Correction: Martínez-Valverde et al. Health Needs Assessment: Chronic Kidney Disease Secondary to Type 2 Diabetes Mellitus in a Population without Social Security, Mexico 2016-2032. Int. J. Environ. Res. Public Health 2022, 19, 9010.

In the original publication [...].

Health Needs Assessment: Chronic Kidney Disease Secondary to Type 2 Diabetes Mellitus in a Population without Social Security, Mexico 2016-2032.

Health needs assessment is a relevant tracer of planning process of healthcare programs. The objective is to assess the health needs of chronic kidney disease (CKD) secondary to type 2 diabetes mellitus (T2 DM) in a population without social security in Mexico. The study design was a statistical simulation model based on data at the national level of Mexico. A stochastic Markov model was used to simulate the progression from diabetes to CKD. The time horizon was 16 years. The results indicate that in 2022, kidney damage progression and affectation in the diabetic patient cohort will be 34.15% based on the time since T2 DM diagnosis. At the end of the 16-year period, assuming that the model of care remains unchanged, early renal involvement will affect slightly more than twice as many patients (118%) and cases with macroalbuminuria will triple (228%). The need for renal replacement therapy will more than double (169%). Meanwhile, deaths associated with cardiovascular risk will more than triple (284%). We concluded that the clinical manifestations of patients with CKD secondary to T2 DM without social security constitute a double challenge. The first refers to the fact that the greatest health need is early care of CKD, and the second is the urgent need to address cardiovascular risk in order to reduce deaths in the population at risk.

Childhood Cancer Survival, 2006-2012 Cohorts of Mexican Institute of Social Security Beneficiaries at the Central-South Region of Mexico.

Introduction: In Mexico, the main institution of social security is the "Instituto Mexicano del Seguro Social" (IMSS), with more than 60 million enrolled individuals. This study of childhood cancer survival is the first based on complete cohorts of incident cases for the population IMSS- affiliated in the central-south region, which represents 27% of all children IMSS affiliated. Methods: It is an observational cohort study from 2006 to 2012 to estimate the 5-year observed survival of the minors under 18 years old, identified in the Central-South Region Registry of Children with Cancer. The survival of cases was carried out through the active and passive search. Survival rates were estimated by the Kaplan-Meier (KM) method, the analysis of equality of survival functions was evaluated for some clinical variables. Results: The study included 2,357 minors; the 5-year observed survival was 56.1% with a time of survival median of 3.4 years, and the overall loss of follow-up was 18.4%. The 5-year survival in cases with a diagnosis of leukemia was 53.5%, while for solid tumors, it was 57.9%. The median time of death was 1 year. The types of cancer with a survival greater than 70% were group V-retinoblastoma (87.2%), IIa-Hodgkin's lymphoma (86.8%), Xc- gonadal tumors (83.3%), Iid-miscellaneous lymphomas (80%), IVa-nephroblastoma (79.5%), and IIc-Burkitt's lymphoma (75.4%). Meanwhile, the lowest survival rates were in group VIII-bone tumors (32.3%), III-CNS (central nervous system; 44.1%), and IX-soft tissues (46.8%). Conclusions: Survival results in the 2006-2012 cohorts show a significant gap in relation to the goal of 60% proposed by the World Health Organization for 2030.

Correction to: socioeconomic inequalities in survival of children with acute lymphoblastic leukemia insured by social security in Mexico: a study of the 2007-2009 cohorts.

Following publication of the original article [1], the author reported her name has been erroneously spelled as Blanca E. Pelcastre. The full name is Blanca E. Pelcastre-Villafuerte.

Socioeconomic inequalities in survival of children with acute lymphoblastic leukemia insured by social security in Mexico: a study of the 2007-2009 cohorts.

