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      Contribution of socioeconomic factors and health care access to the awareness and treatment of diabetes and hypertension among older Mexican adults Translated title: Contribución de los factores socioeconómicos y de acceso a servicios médicos en el autorreporte y el tratamiento de diabetes e hipertensión en adultos mayores en México

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          Objective. To estimate changes in self-report and treatment of diabetes and hypertension between 2001 and 2012 among Mexican aged 50-80, assessing the contribution of education and health insurance coverage. Materials and methods. The Mexican Health and Aging Study was used to estimate associations of education and insurance on prevalence and treatment of diabetes and hypertension in 2001 and 2012. Multivariate decomposition was used to assess the contribution of changes in the composition of covariates vs. their "effects" on changes in prevalence and treatment over time. Results. Increases in the prevalence/diagnosis and treatment during the period are largely attributable to the expansion of health insurance. Its effects on diagnosis/prevalence and treatment have also increased over time. Conclusions. The expansion of Seguro Popular likely improved screening and treatment. More research is needed to assess if these have translated into better control and a lower burden of disease.

          Translated abstract

          Objetivo. Estimar cambios en el autorreporte y en el tratamiento de diabetes e hipertensión en adultos de entre 50 y 80 años en México, en 2001 y 2012, y explicarlos en función de los sufridos en cuanto a composición educativa y de cobertura/derechohabiencia en servicios de salud. Material y métodos. Se utilizó la Encuesta Nacional de Salud y Envejecimiento en México y técnicas de descomposición multivariada. Resultados. El incremento en la prevalencia/ diagnóstico y tratamiento durante el periodo se debe en gran medida al aumento en la cobertura de servicios de salud. Los "efectos" de la cobertura también se incrementaron de forma importante. Conclusiones. La expansión del Seguro Popular probablemente tuvo un papel importante en la detección y tratamiento de la diabetes e hipertensión. Investigaciones futuras discernirán si dicha expansión se ha traducido en un mejor control y una menor carga de morbilidad.

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          The quest for universal health coverage: achieving social protection for all in Mexico.

          Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity.

            The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico. Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980-1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas. SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased. The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available. SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.
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              Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy

              Background Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. Method We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. Results There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. Conclusions The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Salud Pública de México
                Salud pública Méx
                Instituto Nacional de Salud Pública (Cuernavaca )
                : 57
                : suppl 1
                : s06-s14
                [1 ] University of Wisconsin-Madison Estados Unidos de América
                [2 ] University of Illinois at Urbana-Champaign Estados Unidos de América
                [3 ] University of Colorado Estados Unidos de América


                Product Information: SciELO Mexico
                Health Policy & Services


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