Publications by authors named "Marcela Agudelo-Botero"

25 Publications

  • Page 1 of 1

Sociodemographic and Clinical Factors Associated with Severe Obesity in Mexican Adults.

Arch Med Res 2021 Oct 9. Epub 2021 Oct 9.

Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México. Electronic address:

Background: In the last decades, obesity in general, including severe obesity (BMI ≥40 kg/m), has increased disproportionately around the world, especially in low-income and lower-middle income regions.

Aims: To analyze sociodemographic and clinical characteristics of people with severe obesity in Mexico, as well as their associated factors.

Methods: A secondary analysis was carried out from the 2018-19 National Health and Nutrition Survey. Descriptive statistics and bivariate analyses by sex were used. Logistic models were estimated to identify the main factors associated with severe obesity.

Results: Of the total number of people with obesity in the country (2.2 million people), 3.6% had severe obesity, with an average age of 48.2. There were statistically significant differences by sex in the variables of age group, education, socioeconomic status, health insurance, hypertension, myocardial infarction, and heart failure. Being a woman, having hypertension, and hypertension/diabetes increased the odds of severe obesity. These associations were maintained when comparing people with a BMI <40 kg/m, with those with a BMI ≥30 kg/m and a BMI <40 kg/m.

Conclusions: Severe obesity must appear on the Mexican political agenda. Data must be produced that can direct decision-making around the promotion of healthy lifestyles, and obesity prevention, treatment, and follow-up, based in people-centered care and through intersectoral strategies, multidisciplinary management, and holistic approaches.
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http://dx.doi.org/10.1016/j.arcmed.2021.09.003DOI Listing
October 2021

Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico.

Gac Med Mex 2021 ;157(2):127-132

Clinical Epidemiology Research Unit, Specialty Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City. Mexico.

Background: The literature refers that falls are of multifactorial origin, and some authors have proposed to classify risk factors as intrinsic and extrinsic.

Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in older adults who receive medical care at the Mexican Institute of Social Security.

Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used.

Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living.

Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.
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http://dx.doi.org/10.24875/GMM.M21000537DOI Listing
November 2021

The Association of Osteosarcopenia With Functional Disability in Community-Dwelling Mexican Adults 50 and Older.

Front Med (Lausanne) 2021 7;8:674724. Epub 2021 Jun 7.

Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.

Osteosarcopenia (OS) has recently been described as a predictor of negative outcomes in older adults. However, this alteration in body composition has not been widely studied. In Mexico and Latin America, no information is available on its frequency or associated factors. To analyze the association between OS with FD in community-dwelling Mexican adults 50 and older. Cross-sectional secondary data analysis was performed using primary data from a prospective study Frailty, Dynapenia and Sarcopenia Study in Mexican Adults (FraDySMex). Eight hundred and twenty-five people were included, 77.1% women, aged 70.3 ± 10.8 years old. OS was defined as when the person was diagnosed with sarcopenia (SP) plus osteopenia/osteoporosis. The SP diagnosis was evaluated in accordance with the criteria of the European Working Group for the Definition and Diagnosis of Sarcopenia (EWGSOP), and the osteoporosis diagnosis using World Health Organization (WHO) criteria. Muscle mass and bone mass were evaluated using dual-energy X-ray absorptiometry (DXA). FD was evaluated using the basic activities of daily living (BADL) and the instrumental activities of daily living (IADL). Additional sociodemographic and health co-variables were also included, such as sex, age, education, cognitive status, depression, comorbidity, hospitalization, polypharmacy, urinary incontinence, and nutrition variables such as risk of malnutrition and obesity. Associations between OS with FD were evaluated using multiple logistic regression. The prevalence of OS was 8.9% and that of FD was 8.9%. OS was associated with FD [odds ratio (OR): 1.92; CI 95%: 1.11-3.33]. Comprehensive OS assessment could help clinicians identify risk factors early, and thus mitigate the impact on FD in older people.
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http://dx.doi.org/10.3389/fmed.2021.674724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215205PMC
June 2021

Advances and challenges on the path toward the SDGs: subnational inequalities in Mexico, 1990-2017.

