Leading Causes of Excess Mortality in Mexico During the COVID-19 Pandemic 2020 – February 2021: A Death Certificates Study in a Lower-Middle-Income Country

Palacio-Mejía, Lina Sofía; Hernández-Ávila, Juan Eugenio; Hernández-Ávila, Mauricio; Leal, Dwight Dyer; Flores, Arturo Barranco; Sanchez, Amado David Quezada; Cortés-Alcalá, Ricardo; Fernández, Jorge Leonel Wheatley; Hernández, Iliana Ordoñez; Orozco, Edgar Vielma; Troitiño, María de la Cruz Muradás; Orozco, Omar Muro; Luévano, Enrique Navarro; González, Kathia Rodriguez; Gabastou, Jean Marc; Ridaura, Ruy López; López‐Gatell, Hugo

doi:10.2139/ssrn.3968899

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…According to the approach proposed by Karlinsky and Kobak, we estimated excess mortality as the difference between average deaths during the 2016-2019 period compared to deaths registered during 2020 (13). We used average deaths for two reasons: 1) the use of average deaths is a simple approach proven to be a reliable assessment based on sensitivity analyses estimations, and 2) given that we are estimating 436 specific causes of death, predictive methods based on generalized linear models may overestimate the standard error for low-frequency causes (9). Excess deaths were standardized to age-adjusted rates per 100,000 population with age structures by state, municipalities, and regions per 5-year increments using population projections provided by the National Population Council (CONAPO).…”

Section: Excess Mortality Estimationmentioning

confidence: 99%

“…A confluence of health and sociodemographic inequalities that predated the COVID-19 pandemic, a high burden of chronic cardiometabolic conditions, and a fragmented healthcare system all contributed to a high and disproportionate burden of excess mortality among marginalized communities (5,8). A descriptive assessment performed in Mexico showed that chronic cardiometabolic conditions, which are highly prevalent among communities of low socioeconomic status, were the main causes of death independently of registered COVID-19 deaths in Mexico during 2020 (9). However, whether hospital saturation had ripple effects on out-of-hospital excess mortality, particularly for highly prevalent chronic health conditions across different vulnerable regions, has not yet been characterized.…”

Section: Introductionmentioning

confidence: 99%

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Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Antonio-Villa

Aburto

Fernández‐Chirino

et al. 2022

Preprint

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BACKGROUNDIn 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent to which non-COVID deaths contributed to excess mortality, its regional characterization, and the association between municipal-and individual-level sociodemographic inequality has not been characterized.METHODSWe conducted a retrospective municipal an individual-level study using death certificate data in Mexico from 2016-2020. We analyzed mortality related to COVID-19 and to non-COVID-19 causes using ICD-10 codes to identify cause-specific mortality. Excess mortality was estimated as the increase in deaths in 2020 compared to the average of 2016-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. We evaluated correlates of non-COVID-19 mortality at the individual level using mixed effects logistic regression and correlates of non-COVID-19 excess mortality in 2020 at the municipal level using negative binomial regression.RESULTSWe identified 1,069,174 deaths in 2020 (833.5 per 100,000 inhabitants), which was 49% higher compared to the 2016-2019 average (557.38 per 100,000 inhabitants). Overall excess mortality (276.11 deaths per 100,000 inhabitants) was attributable in 76.1% to COVID-19; however, non-COVID-19 causes comprised one-fifth of excess deaths. COVID-19 deaths occurred primarily in-hospital, while excess non-COVID-19 deaths decreased in this setting and increased out-of-hospital. Excess non-COVID-19 mortality displayed geographical heterogeneity linked to sociodemographic inequalities with clustering in states in southern Mexico. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization, and social marginalization. At the individual level, lower educational attainment, blue collar workers, and lack of medical care assistance were associated with non-COVID-19 mortality during 2020.CONCLUSIONNon-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual-and municipal-level sociodemographic inequalities. These findings should prompt an urgent call to action to improve healthcare coverage and access to reduce health and sociodemographic inequalities in Mexico to reduce preventable mortality in situations which increase the stress of healthcare systems, including the ongoing COVID-19 pandemic.

