  The COVID-19 pandemic has caused ~ 2 million fatalities. Significant progress
has been made in advancing our understanding of the disease process, one of the
unanswered questions, however, is the anomaly in the case/mortality ratio with
Mexico as a clear example. Herein, this anomaly is explored by spatial analysis
and whether mortality varies locally according to local factors. To address
this, hexagonal cartogram maps (hexbin) used to spatially map COVID-19
mortality and visualise association with patient-level data on demographics and
pre-existing health conditions. This was further interrogated at local Mexico
City level by choropleth mapping. Our data show that the use of hexagonal
cartograms is a better approach for spatial mapping of COVID-19 data in Mexico
as it addresses bias in area size and population. We report sex/age-related
spatial relationship with mortality amongst the Mexican states and a trend
between health conditions and mortality at the state level. Within Mexico City,
there is a clear south, north divide with higher mortality in the northern
municipalities. Deceased patients in these northern municipalities have the
highest pre-existing health conditions. Taken together, this study provides an
improved presentation of COVID-19 mapping in Mexico and demonstrates spatial
divergence of the mortality in Mexico.
