Leading Causes of Excess Mortality in Mexico During the COVID-19 Pandemic 2020 – February 2021: A Death Certificates Study in a Lower-Middle-Income Country

Abstract

Background: The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. For Mexico, a 28% excess mortality not directly related to the virus infection has been estimated. We aimed to analyze temporal and percentage changes in the distribution of the leading causes of mortality during the COVID-19 pandemic in Mexico.Methods: We did a retrospective longitudinal study of the leading causes of mortality and their variation with respect to expected deaths in Mexico from 2020 until 27 February 2021 using death certificates information. A Poisson regression model was fitted, to predict the expected, cause specific, mortality during the study period, based on the 2015-2019 registered mortality. Excess deaths were estimated as the weekly difference between expected and observed death. Findings: All-cause excess mortality was 46×5% (CI 95%: 45×2-47×8) over expected mortality. Deaths directly attributed to COVID-19 accounted for 69×6%. Leading causes of excess mortality were: Respiratory infections (59×5%), diabetes (48×0%), ischemic heart diseases (37×8%), hypertensive diseases (30×4%), motor vehicle road injuries (29×6%), and other endocrine, metabolic, hematological, and immunological diseases (28×2%). Causes that decreased with respect to expected mortality were: Other accidents (-29×1%), infectious and parasitic diseases (-23×4%), injuries of undetermined intent (-23×2%), other tumors (-22×5%), and skin diseases (-20×4%).Interpretation: Mortality from COVID-19 became the second cause of death in 2020, after cardiovascular diseases. Respiratory infections, diabetes and cardiovascular increased dramatically with respect to 2019, this could be a consequence of lack of access, but also certification errors.Funding Information: This study did not receive any funds.Declaration of Interests: We declare no competing interests.