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Clinical Data, Comorbidities, and 
Mortality of COVID-19 in the 
State of Guanajuato, Mexico until 
May 20, 2020 
 
Nicolás Padilla-Raygoza1*, Efraín 
Navarro-Olivos2, María de Jesús 
Gallardo-Luna2, Francisco J. 
Magos-Vázquez2, Daniel Alberto 
Díaz-Martínez2, Cuauhtémoc 
Sandoval-Salazar3, Luis Antonio 
Díaz-Becerril1 
 
1School of Medicine, University of 
Celaya, Celaya Mexico;  
2Institute of Public Health from 
Guanajuato State, Guanajuato, Mexico;  
3Department of Nursing and Obstetrics, 
Division of Health Sciences and 
Engineering, University of Guanajuato, 
Celaya, Mexico 
 
*Corresponding Author 

 
Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2020.527   |   http://cajgh.pitt.edu 



 
 
PADILLA-RAYGOZA 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: In December 2019, cases of pneumonia of unknown cause arose in Wuhan, China. The causative agent was 
subsequently identified as 2019-nCoV and later called SARS-CoV-2. In Mexico, since January 2020 when the first cases were 
reported, the spread of the infection has occurred throughout the country. The state of Guanajuato, which is located in the center of 
the country, has taken isolation measures and closed public places in March 2020. The objective of this study was to analyze the 
evolution, symptoms, co-morbidities and deaths due to confirmed cases of COVID-19. 
Methods: An ecological study was designed from the database of confirmed cases of COVID-19 in the state of Guanajuato. Odds 
ratios and 95% confidence intervals were calculated for symptoms and co-morbidities in deaths of confirmed cases. Logistic 
regression models were generated adjusting for age group and gender. 
Results: Among the 838 confirmed cases in the state, cases with dyspnea and cyanosis showed more significant effect on death. 
Age group and gender had little involvement as confounders. For practically all comorbidities (including diabetes, hypertension, 
cardiovascular disease, chronic kidney disease, and immunosuppression), there was a significant effect (odds ratio greater than 2) 
on mortality from COVID-19. Age group showed a confounding effect on comorbidities and death, but not gender. 
Conclusion: The confirmed cases had more than twice the possibility of having comorbidities, compared with those who did not 
die. 

Keywords: SARS-CoV-2; COVID-19; Population; Deaths; Clinical data; Comorbidities  

Clinical Data, Comorbidities, and 
Mortality of COVID-19 in the State of 
Guanajuato, Mexico, until May 20, 
2020 
 
Nicolás Padilla-Raygoza1, Efraín 
Navarro-Olivos2, María de Jesús 
Gallardo-Luna2, Francisco J. Magos-
Vázquez2, Daniel Alberto Díaz-
Martínez2, Cuauhtémoc Sandoval-
Salazar3, Luis Antonio Díaz-Becerril1 
 
1School of Medicine, University of Celaya, 
Celaya Mexico;  
2Institute of Public Health from Guanajuato 
State, Guanajuato, Mexico;  
3Department of Nursing and Obstetrics, 
Division of Health Sciences and Engineering, 
University of Guanajuato, Celaya, Mexico 

Research 

At the end of 2019, the World Health 
Organization (WHO) office in Wuhan, Hubei Province, 
China, received the report of a case of pneumonia of 
unknown cause1 that was related to other cases of 
pneumonia in people who worked or lived near the local 
Hunan seafood market2-5. The infection spread 
throughout the city and to other countries and was 
declared an international public health emergency by the 
WHO6. The causative agent was determined to be a new 
coronavirus, called 2019-nCoV and later SARS-CoV-2 
by WHO7. It was reported that the cause of COVID-19 
shares 79.5% of the SARS-CoV sequence and uses the 
same cell entry receptor, angiotensin-converting enzyme-
2, as SARS-CoV8. Zhu et al.9 reported the cytopathic 
effects and morphology of the virus and that it is a 
member of a family of coronaviruses that infect humans. 
This virus grew more in human airway epithelial cells 
than tissue culture cells, suggesting the potential for 
increased infectivity. 



 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

COVID-19 patients who present with a 
comorbid condition may have an increased risk of 
deterioration and should therefore be admitted to a 
designated unit for close monitoring in accordance with 
the WHO guidelines for screening and triage10. In a series 
of 41 patients infected with SARS-CoV-2, 32% had some 
underlying pathology, 20% had diabetes, 15% had 
hypertension, 15% had cardiovascular disease, and 2% 
had chronic obstructive pulmonary disease (COPD)11. 

