Geospatial Variability in Excess Death Rates during the COVID-19 Pandemic in Mexico: Examining Socio Demographic, Climate and Population Health Characteristics

OBJECTIVES: This study examined how socio-demographic, climate and population health characteristics shaped the geospatial variability in excess mortality patterns during the COVID-19 pandemic in Mexico. METHODS: We used Serfling regression models to estimate all-cause excess mortality rates for all 32 Mexican states. The association between socio-demographic, climate, health indicators and excess mortality rates were determined using multiple linear regression analyses. Functional data analysis characterized clusters of states with distinct excess mortality growth rate curves. RESULTS: The overall all-cause excess deaths rate during the COVID-19 pandemic in Mexico until April 10, 2021 was estimated at 39.66 per 10 000 population. The lowest excess death rates were observed in southeastern states including Chiapas (12.72) and Oaxaca (13.42), whereas Mexico City had the highest rate (106.17), followed by Tlaxcala (51.99). We found a positive association of excess mortality rates with aging index, marginalization index, and average household size (P < 0.001) in the final adjusted model (Model R(2)=77%). We identified four distinct clusters with qualitatively similar excess mortality curves. CONCLUSION: Central states exhibited the highest excess mortality rates, whereas the distribution of aging index, marginalization index, and average household size explained the variability in excess mortality rates across Mexico.