ABSTRACT
Resumen: Objetivo: Analizar la tendencia en desigualdades en protección financiera y acceso a servicios de salud en México entre 2000 y 2012, usando medidas de brecha y de gradiente. Material y métodos: Análisis de las encuestas nacionales de salud de 2000, 2006 y 2012, estimando las brechas absoluta y relativa en indicadores de protección financiera y de acceso a servicios de salud y el índice de desigualdad de la pendiente, utilizando como indicador socioeconómico el ingreso imputado, así como las diferencias en resultados por sexo, ámbito de residencia y condición étnica. Resultados: Entre 2000 y 2012 se ha eliminado la desigualdad en protección financiera relacionada con condición socioeconómica de forma paralela a la disminución general de la carencia en protección financiera, en tanto que persiste la desigualdad en indicadores de acceso a servicios de salud, tanto por nivel socioeconómico como por otros estratificadores sociales. Conclusiones: La reforma de 2003 se ha traducido en la eliminación de la desigualdad en protección financiera; no obstante, persiste la desigualdad en el acceso a los servicios de salud. Se requiere reenfocar acciones hacia la eliminación de las barreras relacionadas con la calidad de los servicios de salud, que promuevan el acceso efectivo a la salud en México.
Abstract: Objective: To analyze trends in inequality in financial protection and healthcare in Mexico between 2000 and 2012, using simple and complex measures. Materials and methods: Analysis of national health surveys 2000, 2006 and 2012, generating estimates of absolute and relative gaps and the slope index of inequality using imputated income as socioeconomic measure, and differences by sex, rural/urban residence, and ethnic background. Results: Between 2000 and 2012, socioeconomic inequality in financial protection vanished, while it remains in healthcare access, with larger barriers to access healthcare among those in the lowest socioeconomic condition. These results are consistent with the differences by urban/rural residence and ethnic background. Conclusions: The health reform in 2003, aiming to increase health insurance, resulted in the virtual elimination of socioeconomic inequality in financial protection, but there is still inequality in access to healthcare. Actions to eliminate access barriers related to quality of health services are urgent to promote effective access to healthcare.
Subject(s)
Humans , Socioeconomic Factors , Health Surveys , Healthcare Disparities/economics , Health Services Accessibility/economics , Health Care Reform , Income , MexicoABSTRACT
Resumen: Objetivo: Analizar las desigualdades en comportamientos de riesgo en adolescentes de 10 a 19 años en México y documentar los cambios en las brechas y la magnitud de la desigualdad. Material y métodos: Análisis de las encuestas nacionales de salud de 2000 y 2012 estimando para ambas la brecha absoluta y relativa en indicadores de comportamiento de riesgo, así como el índice de desigualdad de la pendiente. Resultados: Para comportamientos sexuales, el uso de métodos anticonceptivos muestra un índice de desigualdad elevado e incrementado entre 2000 y 2012 tanto para hombres como para mujeres; esto es, menor probabilidad de uso para menor nivel socioeconómico. Para el consumo de tabaco y alcohol, la probabilidad es mayor entre quienes cuentan con mayores recursos. Conclusiones: El análisis presentado señala retos importantes en términos de la atención de comportamientos que comprometen la salud de los adolescentes mexicanos y su bienestar futuro. Comprender mejor los elementos asociados a las desigualdades identificadas es necesario para el desarrollo de acciones preventivas eficaces.
Abstract: Objective: To document socioeconomic health inequalities on adolescents' risk behaviors in Mexico using gap and gradient measures. Materials and methods: Analysis of the national health surveys 2000 and 2012 measuring absolute and relative gaps as well as the slope index of inequality for risk behavior indicators on adolescents using socioeconomic indicators and also measuring gaps for sex, urban/rural residency, and indigenous/non-indigenous population. Results: For sexual risk behaviors, inequalities are reflected in a lower probability of using protection at the first sexual intercourse among those living in households with lower income for women and men as well as higher probability of ever being pregnant for adolescents of lower income. For tobacco and alcohol consumption and for violence related health problems, inequalities imply higher probability of consumption among those in household with larger incomes. Conclusions: Socioeconomic health inequalities are a relevant challenge for adolescents' wellbeing in Mexico, with a complex scenario where resource scarcity is related to increasing risk behaviors that may compromise their future. A better understanding of health inequalities is needed to design effective interventions.
Subject(s)
Humans , Male , Female , Adolescent , Health Status Disparities , Socioeconomic Factors , Health Behavior , Sex Factors , Rural Health , Urban Health , Health Surveys , Population Groups , Healthcare Disparities , MexicoABSTRACT
Resumen Objetivo: Analizar la tendencia entre 2000 y 2012 en desigualdades socioeconómicas para indicadores de diabetes e hipertensión en México, así como el gradiente de desigualdad, por sexo, ámbito de residencia y condición indígena. Material y métodos: Análisis de las encuestas nacionales de salud de 2000, 2006 y 2012, estimando para los tres momentos la brecha absoluta y relativa entre quintiles, en indicadores de diabetes e hipertensión, así como el índice de desigualdad de la pendiente. Resultados: En México, entre 2000 y 2012 se ha reducido la brecha en la prevalencia de diabetes e hipertensión por diagnóstico previo. Asimismo, se han reducido de forma importante las brechas relacionadas con la atención de diabetes e hipertensión, persistiendo diferencias por gradiente de desigualdad, en particular en lo que se refiere a la presencia de complicaciones de diabetes. Conclusión: Los resultados identifican avances importantes en la disminución de la desigualdad para la atención adecuada de diabetes e hipertensión, si bien persisten diferencias de consideración. Si se toma en cuenta la relevancia de estas condiciones de salud en México es necesario fortalecer la calidad de la atención en los servicios públicos para avanzar hacia el acceso efectivo.