In Mexico, the first detected case started with 
symptoms on January 8, 2020, and the first two deaths 
were reported on March 18, 202012. In the state of 
Guanajuato, before the arrival of the pandemic, the local 
authorities began measures of social isolation. The 
closure of educational institutions at all levels began on 
March 20, 2020, and later, there was the closure of 
restaurants, gyms, and public parks. Meetings with more 
than 10 people were also cancelled. 

The state of Guanajuato is located in the center 
of the Mexican Republic (Longitude # 102° 5'49.2” W # 
99° 40'16.68" W, Latitude 19° 54'46.08" N 21° 50'21.84" 
N13). As of the 2010 Mexican census, Guanajuato had 
5,486,372 inhabitants, accounting for 4.88% of the 
national population14. The state is a relay center for 
transportation to the four cardinal points of Mexico. In 
the state of Guanajuato, the first confirmed case of 
COVID-19 was reported with the onset of symptoms on 
March 10, 2020, and the first two deaths were reported 
on April 5, 202015. The number of confirmed cases of 
COVID-19 in Guanajuato State remained low through 
April, but given the significant dates in May for the 
Mexican population, people began to break social 
isolation, and the number of confirmed cases increased 
markedly. 

The aim of this study was to analyze the effect 
of clinical data and comorbidities on deaths from 
COVID-19 in Guanajuato State, Mexico. This is 
important because few studies are published from 
Mexico and even less so from Guanajuato State. 

Methods 

An analytical ecological study was designed 
with the data reported in the database15 of the Secretary 
of Health of the State of Guanajuato, with confirmed 
cases and deaths from COVID-19 until May 20, 2020. A 
suspected case is one that manifests fever, cough, 
dyspnea, and has had a trip abroad to a country with a 
high frequency of COVID-19 cases or have had contact 
with a confirmed case. A confirmed case is one that, in 
addition to the previous criteria, also tested positive for 
the virus using reverse transcriptase-polymerase chain 
reaction (RT-PCR). 

Sociodemographic variables in the database 
were age and gender. Among the study variables, the date 
of onset of symptoms was collected, as well as the 
clinical data recorded: fever, cough, dyspnea, 
odynophagia, diarrhea, vomiting, headache, chest pain, 
cyanosis, abdominal pain, myalgia, arthralgia, and 
rhinorrhea. All were measured as absent or present. Other 
variables were comorbidities in the confirmed patient: 
diabetes, chronic obstructive pulmonary disease 
(COPD), asthma, immunosuppression, hypertension, 
cardiovascular disease, chronic kidney disease, obesity, 
and smoking. The result variable was death and its date. 
All included registries had a positive RT-PCR test for 
SARS-CoV-2. 

For statistical analysis, descriptive statistics 
were used to show the variables. Odds ratios (OR) and 
corresponding 95% confidence intervals (95% CI) were 
used for clinical data, comorbidities, and COVID-19 
death. Logistic regression models were generated 
between comorbidities and death by COVID-19, using 
age categories and gender as potential confounding 
variables. Statistical analyses were performed using 
STATA 13.0 ® (Stata Corp., College Station, TX, USA). 

 

 

 



 
PADILLA-RAYGOZA 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

Results 

The sample consisted of 838 confirmed cases 
distributed throughout the state, with the municipality of 
León predominating. The distribution by gender was 378 
(45.11%) women and 460 (54.89%) men. Ages ranged 

from 0 to 93 years, with an average of 45.03 ± 17.76 
years.  

Figure 1 shows the municipalities of the state of 
Guanajuato with a report of at least 20 cases; the rest of 
the municipalities had at least one case reported.

Figure 1. Map of Guanajuato State, with municipalities with 20 or more confirmed cases of COVID-19 

Figure 2 shows the distribution of confirmed 
cases of COVID-19 per day. The first detected case in 
Guanajuato State started with symptoms on March 10, 
2020 and the curve remained low, possibly due to the 
measures of social isolation and closure of public places 
that began to be applied in the state as of March 17. 
Throughout April, however, the curve for cases 

increased. The few confirmed cases in mid-May may be 
an artifact due to delayed delivery of RT-PCR test results 
for SARS-CoV-2. Figure 3 shows the distribution of 
deaths due to COVID-19 per day. The specific mortality 
rate (SMR=9.55%) for Guanajuato until May 20, 2020 is 
80 deaths among 838 cases. 



