim Rosa Elze, São Cristóvão, SE 49100-000 Brazil
| | - Flavio Manoel Rodrigues da Silva Júnior
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
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Novak B, Hernández Flores JA. A year and a half into the pandemic in Mexico: evidence of differences in COVID-19 mortality between Indigenous and non-Indigenous populations continues to accumulate. ALTERNATIVE (AUCKLAND, N.Z. : 2005) 2022; 18:613-624. [PMID: 38603405 PMCID: PMC9646890 DOI: 10.1177/11771801221134710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Among the groups most vulnerable to COVID-19 are Indigenous populations around the world, and in particular, the Mexican Indigenous population. We used public data made available by the General Directorate of Epidemiology of the Mexican Ministry of Health to compare the risk of COVID-19 mortality among the Indigenous and non-Indigenous Mexican population one and a half years into the pandemic. The analytical sample comprises 3,545,952 Mexicans who were diagnosed as infected with severe acute respiratory syndrome coronavirus-2 between March 18, 2020, and September 16, 2021, of which 1.0% (36,195) are Indigenous. Based on parametric survival models, our results show that the risk of death among Indigenous individuals is 52% higher than that of their non-Indigenous counterparts, regardless of age, sex, area of residence, health service, number of chronic diseases, and obesity status. These results suggest that certain structural conditions of the Mexican Indigenous population increase their vulnerability to the pandemic.
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Affiliation(s)
- Beatriz Novak
- Center for Demographic, Urban and Environmental
Studies, El Colegio de México, Mexico
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Descriptive analysis of deaths associated with COVID-19 in Fiji, 15 April to 14 November 2021. Western Pac Surveill Response J 2022; 13:1-8. [PMID: 36817498 PMCID: PMC9912270 DOI: 10.5365/wpsar.2022.13.4.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective There is limited published information about deaths due to coronavirus disease 2019 (COVID-19) in Fiji, the World Health Organization's Western Pacific Region and low- and middle-income countries. This report descriptively analyses deaths directly associated with COVID-19 in Fiji by age group, sex, ethnicity, geographical location, vaccination status and place of death for the first 7 months of the 2021 community outbreak. Methods A retrospective analysis was conducted of deaths directly associated with COVID-19 that occurred from 15 April to 14 November 2021 in Fiji. Death rates per 100 000 population were calculated by using divisional population estimates obtained from medical zone nurses in 2021. Results A total of 1298 deaths relating to COVID-19 were reported, with 696 directly associated with COVID-19 and therefore included in the analysis. Of these, 71.1% (495) were reported from the Central Division, 54.6% (380) occurred among males, 75.6% (526) occurred among people of indigenous (iTaukei) ethnicity and 79.5% (553) occurred among people who were unvaccinated. Four deaths were classified as maternal deaths. The highest percentage of deaths occurred in those aged 370 years (44.3%, 308), and the majority of deaths (56.6%, 394) occurred at home. Discussion At-risk populations for COVID-19 mortality in Fiji include males, iTaukei peoples, and older (370 years) and unvaccinated individuals. A high proportion of deaths occurred either at home or during the first 2 days of hospital admission, potentially indicating both a reluctance to seek medical care and a health-care system that was stressed during the peak of the outbreak.
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Maza-Arnedo F, Paternina-Caicedo A, Sosa CG, de Mucio B, Rojas-Suarez J, Say L, Cresswell JA, de Francisco LA, Serruya S, Lic DCFP, Urbina L, Hilaire ES, Munayco CV, Gil F, Rousselin E, Contreras L, Stefan A, Becerra AV, Degraff E, Espada F, Conde V, Mery G, Castaño VHÁ, Umbarila ALT, Romero ILT, Alfonso YCR, Lovato Silva R, Calle J, Díaz -Viscensini CM, Frutos VNB, Laguardia EV, Padilla H, Ciganda A, Colomar M. Maternal mortality linked to COVID-19 in Latin America: Results from a multi-country collaborative database of 447 deaths. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100269. [PMID: 35539820 PMCID: PMC9073212 DOI: 10.1016/j.lana.2022.100269] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database. Methods This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges. Findings We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight. Interpretation This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays. Funding Latin American Center for Perinatology, Women and Reproductive Health.
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Affiliation(s)
- Fabian Maza-Arnedo
- Grupo de Investigación en Cuidados Intensivos y Obstetricia (GRICIO), Universidad de Cartagena, Colombia
| | | | - Claudio G. Sosa
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - Bremen de Mucio
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | - José Rojas-Suarez
- Grupo de Investigación en Cuidados Intensivos y Obstetricia (GRICIO), Universidad de Cartagena, Colombia,Corporación Universitaria Rafael Núñez, Cartagena, Colombia
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jenny A. Cresswell
- Department of Sexual and Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Luis Andrés de Francisco
- Family, Health Promotion and Life Course (FPL), Pan American Health Organization-World Health Organization, United States
| | - Suzanne Serruya
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay
| | | | | | - Erika Saint Hilaire
- San Lorenzo de Los Mina Children Maternity Hospital, Santo Domingo, Dominican Republic
| | - César V. Munayco
- National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Perú
| | - Fabiola Gil
- National Epidemiology, Prevention, and Disease Control Center, Ministry of Health, Perú
| | | | | | - Allan Stefan
- Dr Leonardo Martínez Valenzuela Hospital, San Pedro Sula, Honduras
| | | | | | | | | | - Gustavo Mery
- Family, Promotion and Life Course, PAHO Representation, Costa Rica
| | | | | | | | | | | | - Jakeline Calle
- Ministry of Public Health and Welfare, Asunción, Paraguay
| | | | | | | | | | - Alvaro Ciganda
- Clinical and Research Unit (UNICEM), Montevideo, Uruguay
| | - Mercedes Colomar
- Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay,Clinical and Research Unit (UNICEM), Montevideo, Uruguay,Corresponding author at: Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Montevideo, Uruguay.
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