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

Abstract

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.

Online peer support for mental health in individuals with post-acute sequelae of COVID-19: A pre-post pilot study with mixed methods

“…Post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) is de ned as the maintenance, relapse, or emergence of symptoms beyond 4 weeks after COVID-19 infection, such as fatigue, brain fog, dizziness, and gastrointestinal symptoms (Nalbandian et al, 2021;Thaweethai et al, 2023). Of the individuals with COVID-19, 12.44% had at least one symptom of PASC (Bello-Chavolla et al, 2024). The burden of health loss is substantial, with 35-69% of PASC persisting for over 2 years (Bowe et al, 2023).…”

Comparison of Diabetes Mellitus Risk Factors in Mexico in 2003 and 2014

“…It is now estimated that one in two children will develop diabetes mellitus in the future due to weight and lack of physical activity unless public health policies change ( 9 ). In 2019 diabetes was the second highest cause of death in Mexico ( 10 ), in 2020 there were 148,437 diabetes-related deaths ( 11 ), and in 2021 there were 184,384 diabetes-related deaths in adults aged 20–79 years old, with a proportion of diabetes-related deaths in people under 60 years of 9.9% ( 12 ).…”