Unmasking Type 2 Diabetes in an Aging Mexico: Trends and Disparities by Sex and State-Level From the GBD 2021 Study

To examine trends in type 2 diabetes mellitus (T2DM) burden among adults aged ≥ 55 years in Mexico from 1990 to 2021, disaggregated by sex, quinquennial age groups, and subnational level.

We conducted a secondary analysis of Global Burden of Disease (GBD) 2021 data. Age-specific and age-standardized rates (ASR) were estimated for each year and metric, including mortality, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALY). We applied Joinpoint regression to assess ASR-DALY trends, and associations with the Sociodemographic Index (SDI) and Healthcare Access and Quality Index (HAQI) were evaluated.

From 1990 to 2021, the number of T2DM deaths among adults aged ≥ 55 years increased by 104.3%, although the overall age-standardized mortality rate showed a nonsignificant decline of 1.8%. Mortality rates decreased significantly among females by 15.6%, whereas they increased nonsignificantly among males by 18.0%, with significant increases observed in the 80-84 and ≥ 85 age groups. The ASR DALY remained relatively stable, changing from 9629.0 per 100,000 in 1990 to 9649.2 per 100,000 in 2021. In 2021, YLL accounted for 73.5% of DALY among males, whereas YLD accounted for 34.2% among females. Subnational differences were substantial: Tabasco, Guanajuato, and Puebla had the highest DALY rates in 2021, whereas Sinaloa and Nuevo León reported the lowest. Joinpoint analyses identified significant increases in 13 states and significant decreases in 13 states. Nationally, ASR DALY were negatively correlated with the SDI (-0.43) and HAQI -0.56), although state-level associations were heterogeneous.

The burden of T2DM among Mexican adults aged ≥ 55 years shifted from higher rates among women in 1990 to slightly higher rates among men in 2021. In 2021, women experienced a greater disability burden, whereas men had higher premature mortality. Marked subnational disparities and heterogeneous state-level trends suggest uneven epidemiological and health system transitions, underscoring the need for targeted, sex-sensitive, and region-specific strategies for chronic disease prevention and management.