Characteristics and risk factors for COVID-19 diagnosis and adverse outcomes in Mexico: an analysis of 89,756 laboratory-confirmed COVID-19 cases.

BACKGROUND: There is insufficient information about risk factors for COVID-19 diagnosis and adverse outcomes from low and middle-income countries (LMICs).
OBJECTIVES: We estimated the association between patients' characteristics and COVID-19 diagnosis, hospitalisation and adverse outcome in Mexico.
METHODS: This retrospective case series used a publicly available nation-level dataset released on May 31, 2020 by the Mexican Ministry of Health, with patients classified as suspected cases of viral respiratory disease. Patients with COVID-19 were laboratory-confirmed. Their profile was stratified by COVID-19 diagnosis or not. Differences among COVID-19 patients based on two separate clinical endpoints, hospitalisation and adverse outcome, were examined. Multivariate logistic regressions examined the associations between patient characteristics and hospitalisation and adverse outcome.
RESULTS: Overall, 236 439 patients were included, with 89 756 (38.0%) being diagnosed with COVID-19. COVID-19 patients were disproportionately older, males and with increased prevalence of one or more comorbidities, particularly diabetes, obesity, and hypertension. Age, male gender, diabetes, obesity and having one or more comorbidities were independently associated with laboratory-confirmed COVID-19. Current smokers were 23% less likely to be diagnosed with COVID-19 compared to non-smokers. Of all COVID-19 patients, 34.8% were hospitalised and 13.0% experienced an adverse outcome. Male gender, older age, having one or more comorbidities, and chronic renal disease, diabetes, obesity, COPD, immunosuppression and hypertension were associated with hospitalisation and adverse outcome. Current smoking was not associated with adverse outcome.
CONCLUSION: This largest ever case series of COVID-19 patients identified risk factors for COVID-19 diagnosis, hospitalisation and adverse outcome. The findings could provide insight for the priorities the need to be set, especially by LMICs, to tackle the pandemic.

The above mentioned article has been retracted at the request of the editors and the publisher.

The article was originally published “early view” in the European Respiratory Journal on 30 July 2020. Subsequent to this, and prior to publication of the version of record in an issue of the European Respiratory Journal, it was brought to the editors’ attention that two of the authors had failed to disclose potential conflicts of interest at the time of the manuscript's submission: that is, one of the authors (José M. Mier) at the time had a current and ongoing role in providing consultancy to the tobacco industry on tobacco harm reduction; and another (Konstantinos Poulas) at the time was a principal investigator for the Greek NGO NOSMOKE, which has its base at Patras Science Park, a science and innovation hub that has received funding from the Foundation for a Smoke Free World (an organisation funded by the tobacco industry).

After careful review of the manuscript content alongside the new disclosures brought to light, and in consultation with the leadership of the European Respiratory Society (the publisher of the journal), the editors and society were in firm agreement that, if these conflicts of interest had been disclosed at the point of manuscript submission, the editors would not have considered the article for publication, for the following main reasons. 1) The manuscript presents some new data on, and provides a section of discussion of, the effect of tobacco consumption on patient susceptibility to COVID-19, and cites other studies that claim SARS-CoV-2 infection is less prevalent in smokers or tobacco users. 2) The European Respiratory Society, as a leading medical organisation in the respiratory field whose mission is to promote lung health and alleviate suffering from respiratory disease, has bylaws in place that do not permit individuals with ongoing relationships with the tobacco industry to participate in its activities: as well as society membership, and participation in congresses and meetings, publication in the society's journals is also considered an activity covered by these rules. 3) Because of these bylaws, at the point of manuscript submission, the submitting author is specifically asked to assert that no potential conflict of interest involving the tobacco industry exists regarding the submitted manuscript. In the case of this article, the submitting author asserted that no such conflict of interest existed, and for this reason the article duly entered the journal's peer review process.

The journal editors acknowledge that COPE (Committee on Publication Ethics) guidelines state that failure to disclose a potential conflict of interest is not normally sufficient grounds for retraction of a published article. However, on balance the editors felt the decision was justified based on the nature of the undisclosed relationship, in the context of the sensitive subject matter presented, and on the need to align the published journal content with the bylaws of the publishing society.

The editors also acknowledge that at no point was there a question of any scientific misconduct on the part of any of the authors, aside from the failure of two contributing authors to disclose their conflicts of interest relating to the tobacco industry.

As these issues were brought to the editors’ attention before the final version of record for the article was published, this notice of retraction (published 4 March 2021) replaces the early view version of the published article, which has now been removed. The editors thank the authors for their cooperation in the matter. The authors did not agree with the decision to retract the article.