COVID death rate 4X less at high altitude (more UVB which makes Vitamin D) - Oct 2023

Effect of altitude on COVID-19 mortality rate and case incidence in Peru, the country with the highest cumulative mortality rate worldwide

Journal of Public Health (2023)
Valeria Alejandra Castillo-Uribe, Betsabe Milagros Cucho-Vásquez, Zoë Lucía Contreras-León, Roberto Alfonso Accinelli, Leandro Huayanay-Falconi & Fernando Rafael Chu-Rivera

Background
Peru had the highest COVID-19 cumulative mortality rate worldwide. A greater disadvantage in the population infected with COVID-19 living under chronic hypoxia would be expected. However, previous studies reported a lower mortality at higher altitudes.

Aim
The study assessed the relationship between altitude and COVID-19 mortality rate and case incidence in Peru at a district level from March 6, 2020, to February 28, 2022, and in its three waves.

Subject and methods
This was an ecological, analytical study examining open data for 1874 Peruvian districts, ranging from 3 to 4675 m, with 3,372,962 COVID-19 cases and 212,017 deaths. Correlation statistics and a multivariate linear regression model were used to assess this relationship in this period and in three arbitrarily defined waves.

Results
A negative coefficient of −0.00012 (95% CI −0.00015 to −0.00008) between altitude and mortality rate during the pandemic was obtained, corresponding to a 5.82% decrease in mortality for every 500 m. Similar findings for the three waves were observed, the first one with −0.000142 (95% CI −0.000178 to −0.000106); the second one, −0.000071 (95% CI −0.000101 to −0.000041); and the third one, −0.000017 (95% CI −0.000027 to −0.000006), equivalent to a decrease in mortality of 6.85%, 3.5%, and 0.85% for every 500 m. A coefficient of −0.0000905 (95% CI −0.000134 to −0.000047) between altitude and case incidence was observed, meaning a 4.42% decrease for every 500 m. In the first and third waves, a 5.06% and 3.92% decrease in incidence was found for every 500 m.

Conclusion
Altitude had a protective effect against COVID-19 mortality and case incidence in Peru.
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