Impact of Environmental Factors on COVID-19 Mortality in Children and Adolescents in Mexico

Objectives: The aim of this study was to assess potential environmental factors associated to COVID-19 mortality in children and adolescents in Mexico. Methods: This cross-sectional study analyzed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at entity level. Multilevel models were fitted to evaluate the association between contextual factors and Covid-19 mortality. Results: A total of 773 (0.6%) children and adolescents died due to COVID-19. Younger patients (OR= 0.874), immune-mediated disease (OR= 1.022, CI95% 1.007-1.037) and obesity (OR= 3.144, CI95% 2.444-4.045) were associated with mortality. Other comorbidities were no associated with fatality. Social Lag Index was positively associated to COVID-19 mortality (ORvery high = 2.886). Children and adolescents with different malnutrition levels showed a high risk of COVID-19 mortality (ORsevere = 1.436; ORmoderate = 1.412; ORmild = 1.404; ORsevere+moderate+mild = 1.421; ORsevere+moderate = 1.438). A low education level was associated with a higher risk of COVID-19 fatality, incomplete education (OR = 1.046, CI95% 1.010-1.082), children of school age of 6-14 years who do not attend school (OR = 1.275, CI95% 1.034-1.572) and population aged 15 and over that are illiterate (OR = 1.087, CI95% 1.001-1.183). Conclusions: Malnutrition and education level are key factors to understand COVID-19 mortality in children and adolescents. Age, obesity, immune-mediated diseases and population density were also associated to a worst COVID-19 prognosis. Funding: Funding Declaration of Interest: We declare no competing interests.