Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020–2021: A death certificates study in a middle-income country
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Background: The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection. Methods: We did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015-2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model. Findings: COVID-19 was the leading cause of death in 2020-2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%). Interpretation: Mortality from COVID-19 became the first cause of death in 2020-2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out. Funding: This study was funded by Conacyt.
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Mexico, a middle-income country, was one of the most affected countries during the COVID-19 pandemic.
“Mexico, a middle-income country, was one of the most affected countries during the COVID-19 pandemic [13,14], experiencing long periods of lockdown and ongoing uncertainty.”
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- Authors
- Palacio-Mejía, L. S., Hernández-Ávila, J. E., Hernández-Ávila, M., Dyer-Leal, D., Barranco, A., Quezada-Sánchez, A. D., Alvarez-Aceves, M., Cortés-Alcalá, R., Fernández- Wheatley, J. L., Ordoñez-Hernández, I., Vielma-Orozco, E., Muradás-Troitiño, M. D. L. C., Muro-Orozco, O., Navarro-Luévano, E., Rodriguez-González, K., Gabastou, J. M., López-Ridaura, R., & López-Gatell, H.
- Affiliations
- World Health Organization Regional Office for the Americas (US)
- Venue
- The Lancet Regional Health - Americas
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 13
- Pages
- 100303
- ISSN
- 2667-193X (ISSN-L)
- PMC
- PMC9230439
- OpenAlex
- W4283392498
- Cited by
- 77
- References
- 42
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 18 · 2023: 29 · 2022: 7 · 2020: 1 · 2014: 1
- FWCI
- 9.96
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Regional Health - Americas (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Consejo Nacional de Ciencia y Tecnología
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- COVID-19 pandemic, excess mortality, cause-specific mortality, indirect effects of COVID-19, death certificates, diabetes mortality, respiratory infections, ischemic heart disease, hypertension, infectious and parasitic diseases, cancer, health care utilization, Mexico
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