Date Published: June 17, 2008
Publisher: Public Library of Science
Author(s): Gretchen Stevens, Rodrigo H Dias, Kevin J. A Thomas, Juan A Rivera, Natalie Carvalho, Simón Barquera, Kenneth Hill, Majid Ezzati, Martin Tobias
Abstract: BackgroundRates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities.Methods and FindingsWe estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries).ConclusionsMexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.
Partial Text: Knowledge about the relative contributions of diseases, injuries, and their risk factors to the loss of healthy life is needed for priority setting and for evaluation of health programs. Most previous analyses of disease, injury, and risk factor burden have been at the national or global scale [1–6]. In many countries, health policies and programs are implemented and evaluated at the subnational level (e.g., at the state level). Therefore, subnational analyses and evidence are essential for debate, discourse, and cooperation among different levels of government on health policies and allocation of resources to health programs, as well as for understanding disparities in health across regions. There have been few subnational analyses of the burden of disease ; more subnational analyses of mortality are available [8,9].
We calculated mortality and burden of disease from a comprehensive set of diseases and injuries and from selected risk factors in 2004 using the methods and data sources described below (Figure 1 provides a schematic overview of the analysis steps). All analyses were performed at the state level, by sex and age. For presentation, we grouped the 32 Mexican states into six geographic regions on the basis of per-capita income, total mortality, and a composite deprivation index (Figure S1, Table S1). The Northern and the Pacific Central regions are the most socially and economically developed and have relatively close cultural and economic links to the United States. The Southern region is the least developed and has significantly higher poverty and indigenous population than other regions. Mexico City is a highly urbanized, wealthy region with excellent infrastructure but with immigration from poor areas in the Central, Gulf, and Southern regions. Regional and national results were obtained by aggregating state-level results.
In this paper, we used detailed, consistent, and comparable data and analyses to establish the role of diseases, injuries, and their risk factors in the loss of health in Mexico, and identified patterns by age, sex, and region. This analysis demonstrated that the national burden of disease in Mexico is dominated by noncommunicable diseases and their risk factors, consistent with the epidemiological and nutritional transition framework [10–12,39]. Further, the analysis revealed important disease and risk factor patterns that distinguish Mexico from high-income countries at broadly similar stages of the epidemiological transition: the liver cirrhosis and diabetes mortality in Mexico were substantially higher than in high-income countries, but those of other noncommunicable diseases, such as cardiovascular diseases, were comparable. Mirroring these disease patterns, the highest mortality and burden of disease were caused by the high blood glucose, high BMI, and alcohol use risk factors, with lower burden of disease attributable to tobacco smoking, which was primarily due to lower exposure to tobacco. This finding of the highest mortality and disease burden shows the need for further research on the role of genetic, dietary, and other environmental and health system factors as determinants of high blood glucose and high BMI in Mexico.