BMJ Glob Health 2020 10;5(10)

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA

Background: The sustainable development goals (SDGs) have generated momentum for global health, aligning efforts from governments and international organisations toward a set of goals that are expected to reflect improvements in life conditions across the globe. Mexico has huge social inequalities that can affect access to quality care and health outcomes. The objective of this study is to analyse inequalities among Mexico's 32 states on the health-related SDG indicators (HRSDGIs) from 1990 to 2017.

Methods: These analyses rely on the estimation of HRSDGIs as part of the Global Burden of Disease study 2017. We estimated the concentration index for 40+3 HRSDGI stratified by Socio-demographic Index and marginalisation index, and then for indicators where inequalities were identified, we ran decomposition analyses using structural variables such as gross domestic product per capita, poverty and health expenditure.

Findings: Mexico has made progress on most HRSDGIs, but current trends in improvement do not appear to fast enough to meet 2030 targets. Out of 43 HRSDGIs, we identified evidence of inequality between Mexico's states for 30 indicators; of those, 23 HRSDGIs were unequal distributed affecting states with lower development and seven affecting states with higher development. The decomposition analysis indicates that social determinants of health are major drivers of HRSDGI inequalities in Mexico.

Interpretation: Modifying current trends for HRSDGIs will require subnational-level and national-level policy action, of which should be informed by the latest available data and monitoring on the health-related SDGs. The SDGs' overarching objective of should be prioritised not only for individuals but also for communities and other subnational levels.
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http://dx.doi.org/10.1136/bmjgh-2020-002382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597504PMC
October 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach.

Int J Equity Health 2020 06 8;19(1):90. Epub 2020 Jun 8.

Nephrology Services, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.

Background: Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis.

Methods: This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach.

Results: It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment.

Conclusion: Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.
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http://dx.doi.org/10.1186/s12939-020-01205-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282114PMC
June 2020

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Unintentional injuries in Mexico, 1990-2017: findings from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 1;26(Supp 1):i154-i161. Epub 2020 Apr 1.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017).

Methods: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics.

Results: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas.

Conclusions: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations.
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http://dx.doi.org/10.1136/injuryprev-2019-043532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571365PMC
October 2020

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017.

BMJ Open 2020 03 25;10(3):e035285. Epub 2020 Mar 25.

Latin American Faculty of Social Sciences, Mexico City, Mexico

Objective: To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017.

Design: Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017.

Participants: Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved.

Methods: We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017.

Results: From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population.

Conclusions: Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.
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http://dx.doi.org/10.1136/bmjopen-2019-035285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170614PMC
March 2020

Health inequalities in Latin America: persistent gaps in life expectancy.

Lancet Planet Health 2019 12 10;3(12):e492-e493. Epub 2019 Dec 10.

Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico. Electronic address:

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http://dx.doi.org/10.1016/S2542-5196(19)30244-XDOI Listing
December 2019

Sex disparities in the epidemic of type 2 diabetes in Mexico: national and state level results based on the Global Burden of Disease Study, 1990-2017.

Diabetes Metab Syndr Obes 2019 8;12:1023-1033. Epub 2019 Jul 8.

Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.

Purpose: To analyze the type 2 diabetes (T2D) health burden in Mexico by sex at the national and state levels from 1990 to 2017.

Methods: This was a secondary analysis based on data from the Global Burden of Disease Study, 1990-2017. We used the indicators of mortality rates, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs).

Results: At the national level, there was an increase in the standardized mortality rates, YLLs, YLDs and DALYs, especially in the male group. At the state level, the health impacts of T2D varied within the population and did not exhibit any clearly defined geographic pattern. However, the most pronounced increases in the various indicators occurred in the poorer states of the country.

Conclusion: T2D continues to have a dominant impact on Mexican public health, with marked disparities between the states. Working to reduce these health inequalities is necessary, and resources must be focused on the priority groups, for example, men, young and middle-aged adults, and individuals living in the states with the highest index of marginalization.
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http://dx.doi.org/10.2147/DMSO.S205198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625746PMC
July 2019

Epidemiology, progression, and predictive factors of urinary incontinence in older community-dwelling Mexican adults: Longitudinal data from the Mexican Health and Aging Study.

Neurourol Urodyn 2019 09 11;38(7):1932-1943. Epub 2019 Jul 11.

