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Medina-Gómez OS. [Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000-2022]. Semergen 2024; 50:102170. [PMID: 38306759 DOI: 10.1016/j.semerg.2023.102170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. METHODS An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000-2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. RESULTS There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019-2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021-2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. CONCLUSIONS The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.
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Affiliation(s)
- O S Medina-Gómez
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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2
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Aguila E, Dow WH, Menares F, Parker SW, Peniche J, Ryu S. Do conditional cash transfers reduce hypertension? ECONOMICS AND HUMAN BIOLOGY 2024; 53:101370. [PMID: 38442635 PMCID: PMC11110463 DOI: 10.1016/j.ehb.2024.101370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/17/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies have found positive impacts on schooling, the nutritional and health status of children and adolescents, and household consumption. However, the effects on the health of older adult beneficiaries have been particularly understudied. In this paper we analyze the effects of Progresa on middle-aged and older adult health, focusing on a high prevalence chronic condition: hypertension. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and use of treatment drugs. However, we did not find significant changes in uncontrolled hypertension as measured by systolic and diastolic blood pressure biomarkers in household survey data. Thus, while cash transfer programs may facilitate financial access to healthcare visits and the ability to buy prescribed medicines, by itself the program might not improve hypertension outcomes without complementary healthcare system follow-up to ensure dosage titration and medication adherence.
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Affiliation(s)
- Emma Aguila
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - William H Dow
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, CA, USA; Department of Demography, University of California, Berkeley, CA, USA
| | - Felipe Menares
- Department of Demography, University of California, Berkeley, CA, USA.
| | - Susan W Parker
- School of Public Policy, University of Maryland, College Park, MD, USA
| | - Jorge Peniche
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Soomin Ryu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Aguirre-García MM, Amedei A, Hernández-Ruiz P, Gómez-García AP, Niccolai E, Moreno-Rodríguez AM, Pinto-Cardoso S, Alviter-Plata A, Escalona-Montaño AR, Ordaz-Robles ER, González-Salazar MDC, Springall Del Villar R, Berrios-Bárcenas EA, Ávila-Vanzzini N. Cytokine and microbiota profiles in obesity-related hypertension patients. Front Cell Infect Microbiol 2024; 13:1325261. [PMID: 38292856 PMCID: PMC10824975 DOI: 10.3389/fcimb.2023.1325261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Background Systemic arterial hypertension is linked to a heightened risk of cardiovascular diseases on a global scale. In Mexico, nearly half of adults in vulnerable conditions experience hypertension. Imbalance in the oral and intestinal microbiota composition has been observed in patients with hypertension, documented by a decrease of bacteria producing short-chain fatty acids, which play a critical role in blood pressure regulation. Aim To examine the cytokines' profile and assess the characteristics of oral and gut microbiota in obesity-related hypertension in Mexican patients. Methods A cross-sectional, observational, and analytical study was carried out. Twenty-two patients were categorized by their body mass index (BMI) as overweight and obese, and the diagnosis of primary hypertension. DNA from supragingival dental plaque and feces samples was used to carry out 16S rRNA sequencing. Additionally, 13 cytokines were quantified. Results In the oral microbiota, Kluyvera was found to be significantly enriched in obese compared to overweight patients. Instead, the gut microbiota was dominated by Firmicutes. However, the correlation between certain genera and proinflammatory cytokines was noted. Conclusion This exploratory study provides insights into the complex relationship between the oral and gut microbiota and their association with systemic inflammation in obesity-related hypertension.
