Association between the Multidimensional Poverty Measure and COVID-19 mortality in Colombia

Abstract Background Different socioeconomic aspects have been related to mortality from COVID-19. For this reason, the objective of this study was to analyze the association between the Multidimensional Poverty Measure at the municipal level (MPM) and the clinical outcome of mortality in the resident population of Colombia with a diagnosis of COVID-19. Methods Observational, non-concurrent cohort study of confirmed cases of COVID-19 reported in Colombia by August 2021. The main outcome variable was mortality from COVID-19, and the main exposure variable was MPM. The covariates included in the analysis were patient's sex, age, and municipality of residence. Unadjusted and adjusted logistic models were used using balanced random samples of deaths and recovered patients, calculating odds ratios (OR) and 95% confidence interval ranges (CI). Results In total, 4,194,538 cases of COVID-19 were included in the analysis, of which approximately 3% died. According to the adjusted multivariate analysis, it was found that patients who live in municipalities with an MPM between 20 to 40%, 41 to 60%, 61 to 80% and more than 80% had an OR of 1.6 (95% CI 1.4 to 1.8), 1.6 (95% CI 1.3 to 1.9), 1.7 (95% CI 1.2 to 2.5), and 2.2 (95% CI 0.7 to 7.8), respectively, for mortality from COVID-19 compared with an MPM of less than 20%. When analyzing the data according to sex for the MPM from 20 to 40%, 41 to 60%, 61 to 80% and more than 80%, an OR for women of 1.7 (95% CI 1.5 to 2.0), 1.8 (95% CI % 1.5 to 2.1), 1.9 (95% CI 1.3 to 2.6) and 2.8 (CI 0.9 to 10.1) respectively. For men an OR of 1.5 (95% CI 1.3 to 1.7), 1.4 (95% CI 1.2 to 1.7), 1.6 (95% CI 1.1 to 2.3) and 1.9 (95% CI 0.6 to 6.0) respectively compared to a MPM less than 20%. Conclusions The risk of mortality from COVID-19 in Colombia is increased in populations with higher MPM. Social determinants of health have an important effect on the outcomes of COVID-19. Key messages Only a few studies exist in South America on social determinants in health and COVID-19. This study provides evidence to understand the impact of poverty measures on mortality in COVID-19 patients. Multidimensional poverty measure at the municipal level was associated with increased COVID-19 mortality in a large cohort of patients from the Colombian population.


Background:
Migration is a risk factor for both, poor maternal experience with healthcare services (MEHCS) and postpartum depressive symptoms (PPDS), a matter of concern due to their adverse consequences. We aimed to assess the association between MEHCS and PPDS taking into account the migration status. Methods: This is part of a population-based study (baMBINO project), enrolling native (PT; n = 1568), permanent migrant (PM; n = 676) and temporary migrant (TM; n = 757) women recruited at delivery (2017)(2018)(2019) in 32 Portuguese public hospitals. MEHCS was assessed based on 39 items of the Migrant Friendly Maternal Care Questionnaire asking about how women have experienced maternal care during pregnancy, during delivery and after birth. Items were grouped into 9 components each one assessing a different issue of MEHCS. For each component women were classified as having ''good'' or ''less than good'' experience. PPDS were assessed using the Edinburgh Postnatal Depression Scale (cut-off12). Multivariate logistic regression model was fitted to estimate the association between MEHCS and PPDS. Adjusted odds ratio (aOR) and respective 95% confidence interval were obtained. Results: PPDS were reported by 3.8%, 5.8% and 8.2% of PT, PM and TM women, respectively (p < 0.001). After adjustment, 4 out 9 components of MEHCS appeared related with PPDS, such that women reporting less than good experience with ''understanding information'' (aOR = 1.72 95%CI:1.14-2.60), ''decisions according to maternal wishes'' (aOR = 1.56 95% CI:1.04-2.34), ''time waiting for healthcare'' (aOR = 1.50 95%CI:1.04-2.18) and ''healthcare provider's attitudes during pregnancy'' (aOR = 1.58 95%CI:1.01-2.47) showed higher odds of PPDS than women reporting good experience.

Conclusions:
Further than the migration status, poor experience with some issues of maternal care seems play a role in the risk of PPDS Key messages: Awareness should be given to maternal care experience. Public health strategies should address factors underlying a positive maternal experience. Poverty Measure at the municipal level (MPM) and the clinical outcome of mortality in the resident population of Colombia with a diagnosis of COVID-19.

Methods:
Observational, non-concurrent cohort study of confirmed cases of COVID-19 reported in Colombia by August 2021. The main outcome variable was mortality from COVID-19, and the main exposure variable was MPM. The covariates included in the analysis were patient's sex, age, and municipality of residence. Unadjusted and adjusted logistic models were used using balanced random samples of deaths and recovered patients, calculating odds ratios (OR) and 95% confidence interval ranges (CI).

Conclusions:
The risk of mortality from COVID-19 in Colombia is increased in populations with higher MPM. Social determinants of health have an important effect on the outcomes of COVID-19.

Key messages:
Only a few studies exist in South America on social determinants in health and COVID-19. This study provides evidence to understand the impact of poverty measures on mortality in COVID-19 patients.
Multidimensional poverty measure at the municipal level was associated with increased COVID-19 mortality in a large cohort of patients from the Colombian population.

Background:
Coal miners with coal workers' pneumoconiosis (CWP, J60 according to ICD-10) were previously found to have a significantly higher risk of lung carcinoma compared to the general male population. The presented study aimed to analyze the incidence of lung carcinoma in miners, histopathological findings in cohorts with and without CWP, and effect of smoking cessation on the histopathological profile.

Methods:
Analysed cohorts consisted of miners with (n = 3476) and without (n = 6687) CWP. Data on personal and working history obtained from the medical records were combined with information on lung cancer from the Czech Oncological Register and histopathological findings. Statistical analysis was performed using non-parametric tests and the incidence risk ratio (significance level of 5%).

Results:
In 1992-2015, 180 miners (2.7%) without CWP and 169 (4.9%) with CWP, respectively, were diagnosed with lung carcinoma. The risk of lung cancer in miners with CWP was 1.82 (95% CI: 1.48-2.25) times higher than in those without CWP. Squamous cell carcinoma (37%) was the most common histopathological type, followed by adenocarcinoma (22%) and small cell carcinoma (21%). A statistically significant difference between the cohorts (p = 0.003) was found in the histopathological subtypes, with the incidence of small cell carcinoma being 2 times higher in miners without CWP than in those with CWP. Only a few individuals with lung carcinoma were non-smokers. The incidence of small cell carcinoma, which is strongly associated with smoking, is significantly higher in miners without CWP.

Conclusions:
Smoking constitutes the most important risk factor for developing lung carcinoma even in that cohort. However, CWP remains a very important risk factor. This work was supported by grant of Research Support Foundation, Vaduz. Markus R. Tödtli Consulting and project Healthy Aging in the Industrial Environment CZ.02.1.01/0.0/ 0.0/16_019/0000798 (HAIE).

Key messages:
The risk of lung cancer in black coal miners with coal workers' pneumoconiosis (CWP) was 1.82 (95% CI: 1.48-2.25) times higher than in those without CWP.
The incidence of small cell carcinoma was 2 times higher in black coal miners without CWP than in those with CWP.
Abstract citation ID: ckac130.090 Dietary exposure to acrylamide and breast cancer risk: results from the NutriNet-Santé cohort