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Section: Excess Mortality Estimationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Antonio-Villa

Aburto

Fernández‐Chirino

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…In Mexico, COVID-19 became the leading cause of death in 2020-2021 [1], with fatality rates ranging from 20% to 50% among hospitalized patients suffering from severe forms of the disease [2]. It has been observed that approximately 60-80% of COVID-19 survivors who were hospitalized continue to experience long-term multi-systemic sequelae and associated symptoms [3,4].…”

Section: Introductionmentioning

confidence: 99%

Enhancing quality of life in severe post-COVID-19 survivors through multidisciplinary care

Cataneo-Piña,

Castorena-Maldonado,

González-Islas

et al. 2024

ERJ Open Res

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COVID-19 survivors who were hospitalized continue to experience long-term multi-systemic sequelae and symptoms, impacting their health-related quality of life (HRQo). The complexity of post-COVID-19 conditions underscores the importance of adopting a multidisciplinary, patient-centric approach to ensure ongoing care. This study aims to assess HRQoL and post-COVID symptoms in a cohort of severe COVID-19 survivors depending on their participation in a multidisciplinary program.MethodsThis prospective study was conducted in a post-COVID clinic staffed by a multidisciplinary team (physical rehabilitator, nutritionist, psychologist, including experts in pulmonary rehabilitation, nutrition, psychology, and others). Subjects over 18 years old who were hospitalized by COVID-19 severe during acute phase and accept attend the post-COVID clinic within the first three months following discharge were included. Subjects who were unable or unwilling to provide informed consent to participate in the protocol were excluded. Linear mixed-effect models were employed to examine changes in SF-12 component scores. The resolution of post-COVID symptom clusters was compared using Cox Model.ResultsA total of 730 patients were included, with a mean age of 55.78±15.43 years, 60.55% were male, and 90.62% required mechanical ventilation during hospitalization. Program attendants demonstrated improved SF-12 physical and mental component scores at 3 and 12 months. A reduction in the prevalence of post-COVID symptoms was observed in both groups, with greater reductions in those attending the program.ConclusionOur study showed that multidisciplinary programme experienced improvements in fatigue, musculoskeletal, gastrointestinal, neuropsychiatric, and respiratory symptoms, along with enhanced SF-12 mental and physical component scores.

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“…Even though the majority of these excess deaths were directly attributable to COVID-19 case mortality, reports by the National Institute for Statistics and Geography (INEGI) suggest that excess deaths in Mexico during 2020 were also attributable to an increase in mortality from non-COVID-19 causes, including cardiovascular disease and diabetes 4 . However, the extent to which diabetes contributed as a cause of this excess mortality during 2020 compared to recent years has not yet been characterized 5 .…”

Section: Introductionmentioning

confidence: 99%

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

Bello‐Chavolla

Antonio-Villa

Fernández‐Chirino

et al. 2022

Preprint

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BACKGROUND: Excess all-cause mortality rates in Mexico in 2020 during the COVID-19 pandemic were among the highest globally. Recent reports suggest that diabetes-related deaths were also higher, but the contribution of diabetes as a cause of excess mortality in Mexico during 2020 compared to prior years has not yet been characterized. METHODS: We conducted a retrospective, state-level study using national death registries from Mexican adults ≥20 years for the 2017-2020 period. Diabetes-related deaths were classified using ICD-10 codes that listed diabetes as the primary cause of death, excluding certificates which listed COVID-19 as a cause of death. Excess mortality was estimated as the increase in diabetes-related mortality in 2020 compared to average rates in 2017-2019. Analyses were stratified by diabetes type, diabetes-related complication, and in-hospital vs. out-of-hospital death. We evaluated the geographic distribution of diabetes-related excess mortality and its socio-demographic and epidemiologic correlates using spatial analyses and negative binomial regression models. RESULTS: We identified 148,437 diabetes-related deaths in 2020 (177/100,000 inhabitants), 41.6% higher than the average for 2017-2019, with the excess occurring after the onset of the COVID-19 pandemic. In-hospital diabetes-related deaths decreased by 17.8% in 2020 compared to 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes and type 1 diabetes (129.7 and 4.0/100,000 population). Diabetes-related emergencies as contributing causes of death also increased in 2020 compared to 2017-2019 for hyperglycemic hyperosmolar state (128%), and ketoacidosis (116%). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, higher rates of COVID-19 hospitalization, and higher prevalence of HbA1c ≥7.5%. INTERPRETATION: Diabetes-related mortality increased among Mexican adults by 41.6% in 2020 after the onset of the pandemic compared to 2017-2019, largely attributable to type 2 diabetes. Excess diabetes-related deaths occurred disproportionately out-of-hospital, clustered in southern Mexico, and were associated with higher state-level marginalization, rates of COVID-19 hospitalizations, and higher prevalence of suboptimal glycemic control. Urgent policies to mitigate mortality due to diabetes in Mexico are needed, particularly given the ongoing challenges in caring for people with diabetes posed by the COVID-19 pandemic.

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Leading Causes of Excess Mortality in Mexico During the COVID-19 Pandemic 2020 – February 2021: A Death Certificates Study in a Lower-Middle-Income Country

Cited by 5 publications

References 16 publications

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

Enhancing quality of life in severe post-COVID-19 survivors through multidisciplinary care

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

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