Comprehensive evaluation of the impact of sociodemographic inequalities on adverse outcomes and excess mortality during the COVID-19 pandemic in Mexico City.

Antonio-Villa, Neftali Eduardo; Fernandez-Chirino, Luisa; Pisanty-Alatorre, Julio; Mancilla-Galindo, Javier; Kammar-García, Ashuin; Vargas-Vázquez, Arsenio; González-Díaz, Armando; Fermín-Martínez, Carlos A; Márquez-Salinas, Alejandro; Guerra, Enrique C; Bahena-López, Jessica Paola; Villanueva-Reza, Marco; Márquez-Sánchez, Jessica; Jaramillo-Molina, Máximo Ernesto; Gutiérrez-Robledo, Luis Miguel; Bello-Chavolla, Omar Yaxmehen

BACKGROUND The impact of the COVID-19 pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here, we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City. METHODS We analyzed suspected SARS-CoV-2 cases, from the Mexico City Epidemiological Surveillance System from February 24th, 2020, to March 31 st, 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the General Civil Registry. RESULTS We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic. CONCLUSION Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City.