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Affiliation(s)
- María Magdalena Aguirre-García
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Interdisciplinary Internal Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Paulina Hernández-Ruiz
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Ana Pamela Gómez-García
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Aura M. Moreno-Rodríguez
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Sandra Pinto-Cardoso
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México, Mexico
| | - Adriana Alviter-Plata
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Alma R. Escalona-Montaño
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - Erick R. Ordaz-Robles
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
| | - María del C. González-Salazar
- Outpatient Clinic, Cardiovascular Risk Factors Clinic, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, Mexico
| | | | - Enrique A. Berrios-Bárcenas
- Outpatient Clinic, Cardiovascular Risk Factors Clinic, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, Mexico
| | - Nydia Ávila-Vanzzini
- Unidad de Investigación UNAM-INC, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Instituto Nacional de Cardiología "Ignacio Chávez, Ciudad de México, Mexico
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Suárez M, Martínez R, Torres AM, Torres B, Mateo J. A Machine Learning Method to Identify the Risk Factors for Liver Fibrosis Progression in Nonalcoholic Steatohepatitis. Dig Dis Sci 2023; 68:3801-3809. [PMID: 37477764 DOI: 10.1007/s10620-023-08031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
AIM Nonalcoholic fatty liver disease (NAFLD) is a silent epidemy that has become the most common chronic liver disease worldwide. Nonalcoholic steatohepatitis (NASH) is an advanced stage of NAFLD, which is linked to a high risk of cirrhosis and hepatocellular carcinoma. The aim of this study is to develop a predictive model to identify the main risk factors associated with the progression of hepatic fibrosis in patients with NASH. METHODS A database from a multicenter retrospective cross-sectional study was analyzed. A total of 215 patients with NASH biopsy-proven diagnosed were collected. NAFLD Activity Score and Kleiner scoring system were used to diagnose and staging these patients. Noninvasive tests (NITs) scores were added to identify which one were more reliable for follow-up and to avoid biopsy. For analysis, different Machine Learning methods were implemented, being the eXtreme Gradient Booster (XGB) system the proposed algorithm to develop the predictive model. RESULTS The most important variable in this predictive model was High-density lipoprotein (HDL) cholesterol, followed by systemic arterial hypertension and triglycerides (TG). NAFLD Fibrosis Score (NFS) was the most reliable NIT. As for the proposed method, XGB obtained higher results than the second method, K-Nearest Neighbors, in terms of accuracy (95.05 vs. 90.42) and Area Under the Curve (0.95 vs. 0.91). CONCLUSIONS HDL cholesterol, systemic arterial hypertension, and TG were the most important risk factors for liver fibrosis progression in NASH patients. NFS is recommended for monitoring and decision making.
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Affiliation(s)
- Miguel Suárez
- Gastroenterology Department, Virgen de La Luz Hospital, Av. Hermandad de Donantes de Sangre, 1, 16002, Cuenca, Spain.
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain.
| | - Raquel Martínez
- Gastroenterology Department, Virgen de La Luz Hospital, Av. Hermandad de Donantes de Sangre, 1, 16002, Cuenca, Spain
| | - Ana María Torres
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, Universidad de Castilla-La Mancha, Cuenca, Spain
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López-Pérez CA, Santa Cruz-Pavlovich FJ, Montiel-Cortés JE, Núñez-Muratalla A, Morán-González RB, Villanueva-Gaona R, Franco-Mojica X, Moreno-Sandoval DG, González-Bañuelos JA, López-Pérez AU, Flores-González M, Grijalva-Ruiz C, Valdez-Mendoza ED, González-Lucano LR, López-Zendejas M. Risk Factors for Mortality of Hospitalized Adult Patients with COVID-19 Pneumonia: A Two-Year Cohort Study in a Private Tertiary Care Center in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4450. [PMID: 36901460 PMCID: PMC10001871 DOI: 10.3390/ijerph20054450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, the high prevalence of comorbidities and the disparities between the public and private health subsystems in Mexico substantially contributed to the severe impact of the disease. The objective of this study was to evaluate and compare the risk factors at admission for in-hospital mortality of patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 pneumonia was conducted at a private tertiary care center. The study population consisted of 1258 patients with a median age of 56 ± 16.5 years, of whom 1093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p < 0.001), comorbidities such as hypertension (p < 0.001) and diabetes (p < 0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p < 0.001), the presence of cyanosis (p = 0.005), and previous myocardial infarction (p = 0.032) were independent predictors of mortality. In the studied cohort, the risk factors present at admission associated with increased mortality were older age, cyanosis, and a previous myocardial infarction, which can be used as valuable predictors for patients' outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended in a private tertiary hospital in Mexico.
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Affiliation(s)
| | | | - Juan Eduardo Montiel-Cortés
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
- Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Zapopan 44340, Mexico
| | - Adriana Núñez-Muratalla
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
- Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
| | | | | | - Xochitl Franco-Mojica
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Zapopan 45201, Mexico
| | | | | | | | - Marily Flores-González
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
- Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
| | - Cristina Grijalva-Ruiz
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
- Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
| | - Edna Daniela Valdez-Mendoza
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
- Facultad de Medicina, Universidad Autónoma de Guadalajara, Zapopan 45129, Mexico
| | | | - Martín López-Zendejas
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Zapopan 45201, Mexico
- Departamento de Medicina Interna, Hospital San Javier, Guadalajara 44670, Mexico
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Javier Cano-Martínez L, De Los Santos S, Mauricio Coral-Vázquez R, Pablo Méndez J, Trejo S, Roque-Ramírez B, Carlos Pérez-Razo J, Canto P. Variations in protein levels of the apelinergic system in adipose tissue of hypertensive individuals with class 3 obesity. Gene X 2023; 854:147107. [PMID: 36513190 DOI: 10.1016/j.gene.2022.147107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to investigate the expression of apelin (APLN) and its receptor (APLNR) in visceral adipose tissue (VAT), and its effect on the downstream expression of endothelial nitric oxide synthase (eNOS) in individuals with class 3 obesity, with or without hypertension. Seventy-five unrelated individuals presenting obesity class 3 with or without hypertension were included. Gene expression of APLN, and APLNR were analyzed in VAT, by reverse transcription quantitative polymerase chain reaction. The APLN, APLNR and eNOS (total and phosphorylated) levels in VAT were evaluated by Western blot. Analysis of differences between groups of APLN, APLNR and eNOS were performed by a logistic regression adjusting by confounding factors. Forty-five individuals with hypertension formed the case group, and 30 individuals constituted the control group. The APLN mRNA and protein levels were higher in the group of individuals with hypertension versus individuals without hypertension (p = 0.027 and p = 0.036, respectively). Meanwhile, APLNR mRNA and protein levels in subjects with hypertension were lower versus the group of subjects without hypertension (p = 0.001 and p = 0.008, respectively). Further, the group with hypertension presented a lower level of phosphorylation of eNOS Ser1177, compared to the control group (p = 0.002). In conclusion, individuals with class 3 obesity and hypertension present a modified APLN/APLNR expression in visceral adipose tissue, which could be secondary to reduced eNOS phosphorylation.
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Affiliation(s)
- Luis Javier Cano-Martínez
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Sergio De Los Santos
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Ramón Mauricio Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México; Subdirección de Enseñanza e Investigación, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Juan Pablo Méndez
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Silvia Trejo
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas. Hospital General "Dr. Rubén Leñero", CDMX, Ciudad de México, México
| | - Bladimir Roque-Ramírez
- Laboratorio de Nutrigenética y Nutrigenómica, Instituto Nacional de Medicina Genómica CDMX, Ciudad de México, México
| | - Juan Carlos Pérez-Razo
- División de Medicina Genómica, Subdirección de Enseñanza e Investigación, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - Patricia Canto
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México; Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México.
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7
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Rodríguez CE, Mena RH. COVID-19 clinical footprint to infer about mortality. JOURNAL OF THE ROYAL STATISTICAL SOCIETY. SERIES A, (STATISTICS IN SOCIETY) 2022; 185:S547-S572. [PMID: 38607894 PMCID: PMC9877559 DOI: 10.1111/rssa.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/03/2022] [Indexed: 04/14/2024]
Abstract
Information on 4.1 million patients identified as COVID-19 positive in Mexico is used to understand the relationship between comorbidities, symptoms, hospitalisations and deaths due to the COVID-19 disease. Using the presence or absence of these variables a clinical footprint for each patient is created. The risk, expected mortality and the prediction of death outcomes, among other relevant quantities, are obtained and analysed by means of a multivariate Bernoulli distribution. The proposal considers all possible footprint combinations resulting in a robust model suitable for Bayesian inference. The analysis is carried out considering the information on the monthly COVID-19 cases, from March 2020 to the first days of January 2022. This allows one to appreciate the evolution of the mortality risk over time and the effect the strategies of the health authorities have had on it. Supporting information for this article, containing code and the dataset used for the analysis, is available online.
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Affiliation(s)
- Carlos E. Rodríguez
- Department of Probability and Statistics at the Research Institute for Applied Mathematics and SystemsUniversidad Nacional Autónoma de MéxicoMéxico cityMéxico
| | - Ramsés H. Mena
- Department of Probability and Statistics at the Research Institute for Applied Mathematics and SystemsUniversidad Nacional Autónoma de MéxicoMéxico cityMéxico
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Palacio-Mejía LS, Hernández-Ávila JE, Hernández-Ávila M, Dyer-Leal D, Barranco A, Quezada-Sánchez AD, Alvarez-Aceves M, Cortés-Alcalá R, Fernández-Wheatley JL, Ordoñez-Hernández I, Vielma-Orozco E, Muradás-Troitiño MDLC, Muro-Orozco O, Navarro-Luévano E, Rodriguez-González K, Gabastou JM, López-Ridaura R, López-Gatell H. Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100303. [PMID: 35782204 PMCID: PMC9230439 DOI: 10.1016/j.lana.2022.100303] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection. Methods We did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015–2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model. Findings COVID-19 was the leading cause of death in 2020–2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%). Interpretation Mortality from COVID-19 became the first cause of death in 2020–2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out. Funding This study was funded by Conacyt.
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Affiliation(s)
- Lina Sofía Palacio-Mejía
- Ph.D. in Population Studies, Researcher for México-Conacyt, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Juan Eugenio Hernández-Ávila
- Sc.D. in Epidemiology, Researcher in Medical Science, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Mauricio Hernández-Ávila
- M.D., Ms.C., Sc.D. in Epidemiology, Director of Economic and Social Benefits, Mexican Institute of Social Security, Mexico City, Mexico
| | - Dwight Dyer-Leal
- Ph.D. in Political Science, General Directorate of Health Information, Mexico City, Mexico
| | - Arturo Barranco
- Master in Demography, General Directorate of Health Information, Mexico City, Mexico
| | - Amado D Quezada-Sánchez
- Master in Applied Statistics, Researcher in Medical Sciences, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Mariana Alvarez-Aceves
- ScD. in Economic Administrative Sciences, Postdoctoral fellow, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ricardo Cortés-Alcalá
- M.D., M.P.H. General Director of Health Promotion, Ministry of Health, Mexico City, Mexico
| | | | - Iliana Ordoñez-Hernández
- Graduate in Design of Human Settlements, National Registry of Population and Identity, Mexico City, Mexico
| | - Edgar Vielma-Orozco
- Master in Economy, National Institute of Statistics and Geography, Mexico City, Mexico
| | - María de la Cruz Muradás-Troitiño
- Ph.D. in Population Studies, Coordinator of Sociodemographic and Prospective Studies of the General Secretariat of the National Population Council, Mexico City, Mexico
| | - Omar Muro-Orozco
- M.S. National Institute of Statistics and Geography, Aguascalientes, Mexico
| | | | | | | | - Ruy López-Ridaura
- Ms.C., Sc.D. in Nutritional Epidemiology, Director General of the National Center for Preventive Programs and Disease Control, Ministry of Health, Mexico City, Mexico
| | - Hugo López-Gatell
- M.D., Ms.C., Ph.D. in Epidemiology, Undersecretary of Prevention and Health Promotion, Ministry of Health, Mexico City, Mexico
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Valerino-Perea S, Armstrong MEG, Papadaki A. Adherence to a traditional Mexican diet and non-communicable disease-related outcomes: secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey. Br J Nutr 2022; 129:1-14. [PMID: 35876036 PMCID: PMC10011591 DOI: 10.1017/s0007114522002331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
This study evaluated the association between adherence to a traditional Mexican diet (TMexD) and obesity, diabetes and CVD-related outcomes in secondary data analysis of the cross-sectional Mexican National Health and Nutrition Survey 2018-2019. Data from 10 180 Mexican adults were included, collected via visits to randomly selected households by trained personnel. Adherence to the TMexD (characterised by mostly plant-based foods like maize, legumes and vegetables) was measured through an adapted version of a recently developed TMexD index, using FFQ data. Outcomes included obesity (anthropometric measurements), diabetes (biomarkers and diagnosis) and CVD (lipid biomarkers, blood pressure, hypertension diagnosis and CVD event diagnosis) variables. Percentage differences and OR for presenting non-communicable disease (NCD)-related outcomes (with 95 % CI) were measured using multiple linear and logistic regression, respectively, adjusted for relevant covariates. Sensitivity analyses were conducted according to sex, excluding people with an NCD diagnosis and using multiple imputation. In fully adjusted models, high, compared with low, TMexD adherence was associated with lower insulin (-9·8 %; 95 % CI (-16·0, -3·3)), LDL-cholesterol (-4·3 %; 95 % CI (-6·9, -1·5)), non-HDL-cholesterol (-3·9 %; 95 % CI (-6·1, -1·7)) and total cholesterol (-3·5 %; 95 % CI (-5·2, -1·8)) concentrations. Men and those with no NCD diagnosis had overall stronger associations. Effect sizes were smaller, and associations weakened in multiple imputation models. No other associations were observed. While results may have been limited due to the adaptation of a previously developed index, the results highlight the potential association between the TMexD and lower insulin and cholesterol concentrations in Mexican adults.
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Affiliation(s)
- Selene Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK
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Emergent Anthropometric Indices in Differential Prediction of Prehypertension and Hypertension in Mexican Population: Results according to Age and Sex. Int J Hypertens 2022; 2022:4522493. [PMID: 35844253 PMCID: PMC9283069 DOI: 10.1155/2022/4522493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Hypertension (HTN) is recognized as a significant public health problem in the world. The objective of this study is to evaluate emergent anthropometric indices as predictors of preHTN and HTN according to age and sex in a sample of Mexican adults. Methods. A cross-sectional study was conducted in 1,150 participants aged 18–80 years old. Anthropometric data and blood pressure measurements were analyzed. Comparisons between men and women were carried out by independent analysis. Cutoff points for each emergent anthropometric index were obtained using the values’ upper second and third tertiles. Logistic regression models and receiver operating characteristics curve analyses were used to assess the association and the predictive value of several emergent anthropometric indices with the presence of preHTN and HTN. Results. The prevalence of preHTN and HTN was 29.74% and 14.35%, respectively. In a logistic regression analysis adjusted by age and sex, the body roundness index (BRI) (OR = 2.08,
) and conicity index (CI) (OR = 1.37,
) were associated with preHTN, while CI (OR = 2.47,
) and waist to height squared (W/Ht2) (OR = 2.19,
) were associated with HTN. Furthermore, in both sexes, BRI was the main predictor of preHTN (AUC: 0.634 and 0.656, respectively). Particularly, according to sex and age range, the predictive emergent anthropometric indices in men were the body shape index (ABSI) and waist to height cubic (W/Ht3) (AUC = 0.777 and 0.771, respectively), whereas in women, the predictors were CI and ABSI (AUC = 0.737 and 0.729, respectively). In men ≤40 years old, central body fat indices were predictors of preHTN and HTN, but in men >40 years old, the predictor indices were W/Ht3 and W/Ht2. In women ≤40 years, the pulse mass index (PMI) was the best main predictor (AUC = 0.909) of HTN. Conclusion. CI, PMI, W/Ht3, W/Ht2, and ABSI could represent differential predictors of preHTN and HTN between men and women according to age range.
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Sagaceta-Mejía J, Tolentino-Mayo L, Cruz-Casarrubias C, Nieto C, Barquera S. Understanding of front of package nutrition labels: Guideline daily amount and warning labels in Mexicans with non-communicable diseases. PLoS One 2022; 17:e0269892. [PMID: 35749373 PMCID: PMC9231753 DOI: 10.1371/journal.pone.0269892] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022] Open
Abstract
One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile’s labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants’ number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA.
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Affiliation(s)
- Janine Sagaceta-Mejía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- * E-mail:
| | - Carlos Cruz-Casarrubias
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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Palomo-Piñón S, Antonio-Villa NE, García-Cortés LR, Álvarez-Aguilar C, González-Palomo E, Bertadillo-Mendoza OM, Figueroa-Suárez ME, Vargas-Hernández F, Herrera-Olvera IG, Cruz-Toledo JE, Cruz-Arce MA, Serafín-Méndez B, Muñoz-Cortés G, Morfin-Macias CJ. Prevalence and characterization of undiagnosed arterial hypertension in the eastern zone of Mexico. J Clin Hypertens (Greenwich) 2021; 24:131-139. [PMID: 34962058 PMCID: PMC8845470 DOI: 10.1111/jch.14414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
Arterial hypertension is considered a public health problem with severe consequences at an individual and public health levels. However, there is a lack of information regarding its characterization in Mexico. The objective of this study is to estimate the proportion of undiagnosed arterial hypertension (UAH) and the overall prevalence and clinical management of arterial hypertension within the Eastern Zone of Mexico. Additionally, we explore associated factors related with both UAH and uncontrolled arterial hypertension. We obtained information from the May Measure Month (MMM) 2019 study. People were asked for cardiovascular risk factors and blood pressure was measured according to the protocols of the European Society of Hypertension (ESH). Data from 5901 subjects were extracted: 76.04% from the Eastern Zone of the State of Mexico. The overall prevalence of hypertension was 32.4% (95% CI 31.2-33.6). From all subjects living with hypertension, 28.3% had UAH, 22.1% had previous diagnosis but were untreated; 29.3% were treated but had uncontrolled hypertension. Younger men adults living in the State of Michoacán had increased proportion of UAH and untreated hypertension. We observed that male sex, age, obesity, living at Michoacán were risk factors for UAH. Finally, male sex, diabetes, and living at Michoacán were related risk conditions for having uncontrolled arterial hypertension. In summary, there is a high proportion of UAH in Easter Zone of Mexico. Younger adults had higher proportion of UAH and untreated hypertension profiles. Efficient actions are required to make a timely diagnosis in the young adult population to prevent long-term complications.
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Affiliation(s)
- Silvia Palomo-Piñón
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México.,Programa de Posgrado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Luis Rey García-Cortés
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Estado de México Oriente, México
| | - Cleto Álvarez-Aguilar
- Coordinación Auxiliar Médica de Investigación en Salud, IMSS, Morelia, Michoacán, México
| | | | | | - María Eugenia Figueroa-Suárez
- Coordinación Clínica de Educación e Investigación en Salud (CCEIS), Unidad de Medicina Familiar (UMF) No. 52, IMSS, Estado de México Oriente, México
| | | | | | | | - Maria Adriana Cruz-Arce
- CCEIS, Unidad Médica de Atención Ambulatoria con UMF No. 198, IMSS, Estado de México Oriente, México
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Ramirez-Silva I, Pérez Ferrer C, Ariza AC, Tamayo-Ortiz M, Barragán S, Batis C, Cantoral A, Sánchez M, Zambrano E, Burguete-García AI, Avila-Jimenez L, Ramakrishnan U, Stein AD, Martorell R, Rivera JA. Infant feeding, appetite and satiety regulation, and adiposity during infancy: a study design and protocol of the 'MAS-Lactancia' birth cohort. BMJ Open 2021; 11:e051400. [PMID: 34642196 PMCID: PMC8513273 DOI: 10.1136/bmjopen-2021-051400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The prevalence of childhood obesity has risen dramatically in recent years. A proportion of this burden has been attributed to factors that occur during the first 1000 days of life such as genetic predisposition, breast feeding and complementary feeding. Although the mechanisms by which these factors affect weight and adiposity are less well understood, appetite and satiety regulation may be a key to understanding them. This cohort study aims to investigate the role of appetite and satiety regulation as a mediator in the association between infant feeding practices and genetic polymorphisms with children's growth, adiposity and metabolic risk factors. METHODS AND ANALYSIS: 'MAS-Lactancia' (the first word means 'more' and is also an acronym in Spanish for 'Appetite and Satiety Mechanisms', the second word is 'breastfeeding') is an open, ongoing, prospective birth cohort that began the enrolment in 2016 of mother-child pairs affiliated to the Mexican Social Security Institute and that live in the city of Cuernavaca, Mexico. Pregnant women between 16-week and 22-week gestation are followed during the second half of their pregnancies, at birth and throughout their infant's first 48 months of life (at 1 month, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, 36 months and 48 months) at the clinic and at-home visits that include questionnaires, anthropometric measurements and biospecimen collection. The main exposure variables are infant feeding (breast feeding and complementary feeding) and genetic polymorphisms (fat mass and obesity-associated, leptin and adiponectin genes). Outcome variables include infant's growth, adiposity and metabolic risk factors. We will conduct longitudinal models and path analyses to identify the potential mediating role of satiety and appetite indicators (leptin, adiponectin, insulin concentrations, appetite and satiety perception). ETHICS AND DISSEMINATION The study protocol, data collection instruments, consent forms and procedures were approved by the institutional review boards of the National Institute of Public Health and the Mexican Social Security Institute in Mexico. Findings will be disseminated through conferences, peer-reviewed publications and meetings with stakeholders.
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Affiliation(s)
- Ivonne Ramirez-Silva
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Carolina Pérez Ferrer
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Ana Carolina Ariza
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Marcela Tamayo-Ortiz
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Sofía Barragán
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Carolina Batis
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Alejandra Cantoral
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Cátedras CONACYT, National Council for Science and Technology, Mexico City, Mexico
| | - Marcela Sánchez
- Secretaría Académica, National Institute of Public Health, Cuernavaca, Mexico
| | - Elena Zambrano
- Department of the Biology of Reproduction, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Ana I Burguete-García
- Center for Research in Infectious Diseases, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juan A Rivera
- Director General, National Institute of Public Health, Cuernavaca, Mexico
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14
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Trends and age-period-cohort effects on hypertension mortality rates from 1998 to 2018 in Mexico. Sci Rep 2021; 11:17553. [PMID: 34475436 PMCID: PMC8413460 DOI: 10.1038/s41598-021-96175-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/05/2021] [Indexed: 11/08/2022] Open
Abstract
Arterial hypertension is a major global health problem. It is the main risk factor for preventable death and the leading cause of premature death in the world. This study aims to describe the changes in hypertension-related mortality in Mexico between 1998 and 2018. Using death certificates and national population public data sets, a total of 335,863 deaths due to hypertension were found in Mexico, disaggregated by sex and age, during the time period covered in this study. An age-period-cohort analysis was conducted to show trends in hypertension mortality rates. Mortality due to hypertension in Mexico affects more women than men. In the most recent cohorts, the risk of dying from hypertension is two times higher in men compared to women. Hypertensive kidney disease is found to be the main underlying cause, with an average increase throughout the period studied. Our results indicate that mortality rates due to hypertension continue to grow and point to an alarming trend of mortality shifting towards younger ages, with sex-based disparities in absolute numbers and in changing trends.
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15
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Doubova SV, Leslie HH, Kruk ME, Pérez-Cuevas R, Arsenault C. Disruption in essential health services in Mexico during COVID-19: an interrupted time series analysis of health information system data. BMJ Glob Health 2021; 6:e006204. [PMID: 34470746 PMCID: PMC8413469 DOI: 10.1136/bmjgh-2021-006204] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020. METHODS We used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale. RESULTS The study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change. CONCLUSION Significant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Kingston, Jamaica
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study. Geriatrics (Basel) 2021; 6:geriatrics6030063. [PMID: 34202004 PMCID: PMC8293108 DOI: 10.3390/geriatrics6030063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022] Open
Abstract
Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.
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17
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Naghipour M, Joukar F, Salari A, Asgharnezhad M, Hassanipour S, Mansour-Ghanaei F. Epidemiologic Profile of Hypertension in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS). Ann Glob Health 2021; 87:14. [PMID: 33614420 PMCID: PMC7879995 DOI: 10.5334/aogh.3027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Estimates region-related prevalence of hypertension and attempts to identify its related factors at the district levels are required for prevention and management of hypertension. Objective The aim of this study was to investigate the epidemic features and related factors of hypertension and its awareness, treatment, and control rates among the northern Iranian population. Methods It was a community based cross-sectional study based on data from PERSIAN Guilan Cohort Study (PGCS). In total, 10,520 participants (aged 35-70 years) from the Guilan Province in northern Iran included in this study, between October 8, 2014, and January 20, 2017. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or a prior diagnosis of hypertension or being on antihypertensive medication. Potential correlates of hypertension and its awareness, treatment and control were analyzed by multivariate logistic regression adjusted for demographic factors, anthropometric characteristics, lifestyle variables, past medical history, and laboratory data. Results The prevalence of hypertension was 43.2% and the hypertension awareness, treatment, and control rate were 53.4%, 49.8%, and 73.7%, respectively. The multivariate logistic regression analyses revealed that older age, urbanization, lower education, overweight and obesity, lower physical activity, prediabetes and diabetes, cardiovascular disease, psychiatric disorder, positive family history of hypertension and raised serum creatinine were independently associated with presence of hypertension. Awareness of hypertension was greater in the female sex, older age, rural residency, higher education and patient with comorbidities. Older age, rural residency and comorbidities were associated with treatment of hypertension. Control of hypertension was better among younger age, higher education, normal weight and higher physical activity. Conclusion Hypertension is highly prevalent in the northern Iranian population. About half of affected persons are unaware of their disease and untreated. Modifying risk factors (such as weight lose and increase physical activity) and increasing hypertension awareness (by screening) is essential for primary and secondary prevention of high blood pressure in this population, especially in urban areas and among males, younger ages, and less educated.
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Affiliation(s)
- Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehrnaz Asgharnezhad
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Health-care guidelines and policies during the COVID-19 pandemic in Mexico: A case of health-inequalities. HEALTH POLICY OPEN 2020; 2:100025. [PMID: 33521627 PMCID: PMC7836807 DOI: 10.1016/j.hpopen.2020.100025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022] Open
Abstract
Background Heterogeneous government responses have been reported in reaction to COVID-19. The aim of this study is to generate an exploratory review of healthcare policies published during COVID-19 by health-care institutions in Mexico. Analyzing policies within different health sub-systems becomes imperative in the Mexican case due to the longstanding fragmentation of the health-care system and health inequalities. Data and Methods Policies purposely included in the analysis were published by four public health institutions (IMSS, ISSSTE, SSA and PEMEX) during the COVID-19 epidemic in Mexico (from February 29th to June 15th, 2020) on official institutional websites. Researchers reviewed each document and classified them into seven policy categories set by the Rapid Research Evaluation and Appraisal Lab (RREAL): public health response, health-care delivery, human resources, health-system infrastructure and supplies, clinical response, health-care management, and epidemiological surveillance. Results Policy types varied by health institution. The largest number of policies were aimed at public health responses followed by health-care delivery and human resources. Policies were mainly published during the community transmission phase. Conclusions The pandemic exposed underlying health-care system inequalities and a reactive rather than prepared response to the outbreak. Additionally, this study outlines potential policy gaps and delays in the response that could be avoided in the future.
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Soto‐Mota A, Marfil‐Garza BA, Martínez Rodríguez E, Barreto Rodríguez JO, López Romo AE, Alberti Minutti P, Alejandre Loya JV, Pérez Talavera FE, Ávila Cervera FJ, Velazquez Burciaga A, Morado Aramburo O, Piña Olguín LA, Soto‐Rodríguez A, Castañeda Prado A, Santillán Doherty P, O Galindo J, Guízar García LA, Hernández Gordillo D, Gutiérrez Mejía J. The low-harm score for predicting mortality in patients diagnosed with COVID-19: A multicentric validation study. J Am Coll Emerg Physicians Open 2020; 1:1436-1443. [PMID: 33230506 PMCID: PMC7675373 DOI: 10.1002/emp2.12259] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/15/2023] Open
Abstract
Objective We sought to determine the accuracy of the LOW-HARM score (Lymphopenia, Oxygen saturation, White blood cells, Hypertension, Age, Renal injury, and Myocardial injury) for predicting death from coronavirus disease 2019) COVID-19. Methods We derived the score as a concatenated Fagan's nomogram for Bayes theorem using data from published cohorts of patients with COVID-19. We validated the score on 400 consecutive COVID-19 hospital admissions (200 deaths and 200 survivors) from 12 hospitals in Mexico. We determined the sensitivity, specificity, and predictive values of LOW-HARM for predicting hospital death. Results LOW-HARM scores and their distributions were significantly lower in patients who were discharged compared to those who died during their hospitalization 5 (SD: 14) versus 70 (SD: 28). The overall area under the curve for the LOW-HARM score was 0.96, (95% confidence interval: 0.94-0.98). A cutoff > 65 points had a specificity of 97.5% and a positive predictive value of 96%. Conclusions The LOW-HARM score measured at hospital admission is highly specific and clinically useful for predicting mortality in patients with COVID-19.
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Affiliation(s)
- Adrian Soto‐Mota
- Department of Phyisiology, Anatomy and GeneticsThe University of OxfordOxfordOxfordshireUnited Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juan Gutiérrez Mejía
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
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20
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Vargas-Meza J, Jáuregui A, Contreras-Manzano A, Nieto C, Barquera S. Acceptability and understanding of front-of-pack nutritional labels: an experimental study in Mexican consumers. BMC Public Health 2019; 19:1751. [PMID: 31888575 PMCID: PMC6938009 DOI: 10.1186/s12889-019-8108-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Front-of-package labelling is a cost-effective strategy to help consumers make healthier choices and informed food purchases. The effect of labels is mediated by consumer understanding and acceptability of the label. We compared the acceptability and understanding of labels used in Latin-America among low- and middle-income Mexican adults. METHODS Participants (n = 2105) were randomly assigned to one of three labels: Mexican Guideline Daily Allowances (GDA), Ecuador's Multiple Traffic Lights (MTL), or Chile's Warning Labels (WL) in red. Label acceptability was evaluated through items regarding likeability, attractiveness and perceived cognitive workload. Objective understanding was evaluated by asking participants to select the product with the lowest nutritional quality among three products. We measured the time participants took to choose the product. Differences in label acceptability, understanding and time required to choose a product across labels were tested. RESULTS Compared to the GDA, a higher proportion of participants liked the MTL and WL, considered them attractive, and with a lower perceived cognitive workload (p < 0.05). Participants had 4.00 (2.86-5.59) times the odds of correctly identifying the product with the lowest nutritional quality when using the MTL label and 4.52 (3.24-6.29) times the odds when using the WL, in comparison to the GDA. Time required to choose the product was lower for the MTL (Median: 11.25 s; IQR = 8.00-16.09) and the WL (Median = 11.94 s, IQR = 8.56-16.52) compared to the GDA (Median: 15.31 s; IQR = 10.81-20.21; p < 0.05). No differences were observed between the MTL and the WL. CONCLUSIONS GDA had the lowest acceptability and understanding among the labels tested. The MTL and the WL were more accepted and understood, and allowed low- and middle-income consumers to make nutrition-quality related decisions more quickly. WL or MTL may foster healthier food choices in the most vulnerable groups in Mexico compared to the current labelling format.
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Affiliation(s)
- Jorge Vargas-Meza
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | | | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, 62100 Cuernavaca, Mexico
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