A competing risk survival analysis of the sociodemographic factors of COVID-19 in-hospital mortality in Ecuador.

This study aimed to analyze the effect of sociodemographic characteristics on COVID-19 in-hospital mortality in Ecuador from March 1 to December 31, 2020. This retrospective longitudinal study was performed with data from publicly accessible registries of the Ecuadorian National Institute of Statistics and Censuses (INEC). Data underwent a competing risk analysis with estimates of the cumulative incidence function (CIF). The effect of covariates on CIFs was estimated using the Fine-Gray model and results were expressed as adjusted subdistribution hazard ratios (SHR). The analysis included 30,991 confirmed COVID-19 patients with a mean age of 56.57±18.53 years; 60.7% (n = 18,816) were men and 39.3% (n = 12,175) were women. Being of advanced age, especially older than or equal to 75 years (SHR = 17.97; 95%CI: 13.08-24.69), being a man (SHR = 1.29; 95%CI: 1.22-1.36), living in rural areas (SHR = 1.18; 95%CI: 1.10-1.26), and receiving care in a public health center (SHR = 1.64; 95%CI: 1.51-1.78) were factors that increased the incidence of death from COVID-19, while living at an elevation higher than 2,500 meters above sea level (SHR = 0.69; 95%CI: 0.66-0.73) decreased this incidence. Since the incidence of death for individuals living in rural areas and who received medical care from the public sector was higher, income and poverty are important factors in the final outcome of this disease.

A competing risk survival analysis of the sociodemographic factors of COVID-19 in-hospital mortality in Ecuador / Un análisis de supervivencia de riesgos competitivos de los factores sociodemográficos de la mortalidad intrahospitalaria por COVID-19 en Ecuador / Uma análise concorrente de sobrevida de risco dos fatores sociodemográficos da mortalidade intra-hospitalar por COVID-19 no Equador

This study aimed to analyze the effect of sociodemographic characteristics on COVID-19 in-hospital mortality in Ecuador from March 1 to December 31, 2020. This retrospective longitudinal study was performed with data from publicly accessible registries of the Ecuadorian National Institute of Statistics and Censuses (INEC). Data underwent a competing risk analysis with estimates of the cumulative incidence function (CIF). The effect of covariates on CIFs was estimated using the Fine-Gray model and results were expressed as adjusted subdistribution hazard ratios (SHR). The analysis included 30,991 confirmed COVID-19 patients with a mean age of 56.57±18.53 years; 60.7% (n = 18,816) were men and 39.3% (n = 12,175) were women. Being of advanced age, especially older than or equal to 75 years (SHR = 17.97; 95%CI: 13.08-24.69), being a man (SHR = 1.29; 95%CI: 1.22-1.36), living in rural areas (SHR = 1.18; 95%CI: 1.10-1.26), and receiving care in a public health center (SHR = 1.64; 95%CI: 1.51-1.78) were factors that increased the incidence of death from COVID-19, while living at an elevation higher than 2,500 meters above sea level (SHR = 0.69; 95%CI: 0.66-0.73) decreased this incidence. Since the incidence of death for individuals living in rural areas and who received medical care from the public sector was higher, income and poverty are important factors in the final outcome of this disease.

Este estudio tuvo como objetivo analizar el efecto de las características sociodemográficas en la mortalidad intrahospitalaria de los pacientes con COVID-19 confirmado en Ecuador entre el 1 de marzo y el 31 de diciembre de 2020. Se trató de un estudio longitudinal retrospectivo realizado con datos extraídos de registros de acceso público reportados por el Instituto Nacional de Estadística y Censos (INEC) de Ecuador. Los datos se analizaron empleando un enfoque de riesgo competitivo, utilizando estimaciones de la función de incidencia acumulada (FIA). El efecto de las covariables sobre las FIA se estimó mediante el modelo de Fine-Gray, y los resultados se expresaron como cocientes de riesgos de subdistribución (CRS) ajustados. El análisis incluyó 30.991 casos confirmados de COVID-19 con una edad media de 56,57±18,53 años; el 60,7% (n = 18.816) eran hombres y el 39,3% (n = 12.175) mujeres. Los factores que aumentaron la incidencia de muerte por COVID-19 fueron una edad avanzada, con mayor riesgo para los mayores o iguales a 75 años (CRS = 17,97; IC95%: 13,08-24,69); ser hombre (CRS = 1,29; IC95%: 1,22-1,36); residir en zonas rurales (CRS = 1,18; IC95%: 1,10-1,26); y recibir atención en un centro sanitario público (CRS = 1,64; IC95%: 1,51-1,78); mientras que un factor que disminuyó la incidencia de muerte fue residir en altitudes superiores a los 2.500 metros sobre el nivel del mar (CRS = 0,69; IC95%: 0,66-0,73). La mayor incidencia de muerte entre los que residían en zonas rurales y los que recibían atención médica del sector público sugiere que los ingresos y la pobreza son factores importantes en el desenlace final de esta enfermedad.

O objetivo deste estudo foi analisar o efeito de características sociodemográficas sobre a mortalidade intra-hospitalar de pacientes com COVID-19 confirmada no Equador, entre 1º de março e 31 de dezembro de 2020. Este é um estudo longitudinal e retrospectivo desenvolvido com dados extraídos de registros de acesso público declarados pelo Instituto Nacional de Estatística e Censos do Equador (INEC). Os dados foram analisados usando uma abordagem de risco concorrente com estimativas da função de incidência cumulativa (FIC). O efeito das covariáveis sobre as FICs foi estimado pelo modelo de Fine-Gray e os resultados expressos em índices de risco de subdistribuição (IRS) ajustados. A análise incluiu 30.991 casos confirmados da COVID-19 em pacientes com idade média de 56,57±18,53 anos; sendo 60,7% (n = 18.816) do sexo masculino e 39,3% (n = 12.175) do sexo feminino. Os fatores que aumentaram a incidência de óbitos por COVID-19 foram idade avançada, com maior risco para aqueles com 75 anos ou mais (IRS = 17,97; IC95%: 13,08-24,69); ser do sexo masculino (IRS = 1,29; IC95%: 1,22-1,36); residir em áreas rurais (IRS = 1,18; IC95%: 1,10-1,26); e receber atendimento em unidade pública de saúde (IRS = 1,64; IC95%: 1,51-1,78); ao passo que um fator que diminuiu a incidência de óbitos foi residir em altitudes superiores a 2.500 metros acima do nível do mar (IRS = 0,69; IC95%: 0,66-0,73). A maior incidência de óbitos naqueles que residiam em áreas rurais e que receberam atendimento médico do setor público sugere que a renda e a pobreza são fatores importantes no desfecho dessa doença.