Rosaura Gutiérrez-Vargas

Objective: During the COVID-19 pandemic, the Indigenous population in Mexico was subject to several factors that caused them to have a higher mortality risk than the non-Indigenous population. These risk factors included language barriers, poverty, comorbidities, inadequate access to health services, lack of social security, limited education, and substandard housing, inter alia. This study aims to determine the factors associated with COVID-19 mortality in the Indigenous population in Mexico. Study Design: Cohort study. Methods: This study utilized data from the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) collected during 2020 and 2021 to examine the population recognized as Indigenous. Results: A total of 506,956 COVID-19 cases were reported, with 0.75% identified as Indigenous. The logistic regression assessed the combined effect of Indigenous status and each risk factor. Adjusted odds ratios (aORs) with or without interaction terms were reported. The identified risk factors were the following: age of > 60 years × Indigenous (aOR 9.19, CI 95% 6.38–13.2, p < 0.001); male × Indigenous (aOR 3.38, CI 95% 2.72–5.53, p < 0.001); and time from symptom onset to seeking care > 7 days × Indigenous (aOR 5.86, CI 95% 4.10–8.37, p < 0.001). Conclusions: Belonging to the Indigenous population is a significant risk factor for COVID-19 mortality in Mexico. Although both Indigenous and non-Indigenous groups share common risk factors, the combined effect of Indigenous status and each risk factor reveals greater vulnerability among the former. Significant interactions were observed with age over 60 years, sex, and delays in seeking medical care after the onset of symptoms.

Background: In 2020, countries implemented universal surveillance to detect and monitor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases. Although crucial for early monitoring efforts, universal surveillance is resource intensive. To understand the implications of transitioning from universal to sentinel surveillance for monitoring SARS-CoV-2 transmissibility, morbidity and mortality, and disease seriousness, we compared measures of SARS-CoV-2 reported from both surveillance strategies in Argentina, Chile, and Mexico. Methods: We obtained weekly case counts in Argentina, Chile, and Mexico, in periods when both universal and sentinel surveillance were ongoing. To assess the countries' surveillance strategies, we measured the proportion of total sites that were included in sentinel surveillance. We compared 8 measures of SARS-CoV-2 transmissibility, morbidity and mortality, and disease seriousness between sentinel and universal surveillance and assessed the correlation between the 2 strategies for the 8 measures. Pearson and Spearman correlation was classified as very strong (rs = 0.8–1.0), strong (rs = 0.60–0.79), moderate (rs = 0.50–0.59), or poor (r < 0.50). Results: The proportion of total sites included in sentinel surveillance was 5.8% for Argentina, 1.1% for Chile, and 7.6% for Mexico. A total of 21 measures were calculated (8 for Mexico, 8 for Chile, and 5 for Argentina). Of these, 17 showed consistency between the 2 surveillance strategies, with strong or very strong correlations (r = 0.66–0.99): all 8 measures for Mexico, 6 of 8 measures for Chile, and 3 of 5 measures for Argentina. Each country had ≥1 measure reflecting transmissibility and ≥1 reflecting morbidity and mortality for which the correlation was strong or very strong. Chile and Mexico also had ≥1 measure of disease seriousness for which the correlation was strong. Conclusions: Our findings suggest that the integration of SARS-CoV-2 into national sentinel surveillance can yield information comparable to that provided by nationwide universal surveillance for measures related to SARS-CoV-2 transmissibility, morbidity and mortality, and seriousness of disease.

Background and Objective: Fibrotic interstitial lung disease (ILD) is associated with high morbidity and mortality. Patients often exhibit impaired nutritional status and alterations in body composition, such as dynapenia and sarcopenia, which correlate with poor pulmonary function, reduced exercise tolerance and diminished quality of life. However, the impact of dynapenia and sarcopenia on prognosis has not been examined extensively in ILD patients.We assessed the impact of dynapenia and sarcopenia as risk factors for mortality and their prevalence in ILD.Methods: Prospective cohort study. ILD was classified into idiopathic pulmonary fibrosis (IPF), connective tissue disease‐related ILD (CTD‐ILD) and chronic hypersensitivity pneumonitis (CHP). Patients over 18 years old with a confirmed diagnosis of ILD were included, while those with diagnoses of cancer, human immunodeficiency virus and neurological disease were excluded. Dynapenia and sarcopenia were determined according to EWGSOP2 criteria.Results: Ninety‐eight ILD patients were included; 33.66% had IPF, 47.96% had CTD‐ILD, and 18.37% had CHP. The mean age was 63.89 ± 12.02 years; 37.76% were male.The risk factors associated with mortality included dynapenia (HR: 2.04, 95% CI: 1.10–3.77, p = 0.022), sarcopenia (HR: 1.88, 95% CI; 1.00–3.33, p = 0.049) and exercise tolerance (HR: 0.99, 95% CI; 0.99–0.99, p = 0.023), adjusted for confounding variables.The prevalence of dynapenia was 45% in ILD; 51% in IPF, 35% in CTD‐ILD and 61% in CHP. The prevalence of sarcopenia was 29%; both IPF (39%) and CHP (50%) had a higher prevalence of sarcopenia than CTD‐ILD (14%).Conclusion: Sarcopenia and dynapenia are independent risk factors for mortality in ILD. image