Clinical Epidemiology Department, National Institute of Geriatrics, Mexico City, Mexico.

Aims: To understand the epidemiology, progression, and predictive factors of urinary incontinence (UI) in community-dwelling Mexican adults aged ≥ 50 by sex and UI subtypes (stress, urge, and mixed).

Methods: We analyzed longitudinal UI data in community-dwelling adults aged ≥ 50 (7783 women and 5843 men) for the 2012 to 2015 period of the Mexican Health and Aging Study. We estimated mixed, stress, and urgency incontinence prevalence (2012); 2-year cumulative incidence and remissions (2015); and progression (2012-2015). A multivariate analysis was undertaken to evaluate the predictive factors for UI and its subtypes by sex.

Results: The prevalence of UI was higher (27.7%) for women (average age 65.9 ± 9.5) than 12.5% men (average age 67.4 ± 9.3) and increased with age in both sexes (26.7% in women 50 to 59, to 48.5% in ≥ 90; and 6.8% in men 50 to 59, to 26.2% ≥ 90). The most frequent UI subtypes were mixed in women and urge in men. The cumulative incidence of UI was higher in women (22.9%) than men (12.3%) while its remission was higher in men than women. Predictive factors for UI in both sexes were depressive symptoms, a higher number of concomitant diseases and a history of falls; while advanced age was a factor only for men.

Conclusions: UI is a common health problem and its prevalence and severity increase with age. Addressing modifiable risk factors such as depression and falls could decrease the prevalence and incidence of UI and its subtypes. Further studies should also focus on the relationship between mixed UI and male mortality.
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http://dx.doi.org/10.1002/nau.24096DOI Listing
September 2019

Trends and differences in homicide mortality in Colombia and Mexico, 1990-2016: Two Realities, One Problem.

J Interpers Violence 2021 09 9;36(17-18):7962-7977. Epub 2019 May 9.

National Institute of Public Health, Health Systems Research Center, Cuernavaca, Mexico.

Colombia and Mexico are among the countries in the region with the highest rates of homicide mortality and are also the drug traffickers in the world. The objective of this study was to analyze the trends and differences in homicide mortality in Colombia and Mexico between 1990 and 2016. Using data from the Global Burden of Disease Study, we report mortality rates and trends in years of life lost to homicides. This study looked at injuries occurring because of interpersonal violence, which was divided into three types (firearm, sharp object, and others). The homicide mortality rate steadily decreased since 1992 in Colombia, while in Mexico, it varied over time. This rate in Colombia has not been reduced to Mexico's level, and in turn, Mexico has not had a mortality rate as high as Colombia's. Throughout the period, in both countries, the years of life lost rate decreased (52% in Colombia and 18.6% in Mexico); however, between 2002 and 2016, the years of life lost rate from homicides was reduced in all age groups in Colombia, and in Mexico, they increased notably, mainly between 15 and 54 years of age. Public health plays a central role in abating interpersonal violence through the prevention of risk factors, and through making information available so that decision-makers can create public policies using evidence-based arguments. The Global Burden of Disease Study is a crucial resource that can be used to define, describe, and evaluate the consequences of homicides and help direct efforts and resources to the most vulnerable groups.
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http://dx.doi.org/10.1177/0886260519847775DOI Listing
September 2021

Factors associated with environmental barriers of people with disabilities in Mexico.

Rev Saude Publica 2019 Apr 1;53:27. Epub 2019 Apr 1.

Universidad Nacional Autónoma de México. Facultad de Medicina. Centro de Investigación en Políticas, Población y Salud. Ciudad de México, México.

Objective: To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico.

Methods: In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used.

Results: The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment.

Conclusions: This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.
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http://dx.doi.org/10.11606/S1518-8787.2019053000556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474753PMC
April 2019

Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000-2011.

Cad Saude Publica 2018 06 21;34(6):e00093417. Epub 2018 Jun 21.

Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Ciudad de México, México.

