High Altitudes, Population Density, and Poverty: Unraveling the Complexities of Covid-19 in Peru During the Years 2020-2022

Several factors related to hospitalizations, morbidity, and mortality from COVID-19, such as sex, age, and comorbidities, have been identified. However, limited exploration has been done on geographic and socioeconomic factors that could significantly impact these outcomes. This study aimed to determine whether altitude, population density, and percentage of population in total poverty are associated with COVID-19 positive cases (CPC) and deaths due to COVID-19 (DC) in Peru, from 2020 to 2022. This study utilized a multiple group ecological design and relied on secondary databases containing daily records of CPC and DC. An epidemiological analysis was performed, subsequently processed using a random effects model. As of August 2022, Peru had recorded a total of 3,838,028 COVID-19 positive cases (CPC) and 215,023 deaths due to COVID-19 (DC). Our analysis revealed a statistically significant negative association between altitude and both CPC (aBETA: -4.24; Standard Error: 1.23; p<0.05) and DC (aBETA: 12.56; Standard Error: 3.27; p<0.05). Moreover, we observed a positive association between population density and CPC (aBETA: -0.23; Standard Error: 0.07; p<0.05) and DC (aBETA: 0.75; Standard Error: 0.18; p<0.05). However, we found no significant association between the percentage of population in total poverty and COVID-19 incidence. Our study found that an increase in altitude was associated with a decrease in both CPC and DC, while an increase in population density was associated with an increase in both CPC and DC.