Asociación entre la patogenia del virus SARS-CoV-2 y la altitud sobre el nivel del mar en Colombia

Abstract

Introducción: Se ha documentado que las poblaciones que habitan en altas altitudes (entre 2,500 a 3,000msnm) (1) viven bajo condiciones de hipoxia crónica, favoreciendo una regulación disminuida en la producción de la ACE2 como mecanismo fisiológico, lo que podría afectar la patogénesis del SARS-CoV-2 y el desarrollo de complicaciones graves de la COVID-19(2). Objetivo: Determinar la asociación que existe entre la patogenia del virus SARS-CoV-2 y la altitud sobre el nivel del mar en Colombia. Métodos: Estudio ecológico, analítico. La unidad de medida son los municipios en donde se confirmaron casos positivos de COVID-19 entre el 06 de marzo 2020 al 06 de marzo de 2021. Los datos fueron obtenidos de fuentes administrativas públicas en Colombia como el INS, DANE, SISPRO e IDEAM. Como factores de confusión se incluyeron las prevalencias de comorbilidades por municipio: HTA, diabetes mellitus, EPOC, ERC y sobrepeso-obesidad y la distribución etaria de cada municipio.

Introduction: It has been documented that populations living at high altitudes (between 2,500 and 3,000MASL (1) live under conditions of chronic hypoxia, favoring a decreased regulation of ACE2 production as a physiological mechanism, which could affect the pathogenesis of SARS -CoV-2 and the development of serious complications of COVID-19(2). Objective: To determine the association that exists between the pathogenesis of the SARS-CoV-2 virus and the altitude above sea level in Colombia. Methods: Ecological, analytical study. The unit of measurement is the cities where positive cases of COVID 19 were confirmed between March 6, 2020, and March 6, 2021. The data was obtained from public administrative sources in Colombia such as the INS, DANE, SISPRO and IDEAM. Confounding factors included the prevalence of comorbidities by municipality: hypertension, diabetes mellitus, COPD, CKD, and overweight-obesity, and the age distribution of each city. Results: 1,111 cities of Colombia were included, 35.87% are above 2,500MASL. A lethality of 2.77% (n= 63,037) was found, and 3.46% (n= 78,678) presented some type of complication (death, hospitalization or ICU admission). A crude association was found between altitude and mortality (RR=0.76, CI: 0.75-0.77), and between altitude and complications (RR=0.78, CI: 0.77-0.79). However, when adjusting for confounding factors, it is not possible to determine the association between altitude (RR 1.00 CI: 0.85-1.17) and lethality or complications (RR 0.97 CI: 0.84-1.12) of COVID-19 in Colombia).