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BackgroundWhether diabetes is associated with COVID-19-related mortality remains unclear.MethodsIn this retrospective case-series study we examined the risk of death associated with self-reported diabetes in symptomatic adult patients with laboratory-confirmed COVID-19 who were identified through the System of Epidemiological Surveillance of Viral Respiratory Disease in Mexico from January 1 through November 4, 2020. Survival time was right-censored at 28 days of follow-up.ResultsAmong 757,210 patients with COVID-19 included in the study, 120,476 (16%) had diabetes and 80,616 died. Patients with diabetes had a 49% higher relative risk of death than those without diabetes (Cox proportional-hazard ratio; 1.49 (95% confidence interval [CI], 1.47-1.52), adjusting for age, sex, smoking habit, obesity, hypertension, immunodeficiency, and cardiovascular, pulmonary, and chronic renal disease. The relative risk of death associated with diabetes decreased with age (P=0.004). The hazard ratios were 1.66 (1.58-1.74) in outpatients and 1.14 (1.12-1.16) in hospitalized patients. The 28-day survival for inpatients with and without diabetes was, respectively, 73.5% and 85.2% for patients 20-39 years of age; 66.6% and 75.9% for patients 40-49 years of age; 59.4% and 66.5% for patients 50-59 years of age; 50.1% and 54.6% for patients 60-69 years of age; 42.7% and 44.6% for patients 70-79 years of age; and 38.4% and 39.0% for patients 80 years of age or older. In patients without COVID-19 (878,840), the adjusted hazard ratio for mortality was 1.78 (1.73-1.84).ConclusionIn symptomatic adult patients with COVID-19 in Mexico, diabetes was associated with higher mortality. This association decreased with age.