Diabetes-Related Excess Mortality in Mexico: A Comparative Analysis of National Death Registries Between 2017–2019 and 2020

Abstract

OBJECTIVE To estimate diabetes-related mortality in Mexico in 2020 compared with 2017–2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017–2020 period. Diabetes-related death was defined using ICD-10 codes listing 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 sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017–2019 rates. RESULTS We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017–2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017–2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018–2019 data, 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, rates of COVID-19 hospitalization, and 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 outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

“…In our study, the prevalence rates of diabetes among COVID‐19 patients are comparable to those reported in other studies, such as 21.6% among Wuhan's hospitalized COVID‐19 patients 15 . In the wake of the COVID‐19 pandemic, Mexico has seen an increase in the number of diabetes cases 34‐36 . Diabetes has been linked to worse outcomes in COVID‐19 patients in other studies 37‐39 .…”

“…15 In the wake of the COVID-19 pandemic, Mexico has seen an increase in the number of diabetes cases. [34][35][36] Diabetes has been linked to worse outcomes in COVID-19 patients in other studies. [37][38][39] This includes not only a higher risk of severe illness, but also complications from COVID-19.…”

Prediabetes as a risk factor for all-cause and cause-specific mortality: a prospective analysis of 115,919 adults without diabetes in Mexico City

“…All models were stratified by sex and age at risk (in 5-year groups) using the Lexis expansion ( Epi R package) 23,24 and were progressively adjusted for confounders in the following order: 1) municipality of residence (Coyocán or Iztapalapa) (region-level variations in population characteristics have been known to influence mortality related to cardiometabolic diseases in Mexico 25 ), and 2) education level (university/college, or other), physical activity (none, regular), smoking (never, former, current), and alcohol consumption (never, former, current). Sensitivity analyses further adjusted for adiposity markers (body mass index [BMI] and waist-to-height ratio [WHtR]).…”

Prevalence and determinants of post-acute sequelae after SARS-CoV-2 infection (Long COVID) among adults in Mexico during 2022: a retrospective analysis of nationally representative data

“…23 To assess marginalization independently of urbanization, we extracted mean population density from each state and regressed it onto SLI and obtained the residuals which represent a density-independent social lag index (DISLI). 8 , 11 , 24 We then categorized states into DISLI quartiles (Q1< −0.676, Q2 −0.676 to −0.131, Q3 −0.131 to 0.110 and Q4 >0.110) and classified individuals into each quartile according to their state of residence. DISLI is a dimensionless measure which is interpreted, when values are higher, as a proxy of higher sociodemographic inequalities independent of population density.…”