Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020
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Abstract
<p> </p> <p><strong>OBJECTIVE</strong>: Estimate diabetes-related mortality in Mexico in 2020 compared to 2017-2019, following onset of the COVID-19 pandemic. </p> <p><strong>RESEARCH DESIGN AND METHODS</strong>: 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 and 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. </p> <p><strong>RESULTS:</strong> 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%.</p> <p><strong>CONCLUSIONS</strong>: 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. </p>
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SciScore for 10.1101/2022.02.24.22271337: (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 To evaluate the spatial dependence of diabetes-related excess mortality and the out-of-hospital to in-hospital death ratio, we used Moran’s I statistic, which was obtained as an indicator of global spatial autocorrelation, and its significance was assessed through an inference technique based on randomly permuting the observed values over the spatial units. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Second, to visualize the geographical distribution of diabetes-related excess deaths in Mexico, we used chloropleth maps with the ggmap R package with the quantile … SciScore for 10.1101/2022.02.24.22271337: (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 To evaluate the spatial dependence of diabetes-related excess mortality and the out-of-hospital to in-hospital death ratio, we used Moran’s I statistic, which was obtained as an indicator of global spatial autocorrelation, and its significance was assessed through an inference technique based on randomly permuting the observed values over the spatial units. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Second, to visualize the geographical distribution of diabetes-related excess deaths in Mexico, we used chloropleth maps with the ggmap R package with the quantile method. ggmapsuggested: NoneResults 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. The strengths of our analysis include the use of several nationally representative datasets, which allowed us to gain insight into potential socio-demographic, epidemiologic, and COVID-19-related correlates of diabetes-related excess mortality in Mexico. Second, we standardized all mortality analyses by age, which allowed for adequate comparisons across Mexican regions with a diverse population structure and more precise estimation of diabetes-related excess mortality. Finally, given that the pandemic had a differential impact across Mexico, we explored spatial effects in the influence of all evaluated epidemiological indicators; this allowed us to understand the regional impact of diabetes-related excess mortality to better inform public policy. We also acknowledge the following limitations which should prompt caution in the interpretation of our results. By using state-level variables, we were unable to perform inferences for all identified associations at individual or even local levels; this is particularly relevant for socio-demographic inequalities, indicators of glycemic control, and COVID-19 seroprevalence which may have significant heterogeneity within Mexican states at both the municipal, local, and individual level. Finally, since ascertainment of COVID-19 cases in Mexico has been insufficient17, many SARS-CoV-2 infections could have been undetected and some of these may have led to diabetes-related complications such a...
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.
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Results from scite Reference Check: We found no unreliable references.
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