墨西哥首轮疫情过后的 SARS-CoV-2 感染病死率。
SARS-CoV-2 infection fatality rate after the first epidemic wave in Mexico.
机构信息
Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca, Mexico.
出版信息
Int J Epidemiol. 2022 May 9;51(2):429-439. doi: 10.1093/ije/dyac015.
BACKGROUND
Estimates of SARS-CoV-2 infection fatality rates (IFRs) in developing countries remain poorly characterized. Mexico has one of the highest reported COVID-19 case-fatality rates worldwide, although available estimates do not consider serologic assessment of prior exposure nor all SARS-CoV-2-related deaths. We aimed to estimate sex- and age-specific IFRs for SARS-CoV-2 in Mexico.
METHODS
The total number of people in Mexico with evidence of prior SARS-CoV-2 infection was derived from National Survey of Health and Nutrition-COVID-19 (ENSANUT 2020 Covid-19)-a nationally representative serosurvey conducted from August to November 2020. COVID-19 mortality data matched to ENSANUT's dates were retrieved from the death-certificate registry, which captures the majority of COVID-19 deaths in Mexico, and from the national surveillance system, which covers the subset of COVID-19 deaths that were identified by the health system and were confirmed through a positive polymerase chain reaction test. We analysed differences in IFRs by urbanization and region.
RESULTS
The national SARS-CoV-2 IFR was 0.47% (95% CI 0.44, 0.50) using death certificates and 0.30% (95% CI 0.28, 0.33) using surveillance-based deaths. The IFR increased with age, being close to zero at age <30 years, but increasing to 1% at ages 50-59 years in men and 60-69 years in women, and being the highest at ≥80 years for men (5.88%) and women (6.23%). Across Mexico's nine regions, Mexico City (0.99%) had the highest and the Peninsula (0.26%) the lowest certificate-based IFRs. Metropolitan areas had higher certificate-based IFR (0.63%) than rural areas (0.17%).
CONCLUSION
After the first wave of the COVID-19 pandemic, the overall IFR in Mexico was comparable with those of European countries. The IFR in Mexico increased with age and was higher in men than in women. The variations in IFRs across regions and places of residence within the country suggest that structural factors related to population characteristics, pandemic containment and healthcare capabilities could have influenced lethality at the local level.
背景
发展中国家 SARS-CoV-2 感染死亡率（IFR）的估计仍描述不足。墨西哥是全球报告 COVID-19 病死率最高的国家之一，尽管现有估计并未考虑对先前暴露的血清学评估，也未考虑所有与 SARS-CoV-2 相关的死亡。我们旨在估计墨西哥 SARS-CoV-2 的性别和年龄特异性 IFR。
方法
从 2020 年 8 月至 11 月进行的全国健康与营养调查-COVID-19（ENSANUT 2020 Covid-19）——一项具有全国代表性的血清学调查中，得出墨西哥有先前 SARS-CoV-2 感染证据的总人数。从死亡证明登记处检索与 ENSANUT 日期匹配的 COVID-19 死亡率数据，该登记处捕获了墨西哥大部分 COVID-19 死亡人数，从国家监测系统中检索了通过卫生系统识别并通过阳性聚合酶链反应测试确认的 COVID-19 死亡人数。我们分析了城市化和地区差异对 IFR 的影响。
结果
使用死亡证明的全国 SARS-CoV-2 IFR 为 0.47%（95%CI 0.44，0.50），使用基于监测的死亡的 IFR 为 0.30%（95%CI 0.28，0.33）。IFR 随年龄增长而增加，在<30 岁时接近零，但在男性 50-59 岁和女性 60-69 岁时增加到 1%，在男性（5.88%）和女性（6.23%）中最高年龄≥80 岁。在墨西哥的九个地区中，墨西哥城（0.99%）的死亡率最高，半岛地区（0.26%）最低。大都市地区的死亡率高于农村地区（0.63%比 0.17%）。
结论
在 COVID-19 大流行的第一波之后，墨西哥的总体 IFR 与欧洲国家相当。墨西哥的 IFR 随年龄增长而增加，男性高于女性。各地区和国内居住地之间 IFR 的差异表明，与人口特征、大流行控制和医疗保健能力相关的结构性因素可能在当地层面影响了死亡率。
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