Health-care coverage and access to health care in the context of type 2 diabetes and hypertension in rural Mexico: a systematic literature review

Carrillo-Balam, Gabriela; Cantoral, Alejandra; Rodríguez‐Carmona, Yanelli; Christensen, Dirk L.

doi:10.1016/j.puhe.2019.11.017

“…39 40 In the Mexican context, a systematic review found that the lack of economic resources, language barriers (for indigenous populations), and lack of healthcare professionals remain important barriers for patients with T2DM and hypertension in rural areas of Mexico. 41 In the present analysis of disease profiles, we found that more than half of the population had predisease (pre-T2DM, prehypertension or overweight) and more than 35% had a disease (T2DM, hypertension, obesity or dyslipidaemia); only a quarter of the screened population was negative for any of the NCDs screened. The disease profiles observed here were not surprising as Mexico has one of the highest rates of obesity worldwide (36% in 2018).…”

Section: Discussionmentioning

confidence: 51%

“… 39 40 In the Mexican context, a systematic review found that the lack of economic resources, language barriers (for indigenous populations), and lack of healthcare professionals remain important barriers for patients with T2DM and hypertension in rural areas of Mexico. 41 …”

Section: Discussionmentioning

confidence: 99%

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico

Gallardo-Rincón

¹

,

Montoya²,

et al. 2021

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Objectives The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO’s contribution to the continuum of care of the main NCDs. Design Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. Setting Public primary health centres in 27/32 Mexican states. Participants Individuals aged ≥20 years lacking healthcare access. Results From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). Conclusion Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.

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“…Despite progress in the socioeconomic and health conditions of Indigenous peoples in recent years, most of them remain uninsured or are affiliated to the public health care sector, which is often of poorer quality compared to the private sector. (12,18-20) Furthermore, one study found that Indigenous peoples in Mexico were less likely to receive any type of health care among those seeking medical care. (21) The current COVID-19 pandemic has strained health care systems worldwide.…”

Section: Discussionmentioning

confidence: 99%

Ethnic disparities in COVID-19 mortality in Mexico: a cross-sectional study based on national data

Ibarra-Nava

¹

,

Flores-Rodriguez

²

,

Ruiz-Herrera

³

et al. 2020

Preprint

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Objectives: To analyze the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. Design: National, cross-sectional study. Setting: Mexico. Participants: 416546 adult patients; 4178 Indigenous peoples with COVID-19 were the primary population under study. Main outcome measures: The primary outcome was mortality from COVID-19 up to August 3rd, 2020. Logistic regression was used to calculate odds ratios while adjusting for confounders. Results: Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). Conclusions: In the large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico. More research is needed regarding the impact of the COVID-19 among racial and ethnic minorities in Mexico.

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“…This finding suggests that poor access to health care services might be a driver of higher mortality among Indigenous peoples. Despite progress in the socioeconomic and health conditions of Indigenous peoples in recent years, most of them remain uninsured or are affiliated to the public health care sector, which is often of poorer quality compared to the private sector [12,[19][20][21]. Furthermore, one study found that Indigenous peoples in Mexico were less likely to receive any type of health care among those seeking medical care [22].…”

Section: Plos Onementioning

confidence: 99%

Ethnic disparities in COVID-19 mortality in Mexico: A cross-sectional study based on national data

Ibarra-Nava

¹

,

Flores-Rodriguez

²

,

Ruiz-Herrera

³

et al. 2021

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Introduction Across the world, the COVID-19 pandemic has disproportionately affected racial and ethnic minorities. How ethnicity affects Indigenous peoples in Mexico is unclear. The aim of this cross-sectional study was to determine the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. Methods We used open access data from the Mexican Ministry of Health, which includes data of all confirmed COVID-19 cases in the country. We used descriptive statistics to compare differences among different groups of patients. Logistic regression was used to calculate odds ratios while adjusting for confounders. Results From February 28 to August 3, 2020, a total of 416546 adult patients were diagnosed with COVID-19. Among these, 4178 were Indigenous peoples. Among all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). Discussion In this large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico.

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Health-care coverage and access to health care in the context of type 2 diabetes and hypertension in rural Mexico: a systematic literature review

Cited by 24 publications

References 31 publications

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico

Ethnic disparities in COVID-19 mortality in Mexico: a cross-sectional study based on national data

Ethnic disparities in COVID-19 mortality in Mexico: A cross-sectional study based on national data

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