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Dueñas-Espín I, Armijos-Acurio L, Espín E, Espinosa-Herrera F, Jimbo R, León-Cáceres Á, Nasre-Nasser R, Rivadeneira MF, Rojas-Rueda D, Ruiz-Cedeño L, Tello B, Vásconez-Romero D. Is a higher altitude associated with shorter survival among at-risk neonates? PLoS One 2021; 16:e0253413. [PMID: 34260612 PMCID: PMC8279317 DOI: 10.1371/journal.pone.0253413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We hypothesize that high altitudes could have an adverse effect on neonatal health outcomes, especially among at-risk neonates. The current study aims to assess the association between higher altitudes on survival time among at-risk neonates. METHODS Retrospective survival analysis. Setting: Ecuadorian neonates who died at ≤28 days of life. Patients: We analyzed the nationwide dataset of neonatal deaths from the Surveillance System of Neonatal Mortality of the Ministry of Public Health of Ecuador, registered from 126 public and private health care facilities, between January 2014 to September 2017. Main outcome measures: We retrospectively reviewed 3016 patients. We performed a survival analysis by setting the survival time in days as the primary outcome and fixed and mixed-effects Cox proportional hazards models to estimate hazard ratios (HR) for each altitude stratum of each one of the health care facilities in which those neonates were attended, adjusting by individual variables (i.e., birth weight, gestational age at birth, Apgar scale at 5 minutes, and comorbidities); and contextual variables (i.e., administrative planning areas, type of health care facility, and level of care). RESULTS Altitudes of health care facilities ranging from 80 to <2500 m, 2500 to <2750m, and ≥2750 m were associated respectively with 20% (95% CI: 1% to 44%), 32% (95% CI:<1% to 79%) and 37% (95% CI: 8% to 75%) increased HR; compared with altitudes at <80 m. CONCLUSION Higher altitudes are independently associated with shorter survival time, as measured by days among at-risk neonates. Altitude should be considered when assessing the risk of having negative health outcomes during neonatal period.
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Affiliation(s)
- Iván Dueñas-Espín
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Luciana Armijos-Acurio
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Estefanía Espín
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad de las Américas (UDLA) and Facultad de Medicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Fernando Espinosa-Herrera
- Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad de las Américas (UDLA) and Facultad de Medicina, Universidad Central del Ecuador, Quito, Ecuador
- Sociedad Ecuatoriana de Medicina Familiar (SEMF), Quito, Ecuador
| | - Ruth Jimbo
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Ángela León-Cáceres
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Tropical Herping, Quito, Ecuador
| | - Raif Nasre-Nasser
- Programa de Pós-graduação em Ciências Fisiológicas, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande (FURG), Rio Grande, Brasil
| | - María F. Rivadeneira
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - David Rojas-Rueda
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Laura Ruiz-Cedeño
- Postgrado de Pediatría, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Betzabé Tello
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Daniela Vásconez-Romero
- Postgrado de Pediatría, Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
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