Abstract: Objective: To analyze trends from 2000 to 2012 in socioeconomic inequalities in health related to diabetes and hypertension indicators in Mexico. Materials and methods: Cross-sectional analysis of three national health surveys (2000, 2006 and 2012), measuring inequality using absolute and relative gaps as well as the Slope Index of Inequality for diabetes and hypertension indicators. Results: From 2000 to 2012, there is a reduction in the gap related to the prevalence of diagnosed diabetes and hypertension, with a parallel reduction in the inequality related to care for those conditions, while an inequality gradient on diabetes care remains. Conclusion: While there is an evident progress in the reduction of inequalities for diabetes and hypertension diagnostic and care in Mexico, some inequalities remain. Given the contribution of these conditions to the burden of disease in the country, there is a need to strength the quality of health services that will promote effective access.
Subject(s)
Humans , Adult , Socioeconomic Factors , Health Surveys , Diabetes Mellitus/epidemiology , Health Status Disparities , Hypertension/epidemiology , Chronic Disease , Prevalence , Cross-Sectional Studies , Mexico/epidemiologyABSTRACT
Resumen: Objetivo: Analizar las desigualdades en indicadores de atención a niños de 0 a 9 años en México, documentando los cambios en las brechas y gradientes. Material y métodos: Análisis de encuestas nacionales de salud estimando las brechas absoluta y relativa así como el gradiente de desigualdad para cuatro indicadores seleccionados (cobertura de vacunación, atención a infecciones respiratorias agudas (IRA), prácticas saludables en enfermedad diarreica aguda (EDA) y atención por accidentes). Resultados: El análisis documenta el logro de la equidad inmunológica en México y la eliminación de la brecha por condiciones socioeconómicas relacionadas con la atención a accidentes, en tanto que persiste la relacionada con la atención a IRA, misma que también persistente por ámbito de residencia y para la población indígena. Conclusión: En México han disminuido las brechas en los indicadores de salud en niños. Si bien persisten en particular para intervenciones que requieren la participación de los establecimientos de salud, es necesario dirigir acciones específicas para asegurar el acceso homogéneo en todo el país a los servicios e intervenciones.
Abstract: Objective: To analyze inequalities in health care indicators of children 0 to 9 years old in Mexico reporting gap and gradient measures. Materials and methods: Cross-sectional analysis of national health surveys in 2000, 2006 and 2012, measuring absolute and relative gap measures as well as the Slope Index of Inequality for four health care indicators (vaccination, care for acute respiratory infections, care for acute diarrheal diseases, and care for accidents) with socioeconomic stratification, as well as absolute gaps by sex, urbanicity and ethnic background. Results: Between 2000 and 2012, immunological equity was reached in Mexico, as well as elimination in the socioeconomic gap related to care for accidents; nevertheless, there is a persistent socioeconomic gap of care for acute respiratory infections that is also there regarding rural residence and indigenous population. Conclusion: In Mexico, there is a trend to the elimination of socioeconomic differences in the probability of receiving adequate health care among children, although some socioeconomic gaps remain in particular related to provision of services that require more participation of health personnel. There is a need to ensure homogenous access to effective services for all.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Health Surveys , Health Status Disparities , Respiratory Tract Infections/therapy , Socioeconomic Factors , Accidents , Cross-Sectional Studies , Vaccination , Diarrhea/therapy , MexicoABSTRACT
OBJECTIVE:: To document socioeconomic health inequalities on adolescents' risk behaviors in Mexico using gap and gradient measures. MATERIALS AND METHODS:: Analysis of the national health surveys 2000 and 2012 measuring absolute and relative gaps as well as the slope index of inequality for risk behavior indicators on adolescents using socioeconomic indicators and also measuring gaps for sex, urban/rural residency, and indigenous/non-indigenous population. RESULTS:: For sexual risk behaviors, inequalities are reflected in a lower probability of using protection at the first sexual intercourse among those living in households with lower income for women and men as well as higher probability of ever being pregnant for adolescents of lower income. For tobacco and alcohol consumption and for violence related health problems, inequalities imply higher probability of consumption among those in household with larger incomes. CONCLUSIONS:: Socioeconomic health inequalities are a relevant challenge for adolescents' wellbeing in Mexico, with a complex scenario where resource scarcity is related to increasing risk behaviors that may compromise their future. A better understanding of health inequalities is needed to design effective interventions.
