Ten-year hospitalization trends in Mexico: Examining the profile of national and transient and migrants.

Aim: In Mexico, as in other societies, migrants are seen as over-users of health services. However, the extent, distribution, and trends of use over time are unknown. Evidence is needed to inform health policies and improve health services for foreign patients. The objective of this study was to examine factors associated with the distribution and trends of Mexican and foreign resident hospitalizations in Mexican public hospitals from 2010 to 2020. Methods: A graphical and statistical analysis (descriptive and correlational) of discharge trends in public hospitals was carried out. Hospitalization trends were analyzed by country of habitual residence (Mexico, US, Central and South America, and Other Continents), age, sex, primary discharge category, and region of service delivery. Adjusted Poisson modeling was used to examine the factors associated with annual hospitalizations of Mexican and foreign residents. Results: Between 2010 and 2020, there were 26,780,808 hospitalizations in Mexican public hospitals. Of these, 0.05% were of foreign residents. Hospitalizations for Mexican residents remained stable from 2010 to 2019, while those for foreign residents trended upward over the same period. In 2020, hospitalizations of Mexican residents fell by 36.6%, while foreign resident hospitalizations fell by 348.8%. The distribution of hospitalizations by sex was higher among females for all categories of habitual residence, except among US residents. Obstetric discharges were the most common reason for hospitalization among Mexican residents (42.45%), Central and South American residents (42.24%), and residents from Other Continents (13.73%). The average hospital stay was 2 days. Poisson regression confirmed these results, showing that hospitalizations was higher among women (except among foreign residents) and in the ≤ 17 age group. Poisson modeling also showed that trauma injury was the leading cause of discharge for foreign residents after obstetric causes. Discussion: It is unlikely the upward trend in hospitalizations among foreign residents in Mexico from 2010 to 2019 affected the Mexican public health system, given the small proportion (0.05%) of hospitalizations and the brief length of hospital stay. The increased number of hospitalizations during the study period may be explained by local and national measures to facilitate foreign residents' access to hospital services, while the decrease in hospital utilization in 2020 is likely associated with COVID-19. Geographic location and the most frequent primary discharge categories of hospitalizations within each population could provide evidence for modifications to public health policy in Mexico.

A characterization of cross-border use of health services in a transborder population at the Mexico-Guatemala border, September-November 2021.

BACKGROUND: Cross-border use of health services is an important aspect of life in border regions. Little is known about the cross-border use of health services in neighboring low- and middle-income countries. Understanding use of health services in contexts of high cross-border mobility, such as at the Mexico-Guatemala border, is crucial for national health systems planning. This article aims to describe the characteristics of the cross-border use of health care services by transborder populations at the Mexico-Guatemala border, as well as the sociodemographic and health-related variables associated with use. METHODS: Between September-November 2021, we conducted a cross-sectional survey using a probability (time-venue) sampling design at the Mexico-Guatemala border. We conducted a descriptive analysis of cross-border use of health services and assessed the association of use with sociodemographic and mobility characteristics by means of logistic regressions. RESULTS: A total of 6,991 participants were included in this analysis; 82.9% were Guatemalans living in Guatemala, 9.2% were Guatemalans living in Mexico, 7.8% were Mexicans living in Mexico, and 0.16% were Mexicans living in Guatemala. 2.6% of all participants reported having a health problem in the past two weeks, of whom 58.1% received care. Guatemalans living in Guatemala were the only group reporting cross-border use of health services. In multivariate analyses, Guatemalans living in Guatemala working in Mexico (compared to not working in Mexico) (OR 3.45; 95% CI 1.02,11.65), and working in agriculture/cattle, industry, or construction while in Mexico (compared to working in other sectors) (OR 26.67; 95% CI 1.97,360.85), were associated with cross-border use. CONCLUSIONS: Cross-border use of health services in this region is related to transborder work (i.e., circumstantial use of cross-border health services). This points to the importance of considering the health needs of migrant workers in Mexican health policies and developing strategies to facilitate and increase their access to health services.

