Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care

Rosa Magallón-Botaya, Bárbara Oliván-Blázquez, Karen Lizzette Ramírez-Cervantes, Fátima Méndez-López- de-la-Manzanara, Isabel Aguilar-Palacio, Marc Casajuana-Closas and Eva Andrés-Esteban
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Rosa Magallón-Botaya: GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
Bárbara Oliván-Blázquez: GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
Karen Lizzette Ramírez-Cervantes: Department of Applied Economics, Rey Juan Carlos University, 28300 Madrid, Spain
Fátima Méndez-López- de-la-Manzanara: GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
Isabel Aguilar-Palacio: GAIAP Research Group, Institute for Health Research Aragon (IIS Aragon), 50009 Zaragoza, Spain
Marc Casajuana-Closas: Research Network on Preventive Activities and Health Promotion (RedIAPP), 08007 Barcelona, Spain
Eva Andrés-Esteban: Department of Applied Economics, Rey Juan Carlos University, 28300 Madrid, Spain

IJERPH, 2021, vol. 18, issue 7, 1-11

Abstract: Background : The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods : A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results : The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions : Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.

Keywords: COVID-19; primary health care; geographic factors; outcomes (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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