BACKGROUND: Although acute lymphoblastic leukemia (ALL) 5 years survival in minors has reached 90%, socioeconomic differences have been reported among and within countries. Within countries, the difference has been related to the socioeconomic status of the parents, even in the context of public health services with universal coverage. In Mexico, differences in the mortality of children with cancer have been reported among sociodemographic zones. The Instituto Mexicano del Seguro Social (IMSS), the country's main social security institution, has reported socioeconomic differences in life expectancy within its affiliated population. Here, the socioeconomic inequalities in the survival of children (< 15 years old) enrolled in the IMSS were analyzed. METHODS: Five-year survival data were analyzed in cohorts of patients diagnosed with ALL during the period 2007-2009 in the two IMSS networks of medical services that serve 7 states of the central region of Mexico. A Cox proportional risk model was developed and adjusted for the socioeconomic characteristics of family, community of residence and for the clinical characteristics of the children. The slope of socioeconomic inequality of the probability of dying within five years after the diagnosis of ALL was estimated. RESULTS: For the 294 patients studied, the 5 years survival rate was 53.7%; the median survival was 4.06 years (4.9 years for standard-risk diagnosis; 2.5 years for high-risk diagnosis). The attrition rate was 12%. The Cox model showed that children who had been IMSS-insured for less than half their lives had more than double the risk of dying than those who had been insured for their entire lives. CONCLUSIONS: We did not find evidence of socioeconomic inequalities in the survival of children with ALL associated with family income, educational and occupational level of parents. However, we found a relevant gradient related social security protection: the longer children's life insured by social security, the higher their probability of surviving ALL was. These results add evidence of the effectiveness of social security, as a mechanism of wealth redistribution and a promoter of social mobility. Extending these social security benefits to the entire Mexican population could promote better health outcomes.

General surgery referral´s outcomes and solution time / Desenlace y tiempos de solución de las referencias a cirugía general

Background: There are a variety of instruments and indicators to assess continuity of care; however there is a lack of those that describe the result of coordination between the health care levels. Objective: To show two indicators that summarizes the result of the complete circuit primary level-secondary level-primary level. Methods: An observational prospective cohort study was conducted, with a one-year follow-up of a random sample of the references to general surgery services in a family medicine unit of the IMSS. Two indicators were analyzed: the outcome of the reference to general surgery, categorized as resolved, withdrawal and not resolved; and the time of solution of the surgical problem, which measures the median in calendar days from the issuance of the reference to the counter-reference for the reason of original sending. The indicators were compared by characteristics of the patient and the first level physician. Results: The 84.8% of cases were resolved in a median time of 72 days (50-112), 14.1% of patients reject surgery and 1% wasn´t resolved. No statistically significant differences were found according the evaluated characteristics. Conclusions: The overall solution time of the surgical problem in the medical unit is within the range built with previous studies, but in specific diagnoses there are significant variations. The frequency of solution of the surgical problem was high for diagnoses of greater risk.

Introducción: entre la gran variedad de instrumentos e indicadores para evaluar continuidad de la atención, escasean los que describen el resultado de la coordinación entre niveles de atención a la salud. Objetivo: mostrar dos indicadores que resumen el resultado del circuito completo primer nivel de atención-segundo nivel de atención-primer nivel de atención. Métodos: estudio observacional de cohorte prospectiva, con seguimiento a un año de una muestra aleatoria de las referencias realizadas por una unidad de primer nivel de atención a los servicios de cirugía general. Se analizaron dos indicadores: el desenlace de la referencia a cirugía general, categorizado como resuelto/abandono/no resuelto; y el tiempo de solución del problema quirúrgico, que mide la mediana en días naturales desde la emisión de la referencia hasta la contrarreferencia por el motivo de envío original. Se compararon los indicadores por características del paciente y del médico de primer nivel. Resultados: 84.8% de los casos se resolvió en un tiempo mediano de 72 días (rango de 50 a 112), 14.1% de los pacientes rechazaron la cirugía y 1% no se resolvió. No se encontraron diferencias estadísticamente significativas en las características analizadas. Conclusiones: el tiempo de solución global del problema quirúrgico en la unidad médica está dentro del rango construido con estudios previos, pero en diagnósticos específicos hay variaciones significativas. La frecuencia de solución del problema quirúrgico fue alta para diagnósticos de mayor riesgo.

