Trends and Determinants of Dementia-Related Mortality in Mexico, 2017-2023.

BackgroundOlder individuals with dementia have been severely affected by the COVID-19 pandemic. There is a lack of in-depth evaluation of mortality trends using both the underlying cause of death (UCOD) and the multiple causes of death (MCOD) approaches. The objective of this study was to determine the impact of the COVID-19 pandemic on dementia-related deaths considering comorbidities and the place of death.MethodsThis retrospective, population-based study was conducted in Veneto, Italy. All the death certificates of individuals aged ≥65 years issued from 2008 to 2020 were analyzed for dementia-related mortality using age-standardized sex-stratified rates of dementia as UCOD and MCOD. Excess in monthly dementia-related mortality in 2020 was estimated by applying Seasonal Autoregressive Integrated Moving Average (SARIMA) model.ResultsOverall, 70 301 death certificates reported dementia (MCOD proportional mortality: 12.9%), and 37 604 cases identified it as UCOD (proportional mortality: 6.9%). In 2020, the MCOD proportional mortality increased to 14.3% whereas that of UCOD remained static (7.0%). Compared to the SARIMA prediction, MCOD increased by 15.5% in males and 18.3% in females in 2020. Compared to the 2018–19 average, deaths in nursing homes increased by 32% in 2020, at home by 26% and in hospitals by 12%.ConclusionsAn increase in dementia-related mortality during the first months of the COVID-19 pandemic could only be detected using the MCOD approach. MCOD proved to be more robust, and hence, should be included in future analyses. Nursing homes appeared to be the most critical setting which should guide establishing protective measures for similar situations.

To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend.

<p> </p> <p><strong>OBJECTIVE</strong>: Estimate diabetes-related mortality in Mexico in 2020 compared to 2017-2019, following onset of the COVID-19 pandemic. </p> <p><strong>RESEARCH DESIGN AND METHODS</strong>: Retrospective, state-level study using national death registries from Mexican adults ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes which listed 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 socio-demographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared to average 2017-2019 rates. </p> <p><strong>RESULTS:</strong> We identified 148,437 diabetes-related deaths in 2020 (177/100,000 inhabitants), compared with an average of 101,496 deaths in 2017-2019 (125/100,000 inhabitants). 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 (130/100,000 inhabitants). Compared with 2018-2019, 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, higher rates of COVID-19 hospitalization, and higher prevalence of HbA1c ≥7.5%.</p> <p><strong>CONCLUSIONS</strong>: Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately out-of-hospital, and were largely attributable to type 2 diabetes and to hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020. </p>

<p> </p> <p><strong>OBJECTIVE</strong>: Estimate diabetes-related mortality in Mexico in 2020 compared to 2017-2019, following onset of the COVID-19 pandemic. </p> <p><strong>RESEARCH DESIGN AND METHODS</strong>: Retrospective, state-level study using national death registries from Mexican adults ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes which listed 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 socio-demographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared to average 2017-2019 rates. </p> <p><strong>RESULTS:</strong> We identified 148,437 diabetes-related deaths in 2020 (177/100,000 inhabitants), compared with an average of 101,496 deaths in 2017-2019 (125/100,000 inhabitants). 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 (130/100,000 inhabitants). Compared with 2018-2019, 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, higher rates of COVID-19 hospitalization, and higher prevalence of HbA1c ≥7.5%.</p> <p><strong>CONCLUSIONS</strong>: Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately out-of-hospital, and were largely attributable to type 2 diabetes and to hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020. </p>

IntroductionAcross the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico.MethodsWe used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders.ResultsFrom February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92).DiscussionIn this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.

Across the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. We used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders. From February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). In this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.

Based on the comprehensive national death registry of Mexico spanning from 1998 to 2022 a point and interval estimation method for the excess mortality in Mexico during the years 2020–2022 is proposed based on illness-induced deaths only, using a polynomial regression model. The results obtained estimate that the excess mortality is around 788,000 people (39.3%) equivalently to a rate of 626 per 100,000 inhabitants. The male/female ratio is estimated to be 1.7 times. As a reference for comparison, for the whole period 2020–2022 Mexico’s INEGI estimated an excess of mortality between 673,000 with a quasi-Poisson model and 808,000 using endemic channels estimation.