 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by the University Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

Source: SINAVE/DGE15 

Figure 2. Distribution of confirmed cases of COVID-19 by day in Guanajuato State, Mexico (n-848) 

Source: SINAVE/DGE15 

Figure 3. Distribution of deaths for COVID-19 by day in Guanajuato State, Mexico (n=80) 

 

 

 

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PADILLA-RAYGOZA 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

Table 1 shows the distribution by age and 
gender of confirmed cases for COVID-19 by death 
(n=838). Men accounted for 62.50% of the deaths by 
COVID-19, though among the non-deceased, accounted 
for a similar but lower percentage of 54.09%. The OR for 
gender indicates that being a woman was a protective 
factor for dying by decreasing the risk by 29%, an effect 
that is nullified when reviewing the 95% CI. For age 
group, those aged 60 years or older predominated among 
the deceased (57.50%). 

Presence of dyspnea and cyanosis had the 
greatest increased risk of death from COVID-19 
compared to those who were not deceased. The deceased 
had more than ten times the odds of having presented 
dyspnea or cyanosis than those not deceased. Fever and 
chest pain only had an effect on death four times greater. 

Diarrhea, cough, vomiting, headache, myalgia, 
arthralgia, and rhinorrhea had no statistically significant 
effect on mortality. Sore throat had a protective effect 
against death. Age group had a confounding effect for 
dyspnea, chest pain, and cyanosis, but maintained the 
strong effect of these clinical data on death (Table 2). 

Asthma showed a non-significant protective 
effect. Diabetes, hypertension, COPD, cardiovascular 
disease, and chronic kidney disease show a strong effect 
on mortality from COVID-19 with ORs greater than 3. 
For each of these comorbidities, age group acted as a 
confounder, decreasing the ORs, but they remained 
significant. For obesity and smoking, an OR effect was 
found higher than 2, though age group also acted as a 
confounder. Gender in no one comorbidities acted as a 
confounder (Table 3).

 

Variable 

Confirmed cases  

Deaths (n=80) 

n                   % 

Non-deaths (n=758) 

n                 % 
OR (95% CI) 

Gender 

   Female 

   Male 

 

30 

50 

 

37.50 

62.50 

 

348 

410 

 

45.91 

54.09 

0.71 (0.44 to 1.14) 

Age group (years) 

   0–5 

   6–11 

   12–19 

   20–49 

   50–59 

   60 or higher 

 

0 

0 

0 

12 

22 

46 

 

0 

0 

0 

15.00 

27.50 

57.50 

 

14 

10 

24 

444 

145 

121 

 

1.85 

1.32 

3.17 

58.58 

19.13 

15.96 

3.59 (2.66 to 4.85) 

Source: SINAVE/DGE15 

Table 1. Distribution of gender and age group by death for COVID-19 in Guanajuato, Mexico 

 

 

 



 
 
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This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

Clinical data 
Confirmed cases (n=838) Logistic regression OR (95% CI) 

Deaths 
n            % 

Non-deaths 
n            % 

Unadjusted Age-adjusted Gender-adjusted 

Fever* 
   Yes 
   No 

 
74        92.50 
6          7.50 

 
566         74.77 
191         25.23 

4.17 (1.78 to 9.72) 4.19 (1.75 to 10.05) 4.02 (1.72 to 9.41) 

Cough 
   Yes 
   No 

 
72        90.00 
8         10.00 

 
668        88.13 
90         11.87 

1.21 (0.57 to 2.60) 1.18 (0.53 to 2.65) 1.23 (0.57 to 2.65) 

Sore throat 
   Yes 
   No 

 
30        37.50 
50        62.50 

 
466        61.48 
292        38.52 

0.37 (0.23 to 0.60) 0.48 (0.29 to 0.79) 0.38 (0.24 to 0.61) 

Dyspnea 
   Yes 
   No 

 
66        82.50 
14        17.50 

 
152        20.05 
606        79.95 

18.80 (10.28 to 34.37) 11.01 (5.88 to 20.60) 18.73 (10.23 to 34.36) 