The objective of this study was to analyze the level and trend of avoidable deaths and non-avoidable deaths and their contribution to the change in life expectancy in Latin America by studying the situations in Argentina, Chile, Colombia and Mexico between the years 2000 and 2011, stratified by sex and 5-year age groups. The information source used in this study was the mortality vital statistics, and the population data were obtained from censuses or estimates. The proposal by Nolte & McKee (2012) was used to calculate the standardized mortality rates and the influence from avoidable and non-avoidable causes in the change in life expectancy between 0 and 74 years. In Argentina, Chile and Colombia, all the rates declined between the years 2000 and 2011, whereas in Mexico, the avoidable deaths and non-avoidable deaths rates increased slightly for men and decreased for women. In all the countries, the non-avoidable death rates were higher than the avoidable death rates, and the rates were higher for men. The largest contributions to changes in life expectancy were explained by the non-avoidable deaths for men in all countries and for women in Argentina; in contrast, in Chile, Colombia and Mexico, the gains in years of life expectancy for women were mainly a result of avoidable causes. The results suggest there have been reductions in mortality from these causes that have resulted in gains in years of life expectancy in the region. Despite these achievements, differences between countries, sex and age groups are still present, without any noticeable progress in the reduction of these inequalities until now.
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http://dx.doi.org/10.1590/0102-311X00093417DOI Listing
June 2018

Factors associated with occasional and recurrent falls in Mexican community-dwelling older people.

PLoS One 2018 20;13(2):e0192926. Epub 2018 Feb 20.

Unidad de Vigilancia Epidemiológica Hospitalaria, Investigación Sociomédica, Instituto Nacional de Rehabilitación, Mexico City, Mexico.

Falls are a frequent event among older adults that can cause wounds, disability, psychological disorders, and premature death. Although the large number of existing studies on the issue, few have been conducted in middle- and low-income countries. The objective of the present study is to identify the sociodemographic, medical, and functional performance factors associated with occasional and recurrent falls in Mexican older adults dwelling in community. Cross-sectional analysis of 9 598 adults ≥60 years old who participated in the fourth round (2015) of the Mexican Health and Aging Study. Bivariate tests were performed to evaluate the differences between covariates by distinct fall groups (no falls, occasional falls, and recurrent falls). Multiple logistic regressions with unadjusted and adjusted models were estimated. Approximately 46% of older adults had had at least one fall during the previous two years (one fall 16% and recurrent falls 30%). Occasional falls were only associated with being a woman; in addition to the sex, recurrent falls were strongly associated with advanced age, rural residence, bad and very bad self-perception of health status, activity-limiting pain, urinary incontinence, depression, arthritis, limitations in basic activities of daily living, and limitations in advanced activities of daily living. Falls, primarily recurrent falls, deserve to be addressed through multifactorial strategies that include different areas of intervention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192926PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819783PMC
April 2018

Multimorbidity Patterns in Older Adults: An Approach to the Complex Interrelationships Among Chronic Diseases.

Arch Med Res 2017 Jan;48(1):121-127

Departamento de Epidemiología Clínica, Instituto Nacional de Geriatría, Ministerio de Salud, Ciudad de México, México.

Background And Aims: There is a growing need for evidence based answers to multimorbidity, especially in primary care settings. The aim was estimate the prevalence and patterns of multimorbidity in a Mexican population of public health institution users ≥60 years old.

Methods: Observational and multicenter study was carried out in four family medicine units in Mexico City; included older men and women who attended at least one consultation with their family doctor during 2013. The most common diseases were grouped into 11 domains. The observed and expected rates, as well as the prevalence ratios, were calculated for the pairs of the more common domains. Logistic regression models were developed to estimate the magnitude of the association. Cluster and principal components analyses were performed to identify multimorbidity patterns.

Results: Half of all of the patients who were ≥60 years old and treated by a family doctor had multimorbidity. The most common disease domains were hypertensive and endocrine diseases. The highest prevalence of multimorbidity concerned the renal domain. The domain pairs with the strongest associations were endocrine + renal and hypertension + cardiac. The cluster and principal components analyses revealed five consistent patterns of multimorbidity.

Conclusions: The domains grouped into five patterns could establish the framework for developing treatment guides, deepen the knowledge of multimorbidity, develop strategies to prevent it, decrease its burden, and align health services to the care needs that doctors face in daily practice.
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http://dx.doi.org/10.1016/j.arcmed.2017.03.001DOI Listing
January 2017

[Level of and change in road traffic mortality in Argentina, Chile, Colombia and Mexico, 2000-2011].