During the COVID-19 pandemic, the Indigenous population in Mexico was subject to several factors that caused them to have a higher mortality risk than the non-Indigenous population. These risk factors included language barriers, poverty, comorbidities, inadequate access to health services, lack of social security, limited education, and substandard housing, inter alia. This study aims to determine the factors associated with COVID-19 mortality in the Indigenous population in Mexico. Cohort study. This study utilized data from the National Epidemiological Surveillance System for Viral Respiratory Disease (SISVER) collected during 2020 and 2021 to examine the population recognized as Indigenous. A total of 506,956 COVID-19 cases were reported, with 0.75% identified as Indigenous. The logistic regression assessed the combined effect of Indigenous status and each risk factor. Adjusted odds ratios (aORs) with or without interaction terms were reported. The identified risk factors were the following: age of > 60years × Indigenous (aOR 9.19, CI 95% 6.38-13.2, p < 0.001); male × Indigenous (aOR 3.38, CI 95% 2.72-5.53, p < 0.001); and time from symptom onset to seeking care > 7days × Indigenous (aOR 5.86, CI 95% 4.10-8.37, p < 0.001). Belonging to the Indigenous population is a significant risk factor for COVID-19 mortality in Mexico. Although both Indigenous and non-Indigenous groups share common risk factors, the combined effect of Indigenous status and each risk factor reveals greater vulnerability among the former. Significant interactions were observed with age over 60years, sex, and delays in seeking medical care after the onset of symptoms.

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

The present study evaluated the impact of Saharan dust event on particulate matter (PM: PM10 and PM2.5) concentrations by analyzing the daily average PM data between Saharan dust days (June 23–29, 2020) and non-Saharan dust days (June 15 to June 22 and June 30 to July 12, 2020) for four majorly affected regions in Mexico and by comparing with three major previous events (2015, 2018, and 2019). The results showed that PM10 and PM2.5 concentrations were 2–5 times higher during the Saharan dust event with the highest daily averages of 197 μg/m3 and 94 μg/m3, respectively, and exceeded the Mexican standard norm (NOM-020-SSA1-2014). When comparing with the previous Saharan dust episodes of 2015, 2018, and 2019, the levels of PM10 and PM2.5 considerably increased and more than doubled across Mexico. The correlation analysis revealed a positive association of PM levels with the number of daily COVID-19 cases and deaths during Saharan dust event. Furthermore, the human health risk assessment showed that the chronic daily intake and hazard quotient values incremented during Saharan dust days compared to non-Saharan days, indicating potential health effects and importance of taking necessary measures to ensure better air quality following the COVID-19 pandemic.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11356-021-14168-y.

Decision letter: Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset

Epidemiological characteristics of Dementia-related mortality in Mexico between 2012 and 2016

In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. A range of international and regional actors have made important policy recommendations to address the gendered implications of the COVID-19 pandemic on women's health and wellbeing since the start of the pandemic. However, national-level policy responses to the COVID-19 pandemic have been partial and inconsistent with regards to gender in both sub-Saharan Africa and Latin America, largely failing to recognise the multiple drivers of gendered health inequalities. This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.

An intensive search for amyotrophic lateral sclerosis (ALS) in Mexicans revealed only 16 patients diagnosed between 1962 and 1969 in the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) government health program. The prevalence was 0.8 and the average annual incidence and mortality were 0.40 and 0.28/100,000 population, respectively. These low rates confirm reports of a low ALS mortality in Mexico and among Mexican-Americans in the United States based on death certificates. Pathologically, neurofibrillary and granulovacuolar changes were not seen and no familial cases were observed. Clinically, the cases resembled sporadic ALS. Just as there are populations among whom ALS is unusually common (eg, Guamanian Chamorros), there may be others like the Mexicans where ALS is rare. An explanation of population differences in ALS frequency may provide clues to the cause.

Chronic obstructive pulmonary disease (COPD) is a chronic degenerative disease. It is a frequent, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. The National Institute of Respiratory Diseases (INER), ranked COPD in 2016 in fourth place in the table of annual morbidity and mortality in Mexico. The prevalence of COPD is directly related to smoking; however, its development is multifactorial. For its study it is important to know of any prior exposure to risk factors and of any manifestation of the main symptoms. To make a diagnosis, a detailed clinical history, where the largest amount of data is collected from every new possible COPD patient, and a spirometry are essential. Individual pharmacological treatment is necessary due to the great variability among COPD patients. The drugs used in the treatment of COPD reduce the symptoms, the frequency and severity of exacerbations; however, there is no medication that modifies the long-term deterioration of the lung function. Therefore, a basic knowledge of this condition by the medical doctor first contacted, is essential for the suspicion of COPD in its initial stage and thus, offer the patient immediate medical intervention. The objective of the present work is to provide a basic overview of COPD to the general practitioner. Key words:Chronic obstructive pulmonary disease; biomass; tobacco; chronic obstructive bronchitis; emphysema; respiratory system