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

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posted on 2022-10-26, 13:04 authored by Omar Yaxmehen Bello-Chavolla, Neftali Eduardo Antonio-Villa, Carlos A. Fermín-Martínez, Luisa Fernández-Chirino, Arsenio Vargas-Vázquez, Daniel Ramírez-García, Martín Roberto Basile-Alvarez, Ana Elena Hoyos-Lázaro, Rodrigo M. Carrillo-Larco, Deborah J. Wexler, Jennifer Manne-Goehler, Jacqueline A. Seiglie


OBJECTIVE: Estimate diabetes-related mortality in Mexico in 2020 compared to 2017-2019, following onset of the COVID-19 pandemic. 

RESEARCH DESIGN AND METHODS: Retrospective, state-level study using national death registries from Mexican adults ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes which listed diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and socio-demographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared to average 2017-2019 rates. 

RESULTS: We identified 148,437 diabetes-related deaths in 2020 (177/100,000 inhabitants), compared with an average of 101,496 deaths in 2017-2019 (125/100,000 inhabitants). 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 (130/100,000 inhabitants). Compared with 2018-2019, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). 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%.

CONCLUSIONS: Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately out-of-hospital, and were largely attributable to type 2 diabetes and to hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020. 


This research received support from Instituto Nacional de Geriatría in Mexico. JAS was supported by Grant Number 5KL2TR002542-03 (Harvard Catalyst). RMC-L is supported by a Wellcome Trust International Training Fellowship (214185/Z/18/Z).