TY  - JOUR
PY  - 2022//
TI  - Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: a death certificates study in a middle-income country
JO  - Lancet regional health. Americas
A1  - Palacio-Mejia, Lina Sofia
A1  - Hernández-Ávila, Juan Eugenio
A1  - Hernández-Avila, Mauricio
A1  - Dyer-Leal, Dwight
A1  - Barranco, Arturo
A1  - Quezada-Sánchez, Amado D.
A1  - Alvarez-Aceves, Mariana
A1  - Cortés-Alcalá, Ricardo
A1  - Fernández-Wheatley, Jorge Leonel
A1  - Ordoñez-Hernández, Iliana
A1  - Vielma-Orozco, Edgar
A1  - Muradás-Troitiño, María de la Cruz
A1  - Muro-Orozco, Omar
A1  - Navarro-Luévano, Enrique
A1  - Rodriguez-González, Kathia
A1  - Gabastou, Jean Marc
A1  - López-Ridaura, Ruy
A1  - López-Gatell, Hugo
SP  - e100303
EP  - e100303
VL  - 13
IS  - 
N2  - 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>
LA  - en
SN  - 2667-193X
UR  - http://dx.doi.org/10.1016/j.lana.2022.100303
ID  - ref1
ER  -