Diarrhea 
   Yes 
   No 

 
19        23.75 
61        76.25 

 
96         12.66 
662        87.34 

2.15 (1.23 to 3.75) 
 

1.84 (1.01 to 3.37) 2.08 (1.19 to 3.64) 

Vomiting 
   Yes 
   No 

 
6          7.50 
74        92.50 

 
47         6.20 

711        93.80 

1.23 (0.51 to 2.97) 1.54 (0.60 to 3.98) 1.22 (0.50 to 2.95) 

Headache 
   Yes  
   No 

 
65        81.25 
15        18.75 

 
651        85.88 
107        14.12 

0.71 (0.39 to 1.29) 0.75 (0.39 to 1.44) 0.72 (0.39 to 1.30) 

Chest pain* 
   Yes 
   No 

 
40        50.00 
40        50.00 

 
157        20.74 
600        79.26 

3.82 (2.38 to 6.13) 2.61 (1.58 to 4.31) 3.96 (2.46 to 6.38) 

Abdominal pain 
   Yes 
   No 

 
9          11.25 
71        88.75 

 
67          8.84 
691        91.16 

1.31 (0.63 to 2.73) 1.04 (0.48 to 2.28) 1.32 (0.63 to 2.76) 

Myalgias* 
   Yes 
   No 

 
57        71.25 
23        28.75 

 
521        68.82 
236        31.18 

1.12 (0.68 to 1.87) 
 

1.29 (0.75 to 2.22) 1.09 (0.66 to 1.82) 

Arthralgias 
   Yes 
   No 

 
53        66.25 
27        33.75 

 
441         58.18 
317        41.82 

1.41 (0.87 to 2.29) 1.23 (0.74 to 2.07) 1.40 (0.86 to 2.27) 

Rhinorrhea 
   Yes 
   No 

 
28        35.00 
52        65.00 

 
304        40.11 
454        59.89 

0.80 (0.50 to 1.30) 1.00 (0.60 to 1.68) 0.82 (0.51 to 1.33) 

Cyanosis** 
   Yes 
   No 

 
16        20.00 
64        80.00 

 
14          1.85 
742        98.15 

13.25 (6.19 to 28.37) 7.66 (3.34 to 17.53) 13.81 (6.40 to 29.78) 

*One case removed for missing information  **Two cases removed for missing information 
Source: SINAVE/DGE15 
Table 2. Distribution of clinical data by death from COVID-19 in Guanajuato, Mexico 

 



 
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This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.527 | http://cajgh.pitt.edu 

 
 

 Confirmed cases (n=838) Logistic regression OR (95% CI) 
Comorbidity Deaths 

n        % 
Non-deaths 

n         % Unadjusted Age-adjusted Gender-adjusted 

Diabetes 
   Yes 
   No 

 
25        31.25 
66        68.75 

 
97        12.80 
661        87.20 

3.10 (1.84 to 5.22) 1.29 (0.73 to 2.28) 3.17 (1.88 to 5.34) 

Hypertension 
   Yes 
   No 

 
39        48.75 
41        51.25 

 
104        13.72 
654        86.28 

5.98 (3.68 to 9.71) 2.57 (1.50 to 4.40) 6.01 (3.70 to 9.78) 

COPD 
   Yes 
   No 

 
9         11.25 
71        88.75 

 
19         2.51 

739        97.49 

4.93 (2.15 to 11.30) 1.54 (0.64 to 3.69) 5.06 (2.20 to 11.66) 

Asthma 
   Yes 
   No 

 
1         1.25 

79        98.75 

 
11        1.45 

747        98.55 

0.86 (0.11 to 6.75) 0.72 (0.08 to 6.33) 0.85 (0.11 to 6.68) 

Cardiovascular disease* 
   Yes 
   No 

 
6        7.50 

74        92.50 

 
15        1.98 

742        98.02 

4.01 (1.51 to 10.65) 1.57 (0.56 to 4.45) 4.07 (1.53 to 10.85 

Immunosuppression 
   Yes 
   No 

 
0        0.00 

80        100.00 

 
9        1.19 

749       98.81 

N/A N/A N/A 

Chronic kidney disease 
   Yes 
   No 

 
3         3.75 

77        96.25 

 
7         0.92 

751       99.08 

4.18 (1.06 to 16.49) 3.19 (0.71 to 14.28 4.13(1.04 to 16.37) 