Salud Colect 2015 Sep;11(3):411-21

Facultad de Medicina, Universidad CES, Medellín, Colombia.

The aim of this study was to estimate the effect of run-over fatalities and traffic collisions in life expectancy in Argentina, Chile, Colombia and Mexico, between 2000 and 2011. Years of life expectancy lost (YLEL) were calculated for the periods 2000-2002 and 2009-2011. The results show that road traffic deaths made up between 1% and 4% of all deaths in each country. In the first period, the highest level of mortality occurred in Colombia (YLEL=0.96) and the lowest in Argentina (YLEL=0.59). In all the countries studied except Argentina, the impact of these deaths on life expectancy was reduced in the second period. The main change took place in Colombia, reaching 0.72 YLEL in the second period. It is concluded that traffic-related deaths have a negative impact on health systems, victims, the productive sector, and society in general. From this point of view, the issue of road transit must be considered a matter of public health, requiring multi-sector intervention in the design of national and regional policies.
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http://dx.doi.org/10.1590/S1851-82652015000300008DOI Listing
September 2015

[Avoidable mortality in the states adjacent to the Mexico-United States border; 1999-2001 and 2009-2011].

Cien Saude Colet 2015 Apr;20(4):1063-73

Departamento de Estudios de Población, El Colegio de La Frontera Norte.

The scope of this article is to measure the effect of avoidable mortality in changes in life expectancy in the states adjacent to both sides of the US-Mexico border between 1999-2001 and 2009-2011. The data used were the records of mortality and population censuses from official sources in each country. Standardized mortality rates were estimated and the expected years of life lost were calculated. Both in 1999-2001 and in 2009-2011 the states belonging to the southern border of the United States had lower rates of avoidable mortality rates than those observed in the northern states of Mexico. In the border region avoidable deaths have seen an averageincrease of 0.19 years of life for America and a loss of 0.47 years of life for Mexico. The states of the US-Mexico border have common features in their health profiles that make it necessary to address some problemson a global basis and consider the particularities of each, in order to reduce gaps and enhance social equity through strategies involving independent national actions and othersby cross-border coordination.
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http://dx.doi.org/10.1590/1413-81232015204.13782014DOI Listing
April 2015

[Burden of mortality due to diabetes mellitus in Latin America 2000-2011: the case of Argentina, Chile, Colombia, and Mexico.]

Gac Sanit 2015 Mar 5. Epub 2015 Mar 5.

Facultad Latinoamericana de Ciencias Sociales (FLACSO), México D.F., México. Electronic address:

Objective: To analyze trends in mortality in Argentina, Chile, Colombia and Mexico, between 2000 and 2011, by sex and 5-year age groups (between 20 and 79 years of age).

Material And Methods: Mortality vital statistics and census data or projected population estimates were used for each country. Age-specific mortality rates and the years of life lost were calculated.

Results: Among the countries analyzed, Mexico had the highest mortality rate and lost the most years of life due to diabetes. Between 2000 and 2011, Mexicans lost an average of 1.13 years of life, while Colombia (0.24), Argentina (0.21) and Chile (0.18) lost considerably fewer life years. In general, deaths from diabetes were higher in men than in women except in Colombia. Nearly 80% of years of life lost due to diabetes occurred between 50 and 74 years of age in the four countries.

Discussion: Diabetes is a huge challenge for Latin America, especially in Mexico where mortality due to diabetes is accelerating. Even though the proportion of deaths due to diabetes in Argentina, Chile and Colombia is smaller, this disease figures among the main causes of death in these countries.
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http://dx.doi.org/10.1016/j.gaceta.2015.01.015DOI Listing
March 2015

Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010.

Cad Saude Publica 2014 May;30(5):1093-102

Instituto Nacional de Geriatría, Ciudad de México, México.

The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.
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http://dx.doi.org/10.1590/0102-311x00113813DOI Listing
May 2014

[Effect of avoidable and non-avoidable deaths on life expectancy in Mexico, 1998-2000 and 2008-2010].

Rev Panam Salud Publica 2014 Feb;35(2):121-7

Facultad Latinoamericana de Ciencias Sociales, México, D.F, México,

Objective: Estimate the changes in life expectancy related to avoidable and nonavoidable deaths in Mexico between the three-year periods from 1998-2000 and 2008-2010 by sex and age group.

