COVID-19 Was the Leading Cause of Death in Mexico in 2021

Perla Miranda

December 28, 2022

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Between 2020 and 2021, Mexico registered 704,358 more deaths than expected, and COVID-19 was the leading cause, followed by heart disease and diabetes. This figure represents an excess mortality of 47%, according to a report by the National Institute of Statistics and Geography (INEGI) on the deaths registered in the country.

In the period analyzed, COVID-19 remained the leading cause of death, with 238,772 deaths. The second leading cause was heart disease, with 225,449 deaths. In third place was diabetes, with 140,729 deaths.

Specialists told Medscape Spanish Edition that although these data were predictable, the report published by INEGI is an essential tool for evaluating public health strategies and for shedding light on other problems. The latter include the fact that suicide is the third leading cause of mortality among persons aged 10 to 24 years. Assaults (homicides) are the leading cause of death among persons aged 15 to 34 years and is the second for those aged 35 to 44 years. These data are proof that violence is a public health problem.

"This report helps us to understand what Mexicans are dying of; the last 2 years have been completely influenced by COVID-19, which from not existing in 2019 became the main cause of mortality in 2020 and 2021. It is very valuable from a public health standpoint, because it allows us to know how many Mexicans are dying, where they die, what they die of, and although the report doesn't evaluate health policies, it gives us an idea of where they should be directed," said Mauricio Rodríguez Álvarez, MD, professor of virology and spokesperson for the University Commission for Coronavirus Emergency Care of the National Autonomous University of Mexico in Mexico City.

The INEGI report indicated that in 2021, heart disease was associated with excess mortality (42%), given that 310,020 deaths from this cause were expected, and 441,290 occurred: a surplus of 131,270.

In the case of diabetes, 219,077 deaths were expected, and 289,980 occurred: that is 70,903 more than expected, which is equivalent to an excess mortality of 32%.

Andreu Comas García, MD, MHS, PhD, from the Center for Research in Health Sciences and Biomedicine of the School of Medicine of the Autonomous University of San Luis Potosí, explained that these data are a road map to analyze which health interventions have worked and which have not.

He stressed that the excess mortality from cardiovascular diseases and diabetes shows that chronic-degenerative conditions "have not gone anywhere and continue to be the Achilles heel of the Mexican health system," in addition to the impact that the coronavirus has had on the care of patients with these conditions. Problems in caring for these patients that arose during the pandemic include a lack of patient monitoring, the consequences of hospital conversion, and the disappearance of Seguro Popular [Popular Insurance].

"It's true that we still see COVID-19 as the leading cause of mortality, but without a doubt, the excess of mortality due to cardiovascular diseases and diabetes is significant. It reminds us that the strategies to combat these conditions have been insufficient, and it makes space for the health system to reflect on the causes: from the fear of people going to their monthly consultation and catching COVID-19 to the uncertainty generated by the Institute of Health for Well-Being and, of course, that all the services were diverted to coronavirus care," said Comas.

For both specialists, it is essential to analyze the causes of death by age group, because this provides an opportunity to implement more precise actions for the benefit of society.

"What we're seeing is that it's more important for kids to wear seat belts in cars, because crashes are the number one cause of death in their age group, than to prevent suicide in adolescents and young adults aged 10 to 24 years, thinking seriously about the issue of violence, perhaps to reinforce prevention and vaccination campaigns against COVID-19 in adults from 35 to 64 years of age, without neglecting diabetes and heart disease," said Rodríguez.

Toll of Violence

The INEGI reported that in 2021, homicides were the eighth leading cause of mortality in Mexico, with 35,700 deaths, but among men, it was the sixth cause, with 31,263 deaths.

When analyzing the data by age group, the alarm is raised for the 15- to 24-year-olds and 25- to 34-year-olds, because assaults are the leading cause of death for them. Assaults are the second leading cause of death among 35- to 44-year-olds, the fourth leading cause among children and adolescents aged 10 to 14 years, and the fifth among children aged 5 to 9 years.

Given these data, Rodríguez asserted, "Violence in the country is a public health problem. How is it possible that it is the fifth cause in 5- to 9-year-olds? It's a tragedy."

He highlighted that these data should echo in decision-makers' minds, prompting them to create strategies not only for public health but also for the safety of Mexicans.

Comas said that if car accidents are considered a public health problem, violence is also a health problem, because it decreases the ability to have a good quality of life and to increase life expectancy.

"Public health is everything that increases the quality of life of the population and also increases the life expectancy of the population. Therefore, if these homicides ― let's say intentional ― significantly decrease our quality of life, because we fear going out, because at any moment something could happen to us, and of course it reduces the country's life expectancy, we have to focus on making or strengthening public policies," he added.

Review and Interventions

Although a complicated winter is expected for Mexico because of COVID-19, influenza, and respiratory syncytial virus, for García, who is also a virologist, it is likely that in 2022, heart disease will again be the leading cause of mortality, and diabetes could remain in third place. Hence, it is important to reinforce campaigns for early diagnosis and good control of these conditions.

"We have to focus our public policies on reducing the impact of these chronic diseases to improve productivity, quality of life, life expectancy, and let's not forget economic growth. If we don't stop the increase in hypertension and obesity, a large part of the country's workforce will be ill. Public policies must be designed to avoid these catastrophes, these immensely long diseases that worsen people's quality of life. We have to take care of ourselves against COVID-19, but let's not for a second forget the conditions that have afflicted us for years," said García.

Rodríguez commented that it is necessary to continue strategies for the prevention, detection, and treatment of diabetes, and also for its complications.

"We must continue fighting the junk food industry head on, promoting food labeling, everything that informs society, because obesity and diabetes are caused by bad dietary habits. We must not ignore kidney failure as a consequence of diabetes, which is an enormous out-of-pocket expense and causes very painful deaths. That is what this report is for, and despite the fact that it's clear that there will be more waves of COVID-19, it's unlikely that it will continue as the leading cause of mortality."

Rodríguez reiterated that the data published by INEGI should influence the strength of the focus on accident prevention in persons younger than 15 years, on the creation of specific programs to prevent suicide in adolescents, and on addressing the problem of violence at a national level. Additional priorities include the timely detection of diabetes and cancer and guaranteeing access to adequate treatment for these and other diseases. This initiative would help to alter not only the number of deaths but also their causes.

"With this information, health authorities can be much more emphatic in risk communication, warning about the harm caused by alcohol, tobacco, and poor nutrition. These three are the horsemen of this apocalypse, because they cause preventable mortality. This report allows us to find the gaps in public policy and strengthen health education, reconsidering what needs to be changed to reduce the incidence of these causes of mortality," Rodríguez concluded.

Total Men Women
COVID-19 COVID-19 Heart disease
Heart disease Heart disease COVID-19
Diabetes Diabetes Diabetes
Malignant tumors Malignant tumors Malignant tumors
Influenza and pneumonia Influenza and pneumonia Influenza and pneumonia
Liver diseases Assaults (homicides) Cerebrovascular diseases
Cerebrovascular diseases Liver diseases Liver diseases
Assaults (homicides) Accidents Chronic obstructive pulmonary diseases
Accidents Cerebrovascular diseases Accidents
Chronic obstructive pulmonary diseases Chronic obstructive pulmonary diseases Kidney impairment


Rodríguez and Comas have disclosed no relevant financial relationships.

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This article was translated from the Medscape Spanish edition.


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