@article{ref1,
title="Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: a death certificates study in a middle-income country",
journal="Lancet regional health. Americas",
year="2022",
author="Palacio-Mejia, Lina Sofia and Hernández-Ávila, Juan Eugenio and Hernández-Avila, Mauricio and Dyer-Leal, Dwight and Barranco, Arturo and Quezada-Sánchez, Amado D. and Alvarez-Aceves, Mariana and Cortés-Alcalá, Ricardo and Fernández-Wheatley, Jorge Leonel and Ordoñez-Hernández, Iliana and Vielma-Orozco, Edgar and Muradás-Troitiño, María de la Cruz and Muro-Orozco, Omar and Navarro-Luévano, Enrique and Rodriguez-González, Kathia and Gabastou, Jean Marc and López-Ridaura, Ruy and López-Gatell, Hugo",
volume="13",
number="",
pages="e100303-e100303",
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. <br><br>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. <br><br>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%). <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="2667-193X",
doi="10.1016/j.lana.2022.100303",
url="http://dx.doi.org/10.1016/j.lana.2022.100303"
}