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Association between mortality from COVID-19 and altitude during 2020 in Ecuador. An ecological study

Abstract:

Objective: This study aims to ascertain the correlation between COVID-19 mortality and altitude in Ecuador throughout 2020. Methods: This observational, ecological study focuses on the city as the unit of observation. COVID-19 mortality data was sourced from the city compilation of registered deaths, identified by the ICD-10 codes: U071 and U072. Altitude was determined by analyzing a digital elevation model. Given the non-linear relationship between COVID-19 mortality and altitude, a restricted cubic splines model was employed, with the model adjusted for socioeconomic variables. Results: The study incorporated 23,738 deaths across 218 cities. An inverse relationship between mortality and altitude was observed at elevations less than 2000 meters above sea level (masl) (p < 0.05), while a direct relationship was noted from 2000 masl (p < 0.05). Conclusion: In cities situated below 2000 masl, an increase in altitude correlates with lower mortality. Conversely, in towns located above 2000 masl, a higher mortality rate is observed.