Objective:

Indigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among Indigenous and non-Indigenous populations at national and sub-national levels in Mexico.

Methods:

We obtained data from the Ministry of Health of Mexico on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000-person weeks, mortality rate ratio among Indigenous vs. non-Indigenous groups (RR), and hazard ratio (HR) for COVID-19 deaths across four waves from February 2020 to March 2022. We also assessed differences in the reproduction number (R_t).

Results:

The mortality rate among Indigenous populations of Mexico was 68% higher than that of non-Indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among Indigenous groups (P<0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the R_t among the two groups was comparable.

Conclusion:

Indigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks) and COVID-19 vaccination interventions among Indigenous and non-Indigenous populations in Mexico.