Table_1_Coronavirus Disease-2019 Survival in Mexico: A Cohort Study on the Interaction of the Associated Factors.DOCX

The pandemic caused by the new coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently affecting more than 200 countries. The most lethal clinical presentation is respiratory insufficiency, requiring attention in intensive care units (ICU). The most susceptible people are over 60 years old with comorbidities. The health systems organization may represent a transcendental role in survival.
Objective: To analyze the correlation of sociodemographic factors, comorbidities and health system organization variables with survival in cases infected by SARS-CoV-2 during the first 7 months of the pandemic in Mexico.
Methods: The cohort study was performed in a health system public basis from March 1st to September 30th, 2020. The included subjects were positive for the SARS-CoV-2 test, and the target variable was mortality in 60 days. The risk variables studied were: age, sex, geographic distribution, comorbidities, health system, hospitalization, and access to ICU. Bivariate statistics (X2-test), calculation of fatality rates, survival analyses and adjustment of confusing variables with Cox proportional-hazards were performed.
Results: A total of 753,090 subjects were analyzed, of which the 52% were men. There were 78,492 deaths (10.3% of general fatality and 43% inpatient). The variables associated with a higher risk of hospital mortality were age (from 60 years onwards), care in public sectors, geographic areas with higher numbers of infection and endotracheal intubation without management in the ICU.
Conclusions: The variables associated with a lower survival in cases affected by SARS-CoV-2 were age, comorbidities, and respiratory insufficiency (with endotracheal intubation without care in the ICU). Additionally, an interaction was observed between the geographic location and health sector where they were treated.

由新型冠状病毒严重急性呼吸综合征冠状病毒2型（Severe Acute Respiratory Syndrome Coronavirus-2, SARS-CoV-2）引发的疫情目前已波及200余个国家。其最致命的临床表现为呼吸衰竭，需入住重症监护病房（Intensive Care Unit, ICU）接受救治。易感人群多为60岁以上且伴有基础疾病的群体。医疗系统的组织调度对患者生存率或起到至关重要的作用。
研究目的：分析2020年墨西哥疫情暴发首7个月内，感染SARS-CoV-2患者的社会人口学因素、基础疾病与医疗系统组织相关变量与生存率的相关性。
研究方法：本队列研究依托公立医疗系统开展，纳入时段为2020年3月1日至9月30日。研究对象为SARS-CoV-2核酸检测呈阳性的患者，结局变量为患者60天内的死亡率。本次研究的风险变量包括：年龄、性别、地域分布、基础疾病、医疗保障体系、住院情况及重症监护病房接入情况。研究采用卡方检验（X²-test）进行双变量统计分析，计算病死率，开展生存分析，并通过Cox比例风险模型（Cox proportional-hazards）对混杂变量进行校正。
研究结果：本研究共纳入753090例患者，其中男性占比52%。共计78492例患者死亡，总病死率为10.3%，住院患者病死率为43%。与住院患者更高死亡风险相关的变量包括：60岁及以上年龄、公立医疗机构就诊、高感染率地域分布，以及未在重症监护病房规范管理的气管插管操作。
研究结论：与SARS-CoV-2感染患者生存率降低相关的变量包括年龄、基础疾病，以及未在重症监护病房接受规范管理的呼吸衰竭（需行气管插管）。此外，患者就诊地域与所接受医疗服务的机构类型之间存在交互效应。