Obesity 
   Yes 
   No 

 
24        30.00 
56        70.00 

 
116        15.30 
642        84.70 

2.37 (1.41 to 3.98) 2.19 (1.25 to 3.84) 2.44 (1.45 to 4.11) 

Smoking 
   Yes 
   No 

 
13         6.25 
67        83.75 

 
56         7.39 

702        92.61 

2.43 (1.27 to 4.67) 1.76 (0.86 to 3.59) 2.37 (1.23 to 4.56) 

*One case removed for missing information 
Source: SINAVE/DGE15 
Table 3. Distribution among comorbidities by deaths from COVID-19 in Guanajuato, Mexico 
 

Discussion 

The sample of 838 infected with SARS-CoV-2 
who developed COVID-19 registered in the state of 
Guanajuato shows a very slow spread during the month 
of March, but in April and May, the number of cases 
increased markedly (Figure 2). This slow spread is 
possibly due to the initial measures taken by the 
government of the state for social isolation and closure of 
public places, as well as the avoidance of massive events. 
As the quarantine and social isolation continued, the 
population may have gone out to cover basic needs and 

obtain food supplies, and in places of supply possibly 
being infected, infection may have spread. This could 
explain the increase in cases in the months of April and 
May despite social isolation. It should not be forgotten 
that the RT-PCR test only applies to symptomatic 
patients, so asymptomatic carriers are not detected and 
may avoid their isolation. 

It was reported that after social distancing, 20% 
of new cases and many hospitalizations could be avoided, 
but upon completion of isolation, new cases would 
rebound16 and, reinforced by Li et al.17, that the 



 
 

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imposition of social controls impacts the number of new 
cases. 

The SMR of 9.55% in the state of Guanajuato is 
slightly lower than that of Mexico, which was 10.59% as 
of May 15, 202018, but is higher than the global SMR of 
6.34% reported by the WHO19. 

The most reported symptoms among the 
Guanajuato cases were fever, cough, dyspnea, and sore 
throat, but the symptoms that showed the greatest effect 
in terms of mortality were cyanosis, dyspnea, and chest 
pain (Table 2). In a series of 926 symptomatic SARS-
CoV-2 infected cases, there was fever reported in 42.2% 
of cases, cough in 67.2%, dyspnea in 15.0%, arthralgia in 
14.4%, headache in 13.4%, sore throat in 14.0%, diarrhea 
in 3.3%, and vomiting in 4.6%20. The figures reported in 
patients from Guanajuato, Mexico differ from these 
reported by Guan et al.20, but the predominant symptoms 
were still fever, cough, and dyspnea. Liu et al.21, in a 
series of 44 symptomatic patients with COVID-19, 
reported fever in 97.7%, cough in 56.8%, dyspnea in 
9.1%, and arthralgia in 52.3%. In a series of nine 
pregnant women, fever was reported in 77.8%, cough in 
44.4%, dyspnea in 11.1%, arthralgia in 33.3%, headache 
in 33.3%, and sore throat in 33.3%22. 

The comorbidities with the greatest effect on 
mortality in patients from the state of Guanajuato are 
similar (Table 3) to those described in all of Mexico18. In 
a series of 41 patients infected with SASR-CoV-2 in 
Wuhan, China, 32% had some underlying pathology, 
20% had diabetes, 15% had hypertension, 15% had 
cardiovascular disease, and 2% had COPD23. 

The spread of SARS-CoV-2 infection has been 
constantly increasing since January 2020. In the state of 
Guanajuato, since mid-March, the government 
authorities decided to close educational institutions, mass 
events, and public places, which resulted in the curve for 
new confirmed cases remaining low; with community 
transmission, cases increased dramatically during April 
and May. The clinical data of the confirmed cases in the 

state of Guanajuato are similar to those already reported, 
with cough, fever, and dyspnea as the main symptoms. 
Mortality in the presence of comorbidities such as 
diabetes, hypertension, COPD, and cardiovascular 
disease in the state of Guanajuato are similar to what is 
reported throughout Mexico. It is important to continue 
the follow-up of the epidemiology of SARS-CoV-2 in 
Guanajuato State because it is possible that the number 
of confirmed cases may rise with the breaking of 
quarantine. 

 

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2. Lu H, Stratton CW, Tang YW. Outbreak of 
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4. Huang C, Wang Y, Li X, Ren L, Zhao J,  Hu Y, et al. 
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