Epidemiologic panorama of stomach cancer mortality in Mexico

BACKGROUND

Annually, there are more than 6 million deaths from a type of malignant neoplasia worldwide. In developing countries, the highest rates of incidence of malignant neoplasias are uterine cervical cancer, stomach, lung, esophagus, pharynx, and liver cancers. Recent estimates on the incidence of cancer worldwide show that, in 1990, stomach cancer (SC) was the second most frequent type of cancer (900,000 new cases annually). Rates of incidence have decreased consistently in nearly all areas of the world. In Mexico, however, rates of incidence and mortality have increased gradually between 1980 and 1997; in 1995, 4,685 people died of SC in Mexico. This report presents a descriptive analysis of SC mortality in Mexico.

METHODS

A mortality database edited from the electronic files of the National Institute of Informatics, Statistics and Geography (INEGI) in Mexico was used; population denominators were edited by the Mexican National Population Council (Conapo). Adjusted mortality rates, taking as standard of reference the population of Mexico City by sex, year, and 10-year age groups were calculated as well as the sex ratio for the 1980-1997 period. To evaluate the magnitude of risks by state, the standardized mortality ratio (SMR) was calculated; prematurity was evaluated through the potential lost-life years index (PLLYI). The analysis was carried out using the Excel and Stata 5.0 software programs.

RESULTS

During the years from 1980 to 1997, in Mexico the total number of deaths from SC was 76,315. The male:female ratio was 1.2:1.0. SMR by state showed that the states of Yucatán, Sonora, Zacatecas, Michoacán, and Chiapas had higher mortality rates. The PLLYI was higher for males in the states of Chiapas, Sonora, Chihuahua, Zacatecas, and Southern Baja California, and higher for females in Chiapas, Oaxaca, Yucatán, Puebla, and Campeche.

CONCLUSIONS

World statistics on mortality caused by SC suggest a decreasing trend. Findings for this study show an increase in the adjusted mortality rates by SC during the 1980-1997 period in Mexico. However, when analyzing the different indicators that reveal risks, magnitude, and prematurity of mortality, there is a differential trend in mortality by sex that includes regional patterns probably related to different socioeconomic levels.

Bronchial asthma healthcare costs in Mexico: analysis of trends from 1991-1996 with information from the Mexican Institute of Social Security

Cost trends for bronchial asthma have not been previously estimated in Mexico. The increasing prevalence of bronchial asthma as well as its elevated costs make it necessary to expand the availability of information for health planners. This is a growing problem which has been given little attention in national health reports. We did a descriptive, retrospective analysis using national data from the Mexican Institute for Social Security. We estimated the number of medical consultations provided by the state family medicine and specialty areas. A total of 756,843 consultations due to bronchial asthma were provided between 1991 and 1996 in the service areas under study. The healthcare expenditure for bronchial asthma showed an ascending and sustained trend during the study period. When analyzing the trends by type of service, a significant increase in in-hospital care was observed, ranging from US $14.5 (1991) to $19.8 (1996) million and a maximum of $28.4 (1994) million. A similar increase was found in specialty consultation, from $3.96 (1991) to $8.5 (1996) million; in emergencies, from $1. 1 (1991) to $2.9 (1996) million; and family medicine, from $0.66 (1991) to $0.79 (1996) million. Bronchial asthma follows the same pattern as other noncommunicable chronic diseases, increasing in highly urbanized areas and nationwide. In order to improve healthcare and maximize results with scarce resources, a set of strategies is presented to reduce bronchial asthma recurrence, decrease healthcare costs, and improve quality of life.

Association of maternal short stature with stunting in Mexican children: common genes vs common environment

OBJECTIVE

To evaluate the association between stunting in children and maternal short stature, controlling for potential environmental confounders.

DESIGN

1988 Mexico National Nutrition Survey.

SETTING

Mexico

SUBJECTS

The final sample size was 4663 pairs of children (<5 y) and their mothers (12-49 y) from a total of 13 236 surveyed houses.

MAIN OUTCOME MEASURES

Stunting (height-for-age Z-scores <-2).

RESULTS

The prevalence of stunting in children was 19%, and 10% of the mothers exhibited short stature (<145 cm). In the crude analysis, mothers with short stature were significantly more likely to have stunted children (odds ratio (OR)=4.0; 95% confidence interval (CI)=3.2-4.8; P-value <0.001). In a multiple logistic regression model the OR for child stunting was reduced, but remained significant OR=2.0; 95% CI=1.6-2.6; P-value <0.001) after adjustment for region, urban/rural residence, socio-economic status, household size, child age and presence of infection in the past 14 d, and maternal age, body mass index (BMI), and educational level. Adjusted ORs varied between regions (Mexico City, OR=3.9; North Mexico, OR=3. 1; Central Mexico, OR=2.0; South Mexico, OR=1.6. Comparison of crude vs adjusted estimates pointed to regional differences in the proportion of association between maternal and child short statures explained by environmental determinants.

CONCLUSIONS

Maternal stature, reflecting her potential height and early environment, appeared to contribute to child height independently of the shared risk factors that could affect stature. Nonetheless, we could explain much of the association between stunting in children and maternal short stature by environmental factors, and part of the residual variability may be due to unmeasured determinants. Regional differences pointed to a predominance of environmental factors in explaining child stunting in poorer regions.