Ten-year hospitalization trends in Mexico: Examining the profile of national and transient and migrants

Aim In Mexico, as in other societies, migrants are seen as over-users of health services. However, the extent, distribution, and trends of use over time are unknown. Evidence is needed to inform health policies and improve health services for foreign patients. The objective of this study was to examine factors associated with the distribution and trends of Mexican and foreign resident hospitalizations in Mexican public hospitals from 2010 to 2020. Methods A graphical and statistical analysis (descriptive and correlational) of discharge trends in public hospitals was carried out. Hospitalization trends were analyzed by country of habitual residence (Mexico, US, Central and South America, and Other Continents), age, sex, primary discharge category, and region of service delivery. Adjusted Poisson modeling was used to examine the factors associated with annual hospitalizations of Mexican and foreign residents. Results Between 2010 and 2020, there were 26,780,808 hospitalizations in Mexican public hospitals. Of these, 0.05% were of foreign residents. Hospitalizations for Mexican residents remained stable from 2010 to 2019, while those for foreign residents trended upward over the same period. In 2020, hospitalizations of Mexican residents fell by 36.6%, while foreign resident hospitalizations fell by 348.8%. The distribution of hospitalizations by sex was higher among females for all categories of habitual residence, except among US residents. Obstetric discharges were the most common reason for hospitalization among Mexican residents (42.45%), Central and South American residents (42.24%), and residents from Other Continents (13.73%). The average hospital stay was 2 days. Poisson regression confirmed these results, showing that hospitalizations was higher among women (except among foreign residents) and in the ≤ 17 age group. Poisson modeling also showed that trauma injury was the leading cause of discharge for foreign residents after obstetric causes. Discussion It is unlikely the upward trend in hospitalizations among foreign residents in Mexico from 2010 to 2019 affected the Mexican public health system, given the small proportion (0.05%) of hospitalizations and the brief length of hospital stay. The increased number of hospitalizations during the study period may be explained by local and national measures to facilitate foreign residents' access to hospital services, while the decrease in hospital utilization in 2020 is likely associated with COVID-19. Geographic location and the most frequent primary discharge categories of hospitalizations within each population could provide evidence for modifications to public health policy in Mexico.

Cocirculation and replacement of SARS-CoV-2 variants in crowded settings and marginalized populations along the US-Mexico border.

OBJECTIVE: To interrogate the circulating SARS-CoV-2 lin-eages and recombinant variants in persons living in migrant shelters and persons who inject drugs (PWID). MATERIALS AND METHODS: We combined data from two studies with marginalized populations (migrants in shelters and persons who inject drugs) in Tijuana, Mexico. SARS-CoV-2 variants were identified on nasal swabs specimens and compared to publicly available genomes sampled in Mexico and California. RESULTS: All but 2 of the 10 lineages identified were predomi-nantly detected in North and Central America. Discrepan-cies between migrants and PWID can be explained by the temporal emergence and short time span of most of these lineages in the region. CONCLUSION: The results illustrate the temporo-spatial structure for SARS-CoV-2 lineage dispersal and the potential co-circulation of multiple lineages in high-risk populations with close social contacts. These conditions create the potential for recombination to take place in the California-Baja California border.

Access to Health Care for Migrants Along the Mexico-United States Border: Applying a Framework to Assess Barriers to Care in Mexico