Methods: A descriptive cross-sectional study was conducted. Data from official sources on deaths recorded from 0-74 years of age and population estimates (Mexican and worldwide) for the three-year periods from 1998-2000 and 2008-2010 was used. The crude and standardized death rates and years of life expectancy lost in the periods studied were calculated. Estimates were made of the effect of avoidable and non-avoidable deaths on life expectancy from 0-74 years of age, using the Arriaga method, and temporary life expectancy by age group.

Results: Mortality due to avoidable causes increased by 2.1% whereas mortality related to non-avoidable causes decreased by 2.3%, with differences according to sex. Life expectancy at birth was 74.2 years in the three-year period from 1998-2000 and 75.1 years in the three-year period from 2008-2010. Temporary life expectancy from 0-74 years of age remained nearly the same at about 68.6 years.

Conclusions: Years of life expectancy can be gained through actions that promote health and disease prevention, mainly by reducing deaths due to avoidable causes. Cross-sectional population-based interventions and strategies should be developed, focusing on specific subgroups, from a gender and generational perspective, and adjusted for the specific geographical, socioeconomic, and cultural features of the target population.
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February 2014

[Sociodemographic determinants of access to breast cancer screening in Mexico: a review of national surveys].

Salud Colect 2013 Apr;9(1):79-90

Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, México.

The aim of this article is to identify factors affecting access to breast cancer screening in Mexico according to the sociodemographic characteristics of the women, using three nationally-representative surveys. Descriptive statistics were performed and multiple classification analysis techniques were used. The dependent variables were that the women had realized: 1) breast self-examination, 2) clinical breast examination, or 3) mammography; the covariates were: age group, education level, type of locality (urban/rural), marital status, number of children, enrollment in social security and socioeconomic status. A low level of screening use was detected and gaps were observed between different groups of women according to sociodemographic characteristics. In general women of lower economic strata, without enrollment in social security and with lower educational levels, showed fewer detection practices than the national average.
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http://dx.doi.org/10.1590/S1851-82652013000100007DOI Listing
April 2013

Assessing the process of designing and implementing electronic health records in a statewide public health system: the case of Colima, Mexico.

J Am Med Inform Assoc 2013 Mar-Apr;20(2):238-44. Epub 2012 Sep 27.

Information Center for Decisions in Public Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.

The findings of a case study assessing the design and implementation of an electronic health record (EHR) in the public health system of Colima, Mexico, its perceived benefits and limitations, and recommendations for improving the implementation process are presented. In-depth interviews and focus group discussions were used to examine the experience of the actors and stakeholders participating in the design and implementation of EHRs. Results indicate that the main driving force behind the use of EHRs was to improve reporting to the two of the main government health and social development programs. Significant challenges to the success of the EHR include resistance by physicians to use the ICD-10 to code diagnoses, insufficient attention to recurrent resources needed to maintain the system, and pressure from federal programs to establish parallel information systems. Operating funds and more importantly political commitment are required to ensure sustainability of the EHRs in Colimaima.
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http://dx.doi.org/10.1136/amiajnl-2012-000907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638180PMC
August 2013

[Health information systems in the Mesoamerican Region].

Salud Publica Mex 2011 ;53 Suppl 3:S368-74

Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.

Objective: To evaluate and analyze health information systems (his) in the Mesoamerican Region.

Material And Methods: The conceptual framework and tools of the Health Metrics Network (nhm) was used. It measures six components of the his assessment: resources, indicators, data sources, information management, products and use.

Results: In this study we found that the average score of the HIS in the Mesoamerican region was 57%, being the maximum value for Mexico (75%) and the minimum for El Salvador (41%). The item that had lowest scores was that referring to the Management and Administration, where the average assessment was 37%, placing it as present but not adequate. The component with the highest score was Information Products with more than 69%, adequate. In any case, no items were very adequate.

Conclusion: The performance of his is heterogeneous between countries. It is necessary to strengthen and standardize the criteria of the his in the region, so that these are integrated and used in the decision making process based on real information.
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http://dx.doi.org/10.1590/s0036-36342011000900010DOI Listing
June 2012
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