Teresita de Jesús Ramírez

Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social

Objective: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. Material and Methods. Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. Results. The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. Conclusion. The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Disability-adjusted life-years (DALYs) for diabetes in Mexico in 2005: a cross-sectional burden of disease analysis

Abstract Background Diabetes is one of the leading causes of morbidity and mortality in Mexico and its prevalence has been rising since the end of the last century. The aim of this study was to estimate, for 2005, the share of burden due to this disease in the Instituto Mexicano del Seguro Social—the major social security institution in Mexico, which covers nearly half of Mexicos population. Methods Disability-adjusted life-years (DALYs) were calculated by the sum of the estimated years of life lost (YLLs) and years lived with disability (YLDs) due to diabetes. The International Statistical Classification of Disease and Related Health Problems 10th Revision was used, and we included the E10–E14 codes related to diabetes mellitus. YLLs were calculated from age–sex–time-specific estimates of mortality by diabetes. YLDs were calculated by age and sex, and prevalence of diabetes and its disabling sequelae such as retinopathy, amputation, diabetic foot, and neuropathy. Findings In 2005, diabetes contributed 787 397 DALYs, 9·21% (95% CI 9·19–9·23) of total DALYs in Mexico, an increase from 7·31% (7·28–7·33) estimated in 1995. 5·83% (95% CI 5·79–5·89) of DALYs due to diabetes were attributed to retinopathy, 2·62% (2·58–2·65) to amputation, and 0·94% (0·92–0·96) to diabetic foot and neuropathy. While in adults aged between 25 and 44 years of age 64·29% (95% CI 64·00–64·60) of DALYs were due to YLDs, this proportion was 18·70% (18·50–18·90) in adults aged 45–59 years and only 6·47% (6·39–6·54) in those aged 60 years and older. 55·52% (95% CI 55·40–55·60) of the population affected with DALYs due to diabetes were female. Interpretation In recent years, diabetes has been challenging the Mexican health-care system due to its high mortality rate and its high costs of care. In spite of the burden due to mortality, there is also a high burden due to YLDs, mainly among the younger age groups. Some neglected microvascular complications of diabetes, such as retinopathy, neuropathy, and diabetic foot, have contributed considerably to DALYs in Mexico. Funding Mexican Social Security Institute (Grant No. 2005-785-154).