Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country

doi:10.1016/j.lana.2022.100303

. 2022 Sep:13:100303.

doi: 10.1016/j.lana.2022.100303. Epub 2022 Jun 24.

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country

Lina Sofía Palacio-Mejía¹, Juan Eugenio Hernández-Ávila², Mauricio Hernández-Ávila³, Dwight Dyer-Leal⁴, Arturo Barranco⁵, Amado D Quezada-Sánchez⁶, Mariana Alvarez-Aceves⁷, Ricardo Cortés-Alcalá⁸, Jorge Leonel Fernández-Wheatley⁹, Iliana Ordoñez-Hernández¹⁰, Edgar Vielma-Orozco¹¹, María de la Cruz Muradás-Troitiño¹², Omar Muro-Orozco¹³, Enrique Navarro-Luévano¹⁴, Kathia Rodriguez-González¹⁵, Jean Marc Gabastou¹⁶, Ruy López-Ridaura¹⁷, Hugo López-Gatell¹⁸

Affiliations

¹ Ph.D. in Population Studies, Researcher for México-Conacyt, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
² Sc.D. in Epidemiology, Researcher in Medical Science, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
³ M.D., Ms.C., Sc.D. in Epidemiology, Director of Economic and Social Benefits, Mexican Institute of Social Security, Mexico City, Mexico.
⁴ Ph.D. in Political Science, General Directorate of Health Information, Mexico City, Mexico.
⁵ Master in Demography, General Directorate of Health Information, Mexico City, Mexico.
⁶ Master in Applied Statistics, Researcher in Medical Sciences, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
⁷ ScD. in Economic Administrative Sciences, Postdoctoral fellow, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
⁸ M.D., M.P.H. General Director of Health Promotion, Ministry of Health, Mexico City, Mexico.
⁹ Computer Systems Engineer, Director General of the National Registry of Population and Identity, Mexico City, Mexico.
¹⁰ Graduate in Design of Human Settlements, National Registry of Population and Identity, Mexico City, Mexico.
¹¹ Master in Economy, National Institute of Statistics and Geography, Mexico City, Mexico.
¹² Ph.D. in Population Studies, Coordinator of Sociodemographic and Prospective Studies of the General Secretariat of the National Population Council, Mexico City, Mexico.
¹³ M.S. National Institute of Statistics and Geography, Aguascalientes, Mexico.
¹⁴ Ms.C. National Institute of Statistics and Geography, Aguascalientes, Mexico.
¹⁵ Sc.D. (C), General Directorate of Epidemiology, Ministry of Health, Mexico City, Mexico.
¹⁶ M.D., Sc.D. Pan American Health Organization, Mexico City, Mexico.
¹⁷ Ms.C., Sc.D. in Nutritional Epidemiology, Director General of the National Center for Preventive Programs and Disease Control, Ministry of Health, Mexico City, Mexico.
¹⁸ M.D., Ms.C., Ph.D. in Epidemiology, Undersecretary of Prevention and Health Promotion, Ministry of Health, Mexico City, Mexico.

PMID: 35782204
PMCID: PMC9230439
DOI: 10.1016/j.lana.2022.100303

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country

Lina Sofía Palacio-Mejía et al. Lancet Reg Health Am. 2022 Sep.

. 2022 Sep:13:100303.

doi: 10.1016/j.lana.2022.100303. Epub 2022 Jun 24.

Authors

Affiliations

¹ Ph.D. in Population Studies, Researcher for México-Conacyt, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
² Sc.D. in Epidemiology, Researcher in Medical Science, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
³ M.D., Ms.C., Sc.D. in Epidemiology, Director of Economic and Social Benefits, Mexican Institute of Social Security, Mexico City, Mexico.
⁴ Ph.D. in Political Science, General Directorate of Health Information, Mexico City, Mexico.
⁵ Master in Demography, General Directorate of Health Information, Mexico City, Mexico.
⁶ Master in Applied Statistics, Researcher in Medical Sciences, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
⁷ ScD. in Economic Administrative Sciences, Postdoctoral fellow, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
⁸ M.D., M.P.H. General Director of Health Promotion, Ministry of Health, Mexico City, Mexico.
⁹ Computer Systems Engineer, Director General of the National Registry of Population and Identity, Mexico City, Mexico.
¹⁰ Graduate in Design of Human Settlements, National Registry of Population and Identity, Mexico City, Mexico.
¹¹ Master in Economy, National Institute of Statistics and Geography, Mexico City, Mexico.
¹² Ph.D. in Population Studies, Coordinator of Sociodemographic and Prospective Studies of the General Secretariat of the National Population Council, Mexico City, Mexico.
¹³ M.S. National Institute of Statistics and Geography, Aguascalientes, Mexico.
¹⁴ Ms.C. National Institute of Statistics and Geography, Aguascalientes, Mexico.
¹⁵ Sc.D. (C), General Directorate of Epidemiology, Ministry of Health, Mexico City, Mexico.
¹⁶ M.D., Sc.D. Pan American Health Organization, Mexico City, Mexico.
¹⁷ Ms.C., Sc.D. in Nutritional Epidemiology, Director General of the National Center for Preventive Programs and Disease Control, Ministry of Health, Mexico City, Mexico.
¹⁸ M.D., Ms.C., Ph.D. in Epidemiology, Undersecretary of Prevention and Health Promotion, Ministry of Health, Mexico City, Mexico.

