Mexicos surge of violence and COVID 19 drive life expectancy losses 2015 2021.

BackgroundLife expectancy at birth in Mexico has stagnated since the early 2000s. As the COVID-19 pandemic hit, Mexico experienced sizable excess mortality, albeit with large regional variation. We aimed to assess the contribution of violence, COVID-19, and causes of death amenable to healthcare to life expectancy changes between 2015 and 2021 in Mexico. MethodsWe used administrative mortality data by causes of death, and adjusted population exposures from the National Population Council. We applied demographic decomposition methods to assess life expectancy changes at the subnational level, by year and sex. FindingsLife expectancy between 2015 and 2019 declined from 71.8 to 71.1 years for males and stagnated at 77.6 years for females. Violence among young males accounted for 54.3% of life expectancy losses. Between 2019 and 2020, life expectancy decreased by 7.1 and 4.4 years for males and females, respectively. COVID-19 deaths accounted for 55.4% (males) and 57.7% (females). In 2021, male life expectancy stagnated at 64.1 years due to reductions in deaths due to amenable diseases but continued increasing for females by 0.44 years mainly due to reductions in COVID-19 deaths. InterpretationWe document large variations in life expectancy losses across Mexican states, which are associated with preexistent high levels of violence, and socioeconomic disadvantages across geographical areas. Our results serve as a reminder that violence has negative health implications for both sexes and that COVID-19 affected more socially disadvantaged states. FundingSupport from the Netherlands Interdisciplinary Demographic Institute-KNAW, AXA Research Fund, Economic and Social Research Council, and European Unions Horizon 2020 Research and Innovation. Research in context.O_ST_ABSEvidence before this studyC_ST_ABSWe searched for studies in English and Spanish that analyzed life expectancy losses in Mexico before and during the COVID-19 pandemic in PubMed. Most studies that assessed life expectancy during the COVID-19 rely on all-cause mortality and indirect demographic methods. We also identified studies on causes of death, those focused on age-standardized mortality or excess deaths, but as of April 2024, we did not find articles assessing the impact of multiple causes of death on life expectancy. Added value of this studyTo our knowledge, this is the first study to assess the impact of different causes of death on life expectancy before and during the COVID-19 pandemic at the subnational level and by sex in Mexico. We focus on the main causes of death including COVID-19, homicides, and causes amenable to health care (e.g. diabetes). Our findings reveal that before the COVID-19 pandemic (2015-2019) life expectancy decreased for males and remained the same for females. During 2019-2020 life expectancy decreased sharply for both males and females, while in the subsequent years (2020-2021), life expectancy roughly remained the same for males, and continued decreasing for females. Most of the life expectancy losses before the pandemic for males were due to violence and homicides, while since 2020 they were due to COVID-19, but diabetes and causes of death amenable to health care also contributed to reduced life expectancy. Life expectancy losses were unevenly distributed at the subnational level, states from southern and central Mexico experienced the largest life expectancy losses compared to states from north of Mexico. Implications of all the available evidenceThis study contributes to understanding life expectancy changes before and during the COVID-19 pandemic years. By quantifying life expectancy losses we uncover the unequal and devastating impact of the pandemic at the subnational level in Mexico. Moreover, our results highlight the continued failure on reducing homicides and violence in the country.