LAUSR

Objectives This study aimed to evaluate the association of chronic diseases and Indigenous ethnicity on the poor prognosis of coronavirus disease 2019 (COVID-19) outpatients and hospitalised patients in Mexico. Study design Observational study of consecutive COVID-19 cases that were treated in Mexican health care units and hospitals between February 27 and April 27, 2020. Methods Epidemiological, clinical and sociodemographic data were analysed from outpatients and hospitalised patients. Cox regression models were used to analyse the risk of mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Results In total, 15,529 COVID-19 patients were characterised; 62.6% were aged over 40 years, 57.8% were male and 1.4% were of Indigenous ethnicity. A high proportion had a history of diabetes (18.4%), hypertension (21.9%) and obesity (20.9%). Among hospitalised patients, 11.2% received health care in the intensive care unit. Advanced age, being male, Indigenous ethnicity and having a history of chronic diseases, such as hypertension, diabetes and obesity, were significantly associated with a high risk of death following SARS-CoV-2 infection. Diabetes and obesity were the comorbidities most highly associated with death through the models used in this study. Moreover, living in Mexico City and Mexico State (where there is easy access to medical services) and walking (rather than driving or getting public transport), were negatively associated with mortality after SARS-CoV-2 infection. Conclusions Diabetes, hypertension and obesity, combined with older age, being male and Indigenous ethnicity increase the risk of death following SARS-CoV-2 infection in the Mexican population. It is recommended that the incidence of COVID-19 is monitored in Indigenous communities and access to health services is increased nationwide.