Subject(s)
Health Status Disparities , Risk-Taking , Adolescent , Female , Health Behavior , Health Surveys , Healthcare Disparities , Humans , Male , Mexico , Population Groups , Rural Health , Sex Factors , Socioeconomic Factors , Urban HealthABSTRACT
OBJECTIVE:: To analyze trends from 2000 to 2012 in socioeconomic inequalities in health related to diabetes and hypertension indicators in Mexico. MATERIALS AND METHODS:: Cross-sectional analysis of three national health surveys (2000, 2006 and 2012), measuring inequality using absolute and relative gaps as well as the Slope Index of Inequality for diabetes and hypertension indicators. RESULTS:: From 2000 to 2012, there is a reduction in the gap related to the prevalence of diagnosed diabetes and hypertension, with a parallel reduction in the inequality related to care for those conditions, while an inequality gradient on diabetes care remains. CONCLUSION:: While there is an evident progress in the reduction of inequalities for diabetes and hypertension diagnostic and care in Mexico, some inequalities remain. Given the contribution of these conditions to the burden of disease in the country, there is a need to strength the quality of health services that will promote effective access.
Subject(s)
Diabetes Mellitus/epidemiology , Health Status Disparities , Health Surveys , Hypertension/epidemiology , Socioeconomic Factors , Adult , Chronic Disease , Cross-Sectional Studies , Humans , Mexico/epidemiology , PrevalenceABSTRACT
OBJECTIVE:: To analyze trends in inequality in financial protection and healthcare in Mexico between 2000 and 2012, using simple and complex measures. MATERIALS AND METHODS:: Analysis of national health surveys 2000, 2006 and 2012, generating estimates of absolute and relative gaps and the slope index of inequality using imputated income as socioeconomic measure, and differences by sex, rural/urban residence, and ethnic background. RESULTS:: Between 2000 and 2012, socioeconomic inequality in financial protection vanished, while it remains in healthcare access, with larger barriers to access healthcare among those in the lowest socioeconomic condition. These results are consistent with the differences by urban/rural residence and ethnic background. CONCLUSIONS:: The health reform in 2003, aiming to increase health insurance, resulted in the virtual elimination of socioeconomic inequality in financial protection, but there is still inequality in access to healthcare. Actions to eliminate access barriers related to quality of health services are urgent to promote effective access to healthcare.
Subject(s)
Health Services Accessibility/economics , Health Surveys , Healthcare Disparities/economics , Socioeconomic Factors , Health Care Reform , Humans , Income , MexicoABSTRACT
OBJECTIVE:: To analyze inequalities in health care indicators of children 0 to 9 years old in Mexico reporting gap and gradient measures. MATERIALS AND METHODS:: Cross-sectional analysis of national health surveys in 2000, 2006 and 2012, measuring absolute and relative gap measures as well as the Slope Index of Inequality for four health care indicators (vaccination, care for acute respiratory infections, care for acute diarrheal diseases, and care for accidents) with socioeconomic stratification, as well as absolute gaps by sex, urbanicity and ethnic background. RESULTS:: Between 2000 and 2012, immunological equity was reached in Mexico, as well as elimination in the socioeconomic gap related to care for accidents; nevertheless, there is a persistent socioeconomic gap of care for acute respiratory infections that is also there regarding rural residence and indigenous population. CONCLUSION:: In Mexico, there is a trend to the elimination of socioeconomic differences in the probability of receiving adequate health care among children, although some socioeconomic gaps remain in particular related to provision of services that require more participation of health personnel. There is a need to ensure homogenous access to effective services for all.
Subject(s)
Health Status Disparities , Health Surveys , Accidents , Child , Child, Preschool , Cross-Sectional Studies , Diarrhea/therapy , Humans , Infant , Infant, Newborn , Mexico , Respiratory Tract Infections/therapy , Socioeconomic Factors , VaccinationABSTRACT
OBJECTIVE: Compare two indirect methods for measuring adherence to antiretrovirals (ARV) for people living with HIV (PLWHA) in México. MATERIAL AND METHODS: Sectional study of direct interviews with patients selected from a representative sample of PLWHA care units in México. We estimated in 2,054 patients the adherence of four days as the measurement used traditionally in México and the adherence index as a measurement that is reported more correlated with biological measurements. For the latter, use was made of all items on the questionnaire AIDS Clinical Group (ACTG) (adherence rate, monitoring the schedule and special instructions, and time since the last time you stopped taking ARV). In both cases, was considered adequate adhesion values ≥ 95%. RESULTS: The adherence of four days identifies 13.2% (n = 271) of patients with levels less than the recommended (8.3% of 56-94% and 4.9% of 0- 55%) according to the index, the percentage of patients with lower levels of adherence to recommended was 45.0% (n = 924) (40.5% of 56-94%, 4.5% of 0-55%). CONCLUSIONS: The estimate of adherence of 4 days may be underestimating significantly the adherence problem in PLWHA in Mexico, according to the comparison with the calculated value. Considering the values reported by the index, it is necessary to strengthen strategies to promote adherence to treatment and that a high percentage of patients has levels of adherence that jeopardize the effectiveness of treatment.
