José Manuel Aburto

Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000–10

Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century.

Mexico's epidemic of violence and its public health significance on average length of life

Objectives A disproportionate number of homicides have caused Mexican life expectancy to stagnate during the new millennium. No efforts currently exist to quantify the harm of violent acts on the lives of the general population. We quantified the impact of perceived vulnerability on life expectancy. Methods Three Mexican national surveys on perceptions of public safety, life tables, and crime and vital statistics (2000–2014) were used. Prevalence rates of vulnerability/safety by age and sex were obtained from surveys at 2 different levels: federal state and home. The Sullivan method was used to estimate life expectancy lived with and without vulnerability for Mexican women and men. Results Overall life expectancy at age 20 stagnated between 2005 and 2014 for females and males; yet, there was an increase of 40% and 70% in average number of years lived with vulnerability at the state and home levels, respectively. In 2014, female life expectancy at age 20 was 59.5 years (95% CI 59.0 to 60.1); 71% of these years (42.3 years, 41.6 to 43.0) were spent with perceived vulnerability of violence taking place in the state and 26% at the home (15.3 years, 15 to 15.8). For males, life expectancy at age 20 was 54.5 years (53.7 to 55.1); 64% of these years (34.6 years, 34.0 to 35.4) were lived with perceived vulnerability of violence at the state and 20% at the home (11.1 years, 10.8 to 11.5). Conclusions The number of years lived with perceived vulnerability among Mexicans has increased by 30.5 million person-years over the last 10 years. If perceived vulnerability remains at its 2014 level, the average Mexican adults would be expected to live a large fraction of his/her life with perceived vulnerability of violence. Acts of violence continue to rise in the country and they should be addressed as a major public health issue before they become endemic.

Trends in avoidable mortality over the life course in Mexico, 1990–2015: a cross-sectional demographic analysis

Objective To analyse average lifespan and quantify the effect of avoidable/amenable mortality on the difference between state-specific mortality and a low-mortality benchmark in Mexico during 1990–2015. Design Retrospective cross-sectional demographic analysis using aggregated data. Setting Vital statistics from the Mexican civil registration system. Participants Aggregated national data (from 91.2 million people in 1995 to 119.9 in 2015) grouped in 64 populations (32 Mexican states (including Mexico City) by sex) with cause-of-death data. Main outcome measures Cause-specific contributions to the gap in life expectancy with a low-mortality benchmark in three age groups (0–14, 15–49 and 50–84 years). Results Infants and children under the age of 15 years show improvements towards maximal survival in all states. However, adult males aged 15 to 49 years show deterioration after 2006 in almost every state due to increasing homicides, and a slow recovery thereafter. Out of 35 potential years, females and males live on average 34.57 (34.48 to 34.67) and 33.80 (33.34 to 34.27), respectively. Adults aged 50 to 84 years show an unexpected decrease in the low mortality benchmark, indicating nationwide deterioration among older adults. Females and males in this age group show an average survival of 28.59 (27.43 to 29.75) and 26.52 (25.33 to 27.73) out of 35 potential years, respectively. State gaps from the benchmark were mainly caused by ischaemic heart diseases, diabetes, cirrhosis and homicides. We find large health disparities between states, particularly for the adult population after 2005. Conclusions Mexico has succeeded in reducing mortality and between-state inequalities in children. However, adults are becoming vulnerable as they have not been able to reduce the burden of violence and conditions amenable to health services and behaviours, such as diabetes, ischaemic heart diseases and cirrhosis. These trends have led to large health disparities between Mexican states in the last 25 years.