The risk factors in the face of the SARS-CoV2 pandemic vary according to the sociodemographic and economic conditions in each context. Until April 6, the average age of those who have died due to the COVID-19 in Cuba was 67.2 years. According to the information provided by the health authorities, more than half of them had a history of hypertension, diabetes, pneumonia or other risk factors. That same day, 15 people were reported in a critical or serious condition, whose average age was 64.5 years, and 10 of them had similar previous conditions, especially high blood pressure.
The high percentage of older adults (population 60 years or older) constitutes one of the most important risk factors in the face of the COVID-19. However, the prevalence of chronic diseases, family composition and home conditions are other variables to be addressed by both public and health institutions and citizens.
In Cuba, more than 2 million people are over 60 years old, which represents 20.4% of the population. Among them, more than 50% suffer from at least high blood pressure. As can be seen in the table that follows, the age and prevalence of non-transmittable diseases places almost 1,300,000 older adults in a very high risk group in the face of SARS-CoV2.
Prevalence of diabetes mellitus, high blood pressure and bronchial asthma in older adults
Diseases
Population
Percent
Mellitus diabetes
Hypertension
Bronchial asthma
Total adult population
Source: Prepared by the author based on data from the 2018 Health Statistical Yearbook, the 2018 Population Statistical Yearbook, and the Yearbook.
This very high risk group is estimated considering only older adults with high blood pressure. The estimate is also supported by the results of the 2017 National Survey on Population Aging. According to these findings, 25% of older adults suffer from two chronic conditions, just over 19% have between three and four, and almost 6% suffer from five or more diseases.
However, the prevalence of chronic diseases does not only reach this age group. In general, 1 in 5 of the country’s inhabitants suffers from high blood pressure, 9 out of 100 bronchial asthma and 6 out of 100 diabetes mellitus.
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Main causes of death in Cuba, associated with risk factors in the face of the COVID-19
Heart disorders
Influenza and pneumonia
Lower respiratory tract diseases
Diabetes mellitus
Deaths by total inhabitants
Source: Prepared by the author based on data from the 1985-2018 Health and Social Assistance Statistical Series, and the 2018 Demographic Yearbook of Cuba.
Cardiovascular diseases, influenza, pneumonia, chronic diseases of the lower respiratory tract and diabetes mellitus are among the top 10 causes of death in Cuba, and account for more than a third of deaths that occur each year.
Deaths due to causes associated with COVID-19 risk factors
Total deaths
Total deaths from causes associated with COVID-19 risk factors
Source: Prepared by the author based on data from the 1985-2018 Health and Social Assistance Statistical Series, and the 2018 Demographic Yearbook of Cuba.
In 2016, the WHO Global Health Observatory projections indicated that 16.4% (119,373 persons) of the Cuban population between 30 and 34 years old will die before reaching 70, due to cardiovascular disease, cancer, diabetes or chronic respiratory disease.
In general, in the population up to 59 years of age, the prevalence of these diseases varies slightly, as indicated in the following table:
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Population at risk in Cuba in the face of Covid-19
Risks by age and disease
Population
Percent
Prevalence of diabetes mellitus up to 59 years
Prevalence of high blood pressure up to 59 years
Prevalence of bronchial asthma up to 59 years
Older adults
Total population
Source: Prepared by the author based on data from the 2018 Health Statistical Yearbook, the 2018 Population Statistical Yearbook, and the 2018 Demographic Yearbook of Cuba.
The previous data indicates that, if we add the elderly, and people up to 59 years old who suffer from high blood pressure (without considering asthmatics and diabetics), we find that more than 3.5 million Cubans constitute the population at risk in the face of COVID -19.
The main protection measures are common to all, and emphasize preventive isolation and hygiene practices such as systematic hand washing. However, family composition and home conditions affect compliance with these measures and can accentuate the disadvantage of the population at risk.
The graph that follows shows the composition of households in private dwellings, and the presence in them of people aged 60 and over. In 39.8% of Cuban households there is at least one older adult. Of the households, 7.4% are made up of a person 60 years of age or older who lives alone.
Both are very vulnerable. Those who live alone are more exposed to the need to carry out activities such as searching for food, medicines, making bank payments and collections, etc. Those who share the home with other family members potentially have their direct support and help, but they are also exposed to contagion if the members of the household do not comply with the protection measures.
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Households with people aged 60 and over, in private dwellings
Personas = persons
Source: National Population and Housing Census Report, Cuba 2012.
On the other hand, household conditions and access to water service are also relevant variables for crisis management. Hand washing frequently involves an additional effort for more than 4 million people in Cuba, who do not have tap water inside the home.
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Population residing permanently in private dwellings by source of water supply
Tap water inside the house
Tap water outside the home
Water through cistern trucks
Population
Water supply source
Source: National Population and Housing Census Report, Cuba 2012.
Having access to water services or not is aggravated by the drought and the situation of the country’s supply and pipe lines. According to the Meteorological Institute’s Climate Center, 90% of the national territory suffered short-term meteorological drought in the January-March quarter; and according to the National Institute of Hydraulic Resources, different localities of the country present affectations in the water service.
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Number of persons affected by water supply by region, in March 2020
West
Center
East
Source: Prepared by the author based on data provided by Antonio Rodríguez Rodríguez, president of the National Institute of Hydraulic Resources, at the “Cuba contra la COVID-19” Mesa Redonda television program, on March 24, 2020.
For example, in Havana, the province with the highest population density, 78% of the pipe lines have been rehabilitated, but only 36% of the supply lines. More than a fifth of the population in the country’s capital suffers from limitations in the water supply service due to changes in the cycle and schedule.
The chances of getting sick from COVID-19 grow as the pandemic spreads. The risk variables–associated with age, and the presence or absence of chronic diseases–and vulnerability–given the composition of the family and household conditions–considerably affect the Cuban population. More than generating alarms, these data are intended to encourage the informed decisions that help take care of us, take care of our loved ones and our communities.
Sources:
Antonio Rodríguez Rodríguez, president of the National Institute of Hydraulic Resources, at the “Cuba contra la COVID-19” Mesa Redonda television program, on March 24, 2020.
Institute of Meteorology’s Climate Center.
Department of Medical Records and Health Statistics, Cuban Ministry of Public Health (2019). 2018 Health Statistical Yearbook. Edition 47. MINSAP, Havana. ISSN: 1561-4433. Available at https://temas.sld.cu/estadisticassalud/
MINSAP. Official Coronavirus Information in Cuba. https://salud.msp.gob.cu/
ONEI (2014). National Population and Housing Census Report, Cuba 2012.
ONEI and Center for Population and Development Studies (2019). 2018 Demographic Yearbook of Cuba.
ONEI and MINSAP (2019). National Survey on Population Aging ENEP-2017.
ONEI. 2016 Demographic Yearbook of Cuba.
ONEI. 2018 Population Statistical Yearbook.
ONEI. 1985-2018 Health and Social Assistance Statistical Series.
The Global Health Observatory.
*This text was originally published in El Toque/Periodismo de Barrio. It is reproduced with the express authorization of both media.
Authors
Anidelys Rodríguez Brito,
anidelys
