COVID-19 trends in Colombian regions with the highest disease burden

Introduction COVID-19 pandemic is currently the most significant global public health challenge, with more than 31 million cases reported to date. Colombia first reported COVID-19 cases in the country by early March 2020, and six months later it has reached ∼750,471 clinical cases, with significant regional differences in morbidity, mortality, and hospitalization rates. Aims Identify population characteristics and hospital capacity in the 13 municipalities with the highest disease notification and examine differences in cumulative reported cases, hospitalization, and mortality rates that may explain the regional differences. Materials and methods A multi-group ecological study was performed based on the information available from public databases. Notification of cases, hospitalization, and crude mortality and age-adjusted rates were calculated. Results The municipalities with the highest COVID-1 burden at different times during the study period displayed significant differences in population density and the proportion of elderly inhabitants, indigenous and afro descendants minorities; indices of unsatisfied basic needs and multidimensional poverty index, as well as the number of hospital beds. Likewise, essential variations in notification rates, hospitalization, and mortality were observed. The highest age-adjusted of reported cases (4,219 cases) and mortality (230.4 cases) rates were found in Leticia, the lowest general hospitalization rates in Buenaventura (37.5 cases) and the lowest ICU hospitalization rates (0) in Leticia and Tumaco due to a lack of these units in these municipalities. Conclusion The probability of getting sick, hospitalized, and dying from COVID-19 appeared closely related to socio-economic, ethnic, and cultural characteristics, and also to hospital bed capacity. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Neither the authors or the institutions belonging to the study have received payments or services from a third party for any aspect of the submitted work. No external financing was received ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: It is an ecological study based on secondary sources open to the public All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes the data mentioned in the manuscript are available 1. The 2018 Colombian national census conducted by the National Administrative Department of Statistics (DANE)