PMID: 35782204
PMCID: PMC9230439
DOI: 10.1016/j.lana.2022.100303

Abstract

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.

Keywords: COVID-19; Excess mortality; Mexico; Mortality by causes.

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Conflict of interest statement

We declare no competing interests.

Figures

**Figure 1**
Trends in leading causes of death, México 2015 – 2019.

**Figure 2**
Absolute and proportional mortality by sex, age-group cause-groups Mexico 2015–2021.

See this image and copyright information in PMC

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References

1. Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A novel Coronavirus emerging in China — key questions for impact assessment. N Engl J Med. 2020;382(8):692–694. doi: 10.1056/NEJMp2000929. - DOI - PubMed
1. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–160. doi: 10.23750/abm.v91i1.9397. - DOI - PMC - PubMed
1. Center for Systems Science and Engineering at Johns Hopkins University . Johns Hopkins University; Baltimore (MD): 2022. COVID-19 Dashboard.https://coronavirus.jhu.edu/map.html [Internet][updated 2022 Mar 25; cited 2022 Mar 25]. Available from:
1. Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399(10334):1513–1536. doi: 10.1016/S0140-6736(21)02796-3. - DOI - PMC - PubMed
1. Karlinsky A, Kobak D. The World Mortality Dataset: tracking excess mortality across countries during the COVID-19 pandemic. medRxiv [Preprint]. 2021. 10.1101/2021.01.27.21250604 - DOI - PMC - PubMed

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[1] Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A novel Coronavirus emerging in China — key questions for impact assessment. N Engl J Med. 2020;382(8):692–694. doi: 10.1056/NEJMp2000929. - DOI - PubMed

[2] Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A novel Coronavirus emerging in China — key questions for impact assessment. N Engl J Med. 2020;382(8):692–694. doi: 10.1056/NEJMp2000929. - DOI - PubMed

[3] Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–160. doi: 10.23750/abm.v91i1.9397. - DOI - PMC - PubMed

[4] Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–160. doi: 10.23750/abm.v91i1.9397. - DOI - PMC - PubMed

[5] Center for Systems Science and Engineering at Johns Hopkins University . Johns Hopkins University; Baltimore (MD): 2022. COVID-19 Dashboard.https://coronavirus.jhu.edu/map.html [Internet][updated 2022 Mar 25; cited 2022 Mar 25]. Available from:

[6] Center for Systems Science and Engineering at Johns Hopkins University . Johns Hopkins University; Baltimore (MD): 2022. COVID-19 Dashboard.https://coronavirus.jhu.edu/map.html [Internet][updated 2022 Mar 25; cited 2022 Mar 25]. Available from:

[7] Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399(10334):1513–1536. doi: 10.1016/S0140-6736(21)02796-3. - DOI - PMC - PubMed

[8] Wang H, Paulson KR, Pease SA, et al. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399(10334):1513–1536. doi: 10.1016/S0140-6736(21)02796-3. - DOI - PMC - PubMed

[9] Karlinsky A, Kobak D. The World Mortality Dataset: tracking excess mortality across countries during the COVID-19 pandemic. medRxiv [Preprint]. 2021. 10.1101/2021.01.27.21250604 - DOI - PMC - PubMed

[10] Karlinsky A, Kobak D. The World Mortality Dataset: tracking excess mortality across countries during the COVID-19 pandemic. medRxiv [Preprint]. 2021. 10.1101/2021.01.27.21250604 - DOI - PMC - PubMed

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Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country

Affiliations

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country

Authors

Affiliations

Abstract

Conflict of interest statement

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