Abstract
Background
Peru had the highest COVID-19 cumulative mortality rate worldwide. A greater disadvantage in the population infected with COVID-19 living under chronic hypoxia would be expected. However, previous studies reported a lower mortality at higher altitudes.
Aim
The study assessed the relationship between altitude and COVID-19 mortality rate and case incidence in Peru at a district level from March 6, 2020, to February 28, 2022, and in its three waves.
Subject and methods
This was an ecological, analytical study examining open data for 1874 Peruvian districts, ranging from 3 to 4675 m, with 3,372,962 COVID-19 cases and 212,017 deaths. Correlation statistics and a multivariate linear regression model were used to assess this relationship in this period and in three arbitrarily defined waves.
Results
A negative coefficient of −0.00012 (95% CI −0.00015 to −0.00008) between altitude and mortality rate during the pandemic was obtained, corresponding to a 5.82% decrease in mortality for every 500 m. Similar findings for the three waves were observed, the first one with −0.000142 (95% CI −0.000178 to −0.000106); the second one, −0.000071 (95% CI −0.000101 to −0.000041); and the third one, −0.000017 (95% CI −0.000027 to −0.000006), equivalent to a decrease in mortality of 6.85%, 3.5%, and 0.85% for every 500 m. A coefficient of −0.0000905 (95% CI −0.000134 to −0.000047) between altitude and case incidence was observed, meaning a 4.42% decrease for every 500 m. In the first and third waves, a 5.06% and 3.92% decrease in incidence was found for every 500 m.
Conclusion
Altitude had a protective effect against COVID-19 mortality and case incidence in Peru.
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Data availability
All data used for this study are directly downloadable from the publicly available databases “Datos Abiertos” published by the Health Ministry of Peru (Ministerio de Salud), “Información Departamental, Provincial y Distrital de Población que Requiere Atención Adicional y Devengado Per Cápita 2017” published by the National Center of Strategic Planning (Centro Nacional de Planeamiento Estratégico), and “Resultados Definitivos del Censo Nacional 2017” published by National Institute of Statistics and Informatics (Instituto Nacional de Estadística e Informática). The compiled dataset used for this study is available as an Excel spreadsheet at the GitHub repository: https://bit.ly/3K5VFp2
Code availability
The obtained data were analyzed with STATA 16. All the statistical code used for this analysis is provided at the GitHub repository: https://bit.ly/3K5VFp2
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Acknowledgments
The authors would like to express gratitude to Teresa Melgarejo de Roncal for reviewing the manuscript for proper use of the English language.
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All authors contributed to the study conception and design.
Material preparation and data collection and analysis were performed by Betsabe M. Cucho-Vásquez, Fernando R. Chu-Rivera, Valeria A. Castillo-Uribe, and Zoë L. Contreras-León.
Writing, review, and editing were performed by Valeria A. Castillo-Uribe, Roberto A. Accinelli, Zoë L. Contreras-León, Betsabe M. Cucho-Vásquez, and Leonardo Huayanay-Falconi.
The study was conducted under the supervision of Roberto A. Accinelli and Leonardo Huayanay-Falconi.
All authors commented on previous versions of the manuscript.
All authors read and approved the final manuscript.
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As we have used freely available databases, it was not necessary to obtain informed consent. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Universidad Peruana Cayetano Heredia (No. SIDISI: 202671, Date: August 3, 2020)
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The Ethics Committee from the Universidad Peruana Cayetano Heredia approved this study registered under SIDISI 202671.
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Castillo-Uribe, V.A., Cucho-Vásquez, B.M., Contreras-León, Z.L. et al. Effect of altitude on COVID-19 mortality rate and case incidence in Peru, the country with the highest cumulative mortality rate worldwide. J Public Health (Berl.) (2023). https://doi.org/10.1007/s10389-023-02104-y
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DOI: https://doi.org/10.1007/s10389-023-02104-y