The Impact of the COVID-19 Epidemic on Older Adults in Rural and Urban Areas in Mexico

Objectives: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. Method: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (>= 2,500 and <15,000), semiurban (>= 15,000 and <100,000), and urban (>= 100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-1 9 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. Results: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). Discussion: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.