Socio-demographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: a data-driven analysis of 1 069 174 death certificates in Mexico
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Background
In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized.
Methods
We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015–2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively.
Results
We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015–2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths.
Conclusion
Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities.
Article activity feed
-
-
SciScore for 10.1101/2022.05.12.22274973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization For this model, we used the municipality of death occurrence as a random intercept to account for intermunicipal variability in death registration in the model and to establish a hierarchical relationship between individual and municipal-level variables. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has some strengths and limitations. Amongst the strengths, we highlight the use of 1,069,174 nationwide …
SciScore for 10.1101/2022.05.12.22274973: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization For this model, we used the municipality of death occurrence as a random intercept to account for intermunicipal variability in death registration in the model and to establish a hierarchical relationship between individual and municipal-level variables. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has some strengths and limitations. Amongst the strengths, we highlight the use of 1,069,174 nationwide mortality registries to compare all-cause and cause-specific excess mortality during the COVID-19 pandemic in Mexico in 2020. This approach allowed us to estimate with higher confidence state and municipal-level excess morality rates that helped us to study the regional impact of the COVID-19 pandemic and identify vulnerable zones in Mexico which were especially affected during 2020 compared to previous years. Additionally, the use of sociodemographic variables at different levels gave us insights to evaluate municipal and individual-level determinants which shaped excess and non-COVID-19 mortality. Nevertheless, limitations to be acknowledged include the lack of specific clinical information and comorbidity assessment for predictors which have been proven to be crucial determinants that increase the risk of death for COVID-19 and non-COVID-19 causes, particularly regarding control of chronic cardio-metabolic conditions. Second, we could not ascertain the number of non-COVID-19 deaths which occurred due to exacerbation of underlying chronic conditions by current or previous SARS-CoV-2 infection, as it has been proven that it could increase the risk of long-term complications, including cardiovascular diseases (3). Third, our COVID-19 death construct included cases which could have been misclassified by atypical pneumonia or severe acute respiratory infections of u...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
-
