Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country.

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. 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. 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%). 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.

Fraction of COVID-19 hospitalizations and deaths attributable to chronic diseases.

Evidence shows that chronic diseases are associated with COVID-19 severity and death. This study aims to estimate the fraction of hospitalizations and deaths from COVID-19 attributable to chronic diseases associated to poor nutrition and smoking among adults who tested positive to COVID-19 in Mexico. We analyzed 1,006,541 adults aged ≥20 who tested positive for COVID-19 from March 23 to December 5, 2020. Six chronic diseases were considered: obesity, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, cardiovascular disease, and chronic kidney disease (CKD). We calibrated the database using a bias quantification method to consider undiagnosed disease cases. To estimate the total impact of multiple diseases, we defined a multimorbidity variable according to the number of diseases. Risks of hospitalization and death were estimated with Poisson regression models and used to calculate population attributable fractions (PAFs). Chronic diseases accounted for to 25.4% [95% CI: 24.8%-26.1%], 28.3% (95% CI: 27.8%-28.7%) and 15.3% (95% CI: 14.9%-15.7%) of the hospitalizations among adults below 40, 40-59, and 60 years and older, respectively. For COVID-19-related deaths, 50.1% (95% CI: 48.6%-51.5%), 40.5% (95% CI: 39.7%-41.3%), and 18.7% (95% CI, 18.0%-19.5%) were attributable to chronic diseases in adults under 40, 40-59, and 60 years and older, respectively. Chronic diseases linked to poor nutrition and smoking could have contributed to a large burden of hospitalization and deaths from COVID-19 in Mexico, particularly among younger adults. Medical and structural interventions to curb chronic disease incidence and facilitate disease control are urgently needed.

Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction.

INTRODUCTION: Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE: To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD: A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS: An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION: With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN: México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO: Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO: Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS: Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN: Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.

Estimación del exceso de mortalidad por todas las causas durante la pandemia del Covid-19 en México.

 Objetivo. Estimar el exceso de defunciones por todas las causas en México durante 2020. Material y métodos. Se construyó un canal endémico con las defunciones (2015- 2019), estableciendo el umbral epidémico en el percentil 90, y se comparó con las actas de defunción para estimar el exceso de mortalidad. Resultados. A la semana 53, ocurrieron 326 612 defunciones en exceso (45.1%), con un máximo en la semana 28 (98.0%) y un mínimo en la semana 41 (35.2%); después de la semana 4 los hombres (51.3%), principalmente de 45-64 años de edad, sin embargo, en los de 60 años o más ocurrió el mayor nú-mero de defunciones. Conclusión. En México, el exceso de mortalidad ha sido prolongado en comparación con otros países, con alta variabilidad interestatal. Esto podría deberse a las condiciones socioeconómicas y a la alta prevalencia de comorbilidades que aumentan el riesgo de morir en la población mexicana.

The Association of Obesity, Type 2 Diabetes, and Hypertension with Severe Coronavirus Disease 2019 on Admission Among Mexican Patients.

OBJECTIVE: This study's aim was to explore the association of obesity, type 2 diabetes, and hypertension with severe coronavirus disease 2019 (COVID-19) on admission. METHODS: In the present study, a total of 23,593 patient samples were evaluated by a laboratory from the Mexican Institute of Epidemiological Diagnosis and Reference. Of these, 18,443 were negative for COVID-19, 3,844 were positive for COVID-19, and 1,306 were positive for other respiratory viruses. Severe types of respiratory disease were defined by the presence of pneumonia and other organ failure that requires intensive care. Multivariable logistic regression models were used to explore factors associated with severe COVID-19 on admission. RESULTS: Patients who tested positive for COVID-19 had a higher proportion of obesity (17.4%), diabetes (14.5%), and hypertension (18.9%) compared with those without a confirmed diagnosis. Compared with patients without obesity, those with obesity showed a 1.43-fold higher odds of developing severe COVID-19 on admission, whereas subjects with diabetes and hypertension showed a 1.87-fold and 1.77-fold higher odds of developing severe COVID-19 on admission, respectively. CONCLUSIONS: Obesity, diabetes, and hypertension were significantly associated with severe COVID-19 on admission and the association of obesity was stronger in patients < 50 years of age.