Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

OBJECTIVE: To characterize diabetes-related excess mortality in Mexico in 2020 compared to 2017-2019, during the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: 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, 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. RESULTS: 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%. CONCLUSIONS: 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.