Background Migrants in Mexico are entitled to care at all levels, independently of their migration status. However, previous studies show that access to care is difficult for this population. As the movement of in-transit migrants and asylum seekers has been interrupted at the Mexico-United States border by migration policies such as the “Remain in Mexico” program, and by border closures due to the COVID-19 pandemic, the Mexican health system has the challenge of providing them with health care. Levesque et al.'s framework, according to which access occurs at the interface of health system characteristics and potential users' abilities to interact with it, is a useful theoretical tool to analyze the barriers faced by migrants. Objective The objective of this article is to analyze the barriers to access the public Mexican health system, encountered by migrants in cities in Mexican states at the Mexico-United States border during the COVID-19 pandemic. Methods Data came from a multiple case study of the response of migrant shelters to health care needs during the COVID-19 pandemic. The study consisted of a non-probability survey of migrants with a recent health need, and interviews with persons working in civil society organizations providing services to migrants, governmental actors involved in the response to migration, and academics with expertise in the subject. We analyzed the quantitative and qualitative results according to Levesque et al.'s framework. Results 36/189 migrants surveyed had sought health care in a public service. The main limitations to access were in the availability and accommodation dimension (administrative barriers decreasing migrants' ability to reach the system), and the affordability dimension (out-of-pocket costs limiting migrants' ability to pay). Civil society organizations were a major source of social support, helping migrants overcome some of the barriers identified. Conclusions While Mexico's health regulations are inclusive of migrants, in practice there are major barriers to access public health services, which might inhibit migrants from seeking those services. In order to comply with its commitment to guarantee the right to health of all persons, the Mexican health authorities should address the implementation gap between an inclusive policy, and the barriers to access that still remain.

Determinants of COVID-19 Vaccine Acceptance and Uptake in a Transborder Population at the Mexico-Guatemala Border, September-November 2021.

Assessing COVID-19 vaccination uptake of transborder populations is critical for informing public health policies. We conducted a probability (time-venue) survey of adults crossing from Mexico into Guatemala from September to November 2021, with the objective of describing COVID-19 vaccination status, willingness to get vaccinated, and associated factors. The main outcomes were receipt of ≥1 dose of a COVID-19 vaccine, being fully vaccinated, and willingness to get vaccinated. We assessed the association of outcomes with sociodemographic characteristics using logistic regressions. Of 6518 participants, 50.6% (95%CI 48.3,53.0) were vaccinated (at least one dose); 23.3% (95%CI 21.4,25.2) were unvaccinated but willing to get vaccinated, and 26.1% (95%CI 24.1,28.3) were unvaccinated and unwilling to get vaccinated. Those living in Mexico, independent of country of birth, had the highest proportion vaccinated. The main reason for unwillingness was fear of side effects of COVID-19 vaccines (47.7%, 95%CI 43.6,51.9). Education level was positively associated with the odds of partial and full vaccination as well as willingness to get vaccinated. People identified as Catholic had higher odds of getting vaccinated and being fully vaccinated than members of other religious groups or the non-religious. Further studies should explore barriers to vaccination among those willing to get vaccinated and the motives of the unwilling.

Migrant shelters' response to COVID-19: Comparative case study in four cities close to the Mexico-United States border.

Introduction: In the context of a health contingency such as the current COVID-19 pandemic, some groups may remain invisible, so that their health needs go unnoticed. These groups include migrants, asylum seekers, and refugees (MAR). In Mexico there is a network of migrant shelters (casas del migrante-CM) that provide humanitarian assistance, including access to heath care. Given the major role of the CM in caring for migrants, it was important to identify the main elements of their internal capacities, and of the external resources in the cities in which they are located, that contributed to their role in protecting MRA`s health during the COVID-19 pandemic. Methods: we use a comparative case study approach to understand, explain, and compare how internal capacities and external resources available to four CM in the north of Mexico, influenced the development and implementation of COVID-19 related strategies to protect MRA. The project took place during 2021 in Saltillo and Piedras Negras in Coahuila; Ciudad Juarez, Chihuahua, and in Monterrey, Nuevo Leon. A total of 18 in-depth interviews were performed with key actors from the CM, academia, health care services and international agencies. Results: We found a range from a total closure of one CM, to the continuation of operation of three of them, with differences in the strategies developed to provide services and avoid infections within the facilities. MARs' still face multiple barriers to exercise their right to health, and the response of local governments towards migration and health impacts the response that CM were able to implement. Conclusion: There is a need to strengthening the preparedness and response capacities and coordination mechanisms of local, state and federal authorities to attain their responsibilities in the provision of services directed to MAR, including access to health care.

