Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.
MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Diabetes Care. 2022 Dec 1;45(12):2957-2966. doi: 10.2337/dc22-0616.
To estimate diabetes-related mortality in Mexico in 2020 compared with 2017-2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic.
This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes listing 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 sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017-2019 rates.
We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017-2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018-2019 data, 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, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%.
Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.
在 2019 冠状病毒病 2019（COVID-19）大流行开始后，估计 2020 年墨西哥与 2017-2019 年相比与糖尿病相关的死亡率。
本回顾性州级研究使用了 2017-2020 年期间墨西哥成年人全国死亡登记处的数据。糖尿病相关死亡的定义是使用 ICD-10 编码，将糖尿病列为主要死因，但不包括将 COVID-19 列为主要死因的死亡证明。使用空间和负二项式回归模型来描述与糖尿病相关的超额死亡率的地理分布以及社会人口统计学和流行病学相关性，其通过 2020 年与 2017-2019 年平均水平相比，糖尿病相关死亡率的增加来估计。
我们发现 2020 年有 148437 例与糖尿病相关的死亡（每 10 万人中有 177 例），而 2017-2019 年的平均死亡人数为 101496 人（每 10 万人中有 125 例）。2020 年住院与糖尿病相关的死亡人数比 2017-2019 年下降了 17.8%，而院外死亡人数则增加了 89.4%。大多数死亡归因于 2 型糖尿病（每 10 万人中有 130 例）。与 2018-2019 年的数据相比，高血糖高渗状态和糖尿病酮症酸中毒是导致死亡率上升最高的两个原因（分别上升 128%和 116%）。与糖尿病相关的超额死亡率集中在墨西哥南部，在社会滞后程度较高、COVID-19 住院率较高以及 HbA1c≥7.5%的州，死亡率最高。
2019 冠状病毒病大流行开始后，墨西哥成年人的与糖尿病相关的死亡人数增加了 41.6%，不成比例地发生在医院外，主要归因于 2 型糖尿病和高血糖急症。糖尿病护理中断和医院容量紧张可能是 2020 年墨西哥与糖尿病相关的超额死亡率的原因。
