Inequalities in the COVID-19 Case Fatality Rate at a Hospital Institution in Armenia, Colombia, 2020-2021

OBJECTIVES: To estimate the inequalities presented in the COVID-19 case fatality rate at the Clínica La Sagrada Familia in Armenia, Colombia, during the years 2020 to 2021.

METHODS: For the calculation of the defined inequality indicators (Relative Inequality Index -RID, Concentration Curve -CC, and Concentration Index -IC), the socioeconomic variables chosen were the socioeconomic stratum (1 to 6): area of residence (urban, rural and dispersed rural), health insurance regime (special, contributory, subsidized and uninsured) and nationality (Colombian and foreign). Based on each of the above variables, two questions were established, one for the IRD and the other for the CC, from which they were calculated.

RESULTS: In relative terms, COVID-19 was more lethal among patients in socioeconomic stratum 1 (the worst) than among those in stratum 6 (IRD=-1.13; CI= -0.06) and among uninsured patients than among those insured under the exception regime (CI= -0.03). No inequalities in case fatality were found with respect to nationality (IRD= -2.18; CI=-0.14).

CONCLUSIONS: Although this study has some limitations (data were obtained from surveillance information systems and, therefore, not all cases are likely reported), our findings showed that patients from poorer socioeconomic strata and residing in areas farther from the urban center had a higher fatality rate due to COVID-19 compared to those from better conditions, despite having been treated in the same hospital institution. These findings may reflect important implications of social inequalities and differences in fatality outcomes among the communities studied. This scenario calls for urgent strategies to reduce the spread of prevalent and emerging infectious diseases in underserved communities.