Dear Editor:
The reasons why Latin America has one of the highest global mortality rates associated with the 2019 coronavirus disease (COVID-19) are still unknown1. The double health burden posed by obesity and COVID-19 in the American continent is added to a macroeconomic reality of great inequalities2. Some clinicians working at our hospital realized that the proportion of Latin Americans affected by COVID-19 seemed to be even higher during the second wave of the pandemic compared to the first one, particularly among the population of overweight/obese Latin American women. Using a clinical case time series observational design, we formed a cohort of patients who had been admitted for COVID-19 to University Hospital La Princesa during the first (1 January 2020 to 31 July 2020) and second (1 August 2020 to 8 December 2020) waves of the pandemic. We analyzed the distribution of demographic variables and the clinical outcomes registered in the hospital's computerized health care information system (HCIS), particularly focusing on variables of country of origin, sex, and body mass index (BMI).
We extracted data from a total of 2692 medical records of hospital admissions due to COVID19, and, after regrouping readmissions, we obtained a final cohort of 2567 patients. The mean age ± standard deviation (SD) of the patients was 67.7 ± 17.1 years, with 46% of them being women with a mean BMI of 27.0 ± 5.9 kg/m2. Of these patients, 1490 had been admitted during the first wave of the pandemic and 1077 during the second one. The proportion of Latin American patients admitted was 17.3% during the first wave and 24.7% during the second one (p < 0.001). In particular, the proportion of Latin American women admitted for COVID-19 increased from 9.2% to 12.5% during the second wave (p < 0.01). On specific dates, all new admissions exclusively corresponded to Latin American patients. Table 1 shows that both the duration of the hospital stay and the mortality rates were lower among the group of Latin American patients (p < 0.001). Furthermore, in the first group, 12 (4.4%) patients required non-invasive mechanical ventilation (NIMV), 14 (5.1%) required invasive mechanical ventilation (IMV), 5 (1.8%) had to be admitted to the Intermediate Respiratory Care Unit (IRCU), and 21 (7.7%) had to be admitted to the Intensive Care Unit (ICU). The mean BMI of the group of Latin American women was 30.5 ± 4.9 kg/m2, which is higher than that of the control group (p = 0.009).
Table 1.
Demographic and clinical characteristics of patients admitted to our hospital for COVID-19 until October 2020: total, Latin American population, and Latin American women.
| Variable | Latin American population (n = 524) | Latin American women (n = 272) | Other (n = 2043) | Total (n = 2567) | p |
|---|---|---|---|---|---|
| Age, mean ± SD | 53.3 ± 12.9 | 69.3 ± 16.9 | 71.4 ± 16.1 | 67.7 ± 17.1 | <0.001 |
| Women, n (%) | 272 (51.9%) | 272 (100%) | 909 (44.5%) | 1181 (46%) | 0.003 |
| Height in cm, mean ± SD | 163 ± 9.1 | 158 ± 6.9 | 167 ± 10.5 | 166 ± 10.3 | 0.014 |
| Weight in kg, mean ± SD | 79.6 ± 15.2 | 74.3 ± 12.5 | 74.9 ± 17.1 | 75.57 ± 16.8 | 0.025 |
| BMI in kg/m2, mean ± SD | 30.4 ± 5.4 | 30.5 ± 4.9 | 26.8 ± 5.01 | 28.3 ± 5.2 | 0.009 |
| Smokers, n | |||||
| Ex-smokers | 52 (9.9%) | 19 | 435 (21.3%) | 487 | <0.001 |
| Current smokers | 15 (2.8%) | 4 | 98 (4.8%) | 113 | 0.071 |
| Comorbidities | |||||
| COPD | 52 (9.9%) | 38 | 301 (14.7%) | 353 | 0.005 |
| Cancer | 15 (2.8%) | 7 | 116 (5.6%) | 131 | 0.012 |
| PTE | 10 (1.9%) | 3 | 102 (4.9%) | 112 | 0.003 |
| Hospital stay duration, mean ± SD | 9.7 ± 11.0 | 9.1 ± 11.1 | 11.9 ± 15.1 | 11.4 ± 14.3 | <0.001 |
| Outcome, n | |||||
| NIMV | 31 (5.9%) | 12 (4.4%) | 87 (4.2%) | 118 | 0.134 |
| IMV | 32 (6.1%) | 14 (5.1%) | 114 (5.5%) | 146 | 0.720 |
| IRCU | 8 (1.5%) | 5 (1.8%) | 42 (2.1%) | 50 | 0.545 |
| ICU | 48 (9.1%) | 21 (7.7%) | 141 (6.9%) | 189 | 0.094 |
| Outcome, n | |||||
| Discharged | 492 (93.9%) | 257 | 1681 (82.3%) | 2173 | <0.001 |
| Deceased | 32 (6.1%) | 15 (5.5%) | 362 (17.7%) | 394 |
Note: Latin American patients vs. other patients.
BMI: body mass index; COPD: chronic obstructive pulmonary disease; ICU: Intensive Care Unit; IMV: invasive mechanical ventilation; IRCU: Intermediate Respiratory Care Unit; NIMV: non-invasive mechanical ventilation; PTE: pulmonary thromboembolism; SD: standard deviation.
Little research has been carried out on the epidemiological distribution of COVID-19 in Spain according to the patients’ nationality and ethnicity3, 4. The social characteristics of these female patients, which include the fact that many of them are domestic workers in other people’s houses, live in a relative state of overcrowding, have potentially precarious jobs, or use public transport more often, may explain why this particular population could be at a higher risk of developing COVID-19 compared with other women who were able to remain isolated or work from home during the health crisis. The existence of a potential bias during the first wave of the pandemic should be considered as a limitation, as only severely ill patients, most of whom corresponded to elderly or institutionalized individuals, were admitted at that time. Another limitation could be a potential selection bias during the second wave of the pandemic, during which there was a greater capacity to admit younger patients, an age group that is overrepresented among the immigrant population.
Our case series confirms that the proportion of overweight/obese Latin American women admitted for COVID-19 was higher during the second wave of the pandemic compared to the first one. However, their mortality associated with COVID-19 was lower and the duration of their hospital stay did not differ from that of the non-Latin American population. It would be interesting to analyze the reasons for this increased frequency of hospitalizations and to propose specific information and prevention campaigns targeting the Latin American population living in Spain5.
Funding
We received no funding for the conduct of this research.
Conflicts of interest
The authors declare no conflicts of interest.
Footnotes
Please cite this article as: Bengelloun AK, Ortega GJ, Soriano JB. Impacto de la COVID-19 en la población latinoamericana en España durante la primera y segunda ola. Med Clin (Barc). 2021;157:496–497.
References
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