Migrants on the Move and Food (In)security: A Call for Research.

Food insecurity contributes to negative outcomes for health and wellbeing, and its impact may be exacerbated during periods of vulnerability. While food insecurity is both a driver and a consequence of migration, anecdotal evidence indicates that it is also common during migration when people are 'on the move', although its prevalence and severity during these periods are largely undocumented. Food security monitoring is critical to ensuring the universal right to food for migrants, and instruments must be designed which capture the unique challenges faced during these 'extra-ordinary' periods of mobility, including in the context of emergencies such as the COVID-19 pandemic. This paper reviews knowledge on food security in migrants on the move and examines how active mobility intersects with food security and its measurement. Considering the potential consequences on health and wellbeing, we call for interdisciplinary research using standard instruments to document food insecurity in migrants on the move.

Profiles of Depressive Symptoms Among Men Who Have Sex With Men and Transgender Women During the COVID-19 Outbreak in Mexico: A Latent Class Analysis.

The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.

Excess Out-of-Hospital Mortality and Declining Oxygen Saturation: The Sentinel Role of Emergency Medical Services Data in the COVID-19 Crisis in Tijuana, Mexico.

STUDY OBJECTIVE: Emergency medical services (EMS) may serve as a key source of real-time data about the evolving health of coronavirus disease 2019 (COVID-19)-affected populations, especially in low- and middle-income countries with less rapid and reliable vital statistics registration systems. Although official COVID-19 statistics in Mexico report almost exclusively inhospital mortality events, excess out-of-hospital mortality has been identified in other countries, including 1 EMS study in Italy that showed a 58% increase. Additionally, EMS and hospital reports from several countries have suggested that silent hypoxemia-low Spo2 in the absence of dyspnea-is associated with COVID-19. It is unclear, however, how these phenomena can be generalized to low- and middle-income countries. We assess how EMS data can be used in a sentinel capacity in Tijuana, a city on the Mexico-United States border with earlier exposure to COVID-19 than many low- and middle-income country settings. METHODS: In this observational study, we calculated numbers of weekly out-of-hospital deaths and respiratory cases handled by EMS in Tijuana, and estimated the difference between peak epidemic rates and expected trends based on data from 2014 to 2019. Results were compared with official COVID-19 statistics, stratified by neighborhood socioeconomic status, and examined for changing demographic or clinical features, including mean Spo2. RESULTS: An estimated 194.7 excess out-of-hospital deaths (95% confidence interval 135.5 to 253.9 deaths) occurred during the peak window (April 14 to May 11), representing an increase of 145% (95% CI 70% to 338%) compared with expected levels. During the same window, only 5 COVID-19-related out-of-hospital deaths were reported in official statistics. This corresponded with an increase in respiratory cases of 236.5% (95% CI 100.7% to 940.0%) and a decrease in mean Spo2 to 77.7% from 90.2% at baseline. The highest out-of-hospital death rates were observed in low-socioeconomic-status areas, although respiratory cases were more concentrated in high-socioeconomic-status areas. CONCLUSION: EMS systems may play an important sentinel role in monitoring excess out-of-hospital mortality and other trends during the COVID-19 crisis in low- and middle-income countries. Using EMS data, we observed increases in out-of-hospital deaths in Tijuana that were nearly 3-fold greater than increases reported in EMS data in Italy. Increased testing in out-of-hospital settings may be required to determine whether excess mortality is being driven by COVID-19 infection, health system saturation, or patient avoidance of health care. We also found evidence of worsening rates of hypoxemia among respiratory patients treated by EMS, suggesting a possible increase in silent hypoxemia, which should be met with increased detection and clinical management efforts. Finally, we observed social disparities in out-of-hospital death that warrant monitoring and amelioration.