Decision-making Process by Users and Providers of Health Care Services During the AH1N1 Epidemic Influenza in Mexico: Lessons Learned and Challenges Ahead.

OBJECTIVE: The aim of the study was to analyze, using a decision analysis approach, the probability of severity of illness due to delayed utilization of health services and inappropriate hospital medical treatment during the 2009 AH1N1 influenza epidemic in Mexico. METHODS: Patients with influenza AH1N1 confirmed by the polymerase chain reaction (PCR) test from two hospitals in Mexico City, were included. Path methodology based upon literature and validated by clinical experts was followed. The probability for severe illness originated from delayed utilization of health services, delayed prescription of neuraminidase inhibitors (NAIs) and inappropriate use of antibiotics was assessed. FINDINGS: Ninety-nine patients were analyzed, and 16% developed severe illness. Most patients received NAIs and 85.9% received antibiotics. Inappropriate use of antibiotics was observed in 70.7% of cases. Early utilization of services increased the likelihood of non-severe illness (cumulative probability CP = 0.56). The major cumulative probability for severe illness was observed when prescription of NAIs was delayed (CP = 0.19). CONCLUSION: Delayed prescription of NAIs and irrational use of antibiotics are critical decisions for unfavorable outcomes in patients suffering influenza AH1N1.

Incidence of Childhood Hodgkin Lymphoma in Mexico by Histologic Subtypes and Socioeconomic Regions.

BACKGROUND: Incidence rates of the histologic subtypes of Hodgkin lymphoma (HL) differed with socioeconomic conditions. MATERIALS AND METHODS: HL cases from the Register of Childhood Cancer (below 15 y of age) for 2 socioeconomic regions were analyzed. Central region has a high socioeconomic index; and the southern region a low index. The incidence rates (cases per million children/year) were estimated according to histologic subtypes, age groups, sex, clinical stages, time to diagnosis, and overall survival by regions. RESULTS: The overall incidence was greater in the south (6.8 vs. 4.6), principally due to higher incidence of mixed cellularity subtype (3.8 vs. 1.0). In the south, the highest incidence was found in the 5- to 9-year-old group (9.2), whereas in the central region it was found in the 10- to 14-year-old group (7.4). There was a delay of ∼3 weeks in the time to diagnosis (P=0.36) in the south, but no difference in the percentage of advanced stages, adjusted by histologic subtype (61%, III and IV). The overall survival was 71%, differences were identified only for mixed cellularity cases (center=89.2 vs. south=61.5%, P=0.03). CONCLUSIONS: Incidences of HL subtypes differed in relation to socioeconomic conditions in Mexico. In the south, the incidence of mixed cellularity was higher and there was an earlier peak of presentation.

Direct medical costs of neonatal respiratory distress syndrome in two specialized public hospitals in Mexico / Costo médico directo del síndrome de dificultad respiratoria neonatal en dos hospitales públicos de alta especialidad en México

Objective. To estimate direct medical costs (DMC) associated with treatment of Respiratory Distress Syndrome (RDS) in newborns (NB) in two specialized public hospitals in Mexico. Materials and methods. The perspective used was health care payer. We estimated DMC associated with RDS management. The pattern of resource use was established by reviewing clinical records. Microcosting and bootstrap techniques were used to obtain the DMC. Estimated costs were reported in 2011 US dollars. Results. Average DMC per RDS event was 14 226 USD. The most significant items that account for this cost were hospitalization (38%), laboratory and diagnostic exams (18%), incubator time (10%), surfactant therapy (7%), and mechanical ventilation (7%). Conclusion. Average DMC in NB with RDS fluctuated in relation to gestational age weight at birth and clinical complications presented by patients during their hospitalization.

Objetivo. Determinar los costos médicos directos (CMD) asociados con el tratamiento del síndrome de dificultad respiratoria (SDR) en recién nacidos pretérmino en dos hospitales públicos de alta especialidad de México. Material y métodos. Se utilizó la perspectiva del pagador de servicios de salud. El uso de recursos se estimó mediante la revisión de expedientes clínicos. Se empleó la técnica de microcosteo y de bootstrap para la obtención de los CMD. Los costos fueron reportados en dólares estadounidenses de 2011. Resultados. El CMD por evento de SDR promedio fue de 14 226 dólares distribuidos entre los costos de hospitalización (38%), laboratorio y exámenes de diagnóstico (18%), tiempo en incubación (10%), terapia con surfactantes (7%) y ventilación mecánica (7%). Conclusión. Los CMD promedio en recién nacidos pretérmino con SDR están relacionados con la edad gestacional, el peso al nacer y las complicaciones clínicas que presentan los pacientes durante su hospitalización.

Triggering factors of primary care costs in the years following type 2 diabetes diagnosis in Mexico.

BACKGROUND AND AIMS: Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. METHODS: Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. RESULTS: The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. CONCLUSIONS: Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.

Direct medical costs of neonatal respiratory distress syndrome in two specialized public hospitals in Mexico.

OBJECTIVE: To estimate direct medical costs (DMC) associated with treatment of Respiratory Distress Syndrome (RDS) in newborns (NB) in two specialized public hospitals in Mexico. MATERIALS AND METHODS: The perspective used was health care payer. We estimated DMC associated with RDS management. The pattern of resource use was established by reviewing clinical records. Microcosting and bootstrap techniques were used to obtain the DMC. Estimated costs were reported in 2011 US dollars. RESULTS: Average DMC per RDS event was 14 226 USD. The most significant items that account for this cost were hospitalization (38%), laboratory and diagnostic exams (18%), incubator time (10%), surfactant therapy (7%), and mechanical ventilation (7%). CONCLUSION: Average DMC in NB with RDS fluctuated in relation to gestational age weight at birth and clinical complications presented by patients during their hospitalization.

Socioeconomic factors associated with drug consumption in prison population in Mexico.

BACKGROUND: Consumption of illegal drugs is a public health problem in Mexico, and the prison population is a vulnerable group with higher rates of prevalence than in the general population. The objective of this study was to determine the main socioeconomic variables associated with drug consumption in the prison population. METHODS: Utilizing data from the Second Incarcerated Population Survey carried out by the Centre of Research and Teaching of Economics (CIDE) in Mexico, a logistic model in two stages was developed. The first stage analyzed the determinants of habitual drug consumption by prisoners (prior to admittance into prisons), while the second stage of the model addressed drug consumption within prisons. RESULTS: Prevalence of drug consumption previous to incarceration was 28.5%, although once people were imprisoned this figure dropped to 7.4%. The characteristics that most heavily influenced against the possibility of habitual drug consumption prior to admittance to prison were: preparatory school or higher, being employed and having children; while the variables associated negatively were: male gender, childhood home shared with adults who consumed illegal drugs; abandoning childhood home; and having previous prison sentences. Once in prison, the negative conditions in there are associated with drug consumption. CONCLUSIONS: Work and study during incarceration, in addition to being instruments for rehabilitation, seem to exert an important positive association against drug consumption. However, this correlation seems to be minimized in the face of negative conditions of the penal institution; thus, public policies are necessary to improve the prisoner's environment.

Effectiveness of a medical education intervention to treat hypertension in primary care.

BACKGROUND AND OBJECTIVES: In Mexico, hypertension is among the top five causes for visits to primary care clinics; its complications are among the main causes of emergency and hospital care. The present study reports the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. METHODS: A secondary data analysis was carried out using data of hypertensive patients treated by family doctors who participated in the CME intervention. The evaluation was designed as a pre-/post-intervention study with control group in six primary care clinics. The effect of the CME intervention was analysed using multiple logistic regression modelling in which the dependent variable was uncontrolled blood pressure in the post-intervention patient measurement. RESULTS: After the CME intervention, the net reduction of uncontrolled blood pressure between stages in the intervention group was 10.3%. The model results were that being treated by a family doctor who participated in the CME intervention reduced by 53% the