Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis

OBJECTIVE

The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex.

STUDY DESIGN

Joinpoint regression and age-period-cohort effect analysis.

METHODS

Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects.

RESULTS

From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17).

CONCLUSION

The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

SARS-CoV-2 seroprevalence and vaccine coverage from August to November 2021: A nationally representative survey in Mexico

We aimed to estimate self-reported vaccine coverage and SARS-CoV-2 anti-N and anti-S seroprevalence in Mexico overall and for five vaccine types. We used a nationally representative survey with 7236 dried blood spot samples for adults 18 years and older collected from August to November 2021. Anti-N and anti-S seroprevalence were estimated adjusting for the sensitivity and specificity of the immunoassay test. A multivariate Poisson regression model was used to estimate seroprevalence by vaccine type and by age group adjusting for confounders and test performance. Vaccination coverage was 74%, being higher in women compared to men, high socioeconomic status (SES) compared to low and middle SES, graduates compared to people with high school, and formal workers compared to other employment statuses. Anti-N seroprevalence was 59.2%, compared to 84.1% anti-S seroprevalence. Anti-S seroprevalence was higher for vaccinated than unvaccinated participants. All vaccines were associated with more than 70% anti-S seroprevalence, with the lowest being observed for CoronaVac and Ad5-nCoV. Fully vaccinated participants over 60 years presented a lower seroprevalence (77.6%) compared to younger adults (91.1%), with larger differences for ChAdOx1 and CoronaVac vaccines. Between August and November 2021, three out of four Mexican adults had been vaccinated. Vaccination was associated with a higher positivity to anti-S antibodies. While antibodies do not reflect immunity, our results suggest that booster doses should be offered to people over 60 years of age and to adults who received Ad5-nCoV or CoronaVac as primary vaccination schemes.

Encuesta Nacional de Salud y Nutrición 2023: metodología y avances de la Ensanut Continua 2020-2024

OBJETIVO

Presentar la metodología de la Encuesta Nacional de Salud y Nutrición 2023 (Ensanut 2023) y describir los procedimientos de inferencia para conjuntar la información colectada por la Ensanut Continua 2020-2024. Material y métodos. La Ensanut 2023 es la cuarta encuesta de la serie Ensanut Continua. Se describe el alcance de la Ensanut 2023 junto con sus procedimientos de muestreo, estimación, medición y organización logística. Además, se discute el procedimiento básico de estimación para analizar la integración de las encuestas Ensanut Continua 2020-2024.

RESULTADOS

La Ensanut 2023 obtendrá a nivel nacional al menos 11 720 entrevistas completas de hogar y 13 378 cuestionarios completos de adulto. La unión de las Ensanut Continua 2020-2023 permitirá, en general, estimar a nivel estatal prevalencias p≥5% en adultos, con confiabilidad tolerable según las recomendaciones del Instituto Nacional de Estadística y Geografía.

CONCLUSIONES

El análisis de la unión de la Ensanut Continua 2020-2023 permitirá iniciar la generación de estimaciones nacionales y estatales sobre el estado de salud y nutrición de la población mexicana.

Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico

BACKGROUND

Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities.

METHODS

Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth.

RESULTS

Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (β: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (β: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (β: -0.15, 95% CI: -0.36, 0.06).

CONCLUSIONS

Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.

Aflatoxin levels and prevalence of TP53 aflatoxin-mutations in hepatocellular carcinomas in Mexico

Objective. To determine the exposure to aflatoxin B1 (AFB1) in southern Mexico and the presence of the aflatoxin signature mutation in hepatocellular carcinoma (HCC) tissue from patients from a cancer referral center. Materials and methods. We estimated the prevalence and distribution of AFB1 in a representative sample of 100 women and men from Chiapas using the National Health and Nutrition Survey 2018-19. We also examined the presence of the aflatoxin signature mutation in codon 249 (R249S), and other relevant mutations of the TP53 gene in HCC tissue blocks from 24 women and 26 men treated in a national cancer referral center. Results. The prevalence of AFB1 in serum samples was 85.5% (95%CI 72.1-93.1) and the median AFB1 was 0.117 pg/μL (IQR, 0.050–0.350). We detected TP53 R249S in three of the 50 HCCs (6.0%) and observed four other G>T transversions potentially induced by AFB1. Conclusion. Our analysis provides evidence that AFB1 may have a relevant role on HCC etiology in Mexico.

Work status, retirement, and depression in older adults: An analysis of six countries based on the Study on Global Ageing and Adult Health (SAGE)

The aim of the present study was to analyse the association between the occurrence of a major depressive episode among older adults and work status in low- and medium-income countries. A cross-sectional study was conducted with people 60 years of age and older from the six countries (Mexico, India, China, Russian Federation, Ghana and South Africa) included in the Study on Global Ageing and Adult Health (SAGE) and who participated in its first wave (2009-2010). The occurrence of a major depressive episode (MDE) over the previous 12 months was determined based on an adaptation of the ICD-10 diagnostic criteria. The association between current work status and the presence of an MDE was estimated using binary logistic regression models with country-level fixed effects, and interaction terms between the country and work status. Results showed the odds of presenting an MDE were lower for older adults who were retired with a pension than for those who were currently working, although this protective association was observed only for men in China (OR=0.23; CI 95%:0.08-0.70) and Ghana (OR=0.25; CI 95%:0.07-0.95) and for women in India (OR=0.05; CI 95%:0.01-0.51) and South Africa (OR=0.19; CI 95%:0.04-0.97). For women, being a homemaker also showed a protective association in South Africa (OR=0.09; CI95%:0.01-0.66) and Mexico (OR=0.32; CI95%:0.14-0.76). In the case of being retired without a pension, no significant association was found in any country. The previous indicates that retirement with pension has a protective association with MDE only for men in China and Ghana and women in India and South Africa. The heterogeneity of this association reflects cultural and socioeconomic differences between the analysed countries.

670. Estimating Bordetella pertussis Seroprevalence in Persons Aged 10–25 Years in Mexico Using the 2012 National Health and Nutrition Survey (ENSANUT): Challenges and Lessons Learned

Background

Low vaccination rates and under-detection of cases in adolescents and young adults have been implicated in the transmission of Pertussis to children. In this study, the proportion of adolescents and young adults with anti Bordetella pertussis IgG antibodies was estimated in a population-based survey in Mexico.

Methods

Frozen sera and data from 1,581 subjects—1,102 adolescents and 479 young adults (10–19 and 20–25 years old, respectively)—56% female were randomly selected from the Mexico’s National Health and Nutrition Survey (ENSANUT) 2012. CDC/FDA validated PT ELISA test was used to detect anti-pertussis toxin (PT) antibodies. A subset of 300 samples was also tested with Bp-IgG PT ELISA kit (Euroimmun AG, Lubeck, Germany^®), both tests used international standards. Threshold values were established to identify vaccination or infection within the previous year, according to a US survey (Baughman et al.). Population-weighted estimates of seroprevalence were calculated.

Results

Overall Bp seroprevalence was 3.9% (95% CI: 2.3, 6.3); 3.1% (1.9, 5.0) in adolescents, and 4.9% (2.2, 11) in young adults. Seroprevalence did not significantly vary by gender, socioeconomic status, region or rural/urban location. Compared with the CDC/FDA PT ELISA, the Euroimmun^® test showed 76% sensitivity, 88% specificity.

Conclusion

Booster vaccination to Bp after toddlerhood is not in the Mexican national policy; therefore, anti-PT IgG seropositivity may reasonably be attributed to recent Bp infection. Our weighted estimates of recent Bp infection, which are based on a national population-based serosurvey and a standardized serological test, represent a considerable burden of infections in adolescents and young adults that sharply contrast with the official surveillance reports. Also, the Bp-IgG PT ELISA commercial kit lower sensitivity than the CDC/FDA PT ELISA may lead underestimation of recent infections. In conclusion, assessing pertussis seroprevalence requires careful consideration of the right tests and epidemiological model for interpretation.

Disclosures

All authors: No reported disclosures.

Hepatitis B seroprevalence in 10-25-year-olds in Mexico - the 2012 national health and nutrition survey (ENSANUT) results

Objectives: To estimate hepatitis B virus (HBV) seroprevalence from natural infection or vaccination in 10–25-year-olds in Mexico, using the 2012 National Health and Nutrition Survey (ENSANUT).

Methods: Randomly selected serum samples (1,581) from adolescents and young adults, representative of 38,924,584 Mexicans, were analyzed to detect hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody (anti-HBc). Weighted HBV seroprevalence in the Mexican population and association with sociodemographic variables were calculated.

Results: Overall weighted seroprevalence from natural infection (positive for anti-HBs and anti-HBc) was 0.23% (95% confidence interval [95% CI] 0.10–0.52). No HBsAg was detected, indicating no acute or chronic infection. Vaccine-derived immunity (positive ≥ 10.0 mIU/ml for anti-HBs and negative to anti-HBc) was 44.7% (95% CI: 40.2–49.4) overall; lower in persons aged 20–25 years (40.83%) than in persons aged 10–19 years (47.7%). Among the population analyzed, 54.2% (95% CI: 49.6–58.8) were seronegative to HBV (negative for all three markers) and no sociodemographic risk factors were identified.

Conclusions: HBV seroprevalence from natural infection was low. Vaccination-induced immunity was higher among Mexican adolescents than young adults, possibly due to vaccination policies since 1999.

[Decrease of HCV seroprevalence in Mexico: Results from the National Health and Nutrition Survey 2012]

OBJECTIVE

To estimate seroprevalence of hepatitis C virus (HCV) among 15-49 years old Mexicans living in households and to describe the profile of seroreactive individuals.

MATERIALS AND METHODS

Cross-sectional study implemented in 2012 using a national probabilistic sample with behavioral data from face-to-face interviews at households and HCV antibodies screening using capillary blood from same individuals.

RESULTS

HCV seroprevalence in Mexico was estimated at 0.27% (IC95% 0.12-0.60), representing 161 000 persons. Seroprevalence was significantly higher among males (0.45% CI95% 0.01-0.89) than females (0.10% CI95% 0.00-0.22). Multivariate analysis suggests a higher possibility of HCV reactivity among men, increasing with age and higher among those sexually active, and lower for higher socioeconomic level.

CONCLUSION

HCV seroprevalence in Mexico by 2012 seems significantly lower than the estimation from 2000 of 1.2% for the same age-group. Evidence of infection among individuals 15-19 years old suggests the need to strength preventive actions, particularly in subjects with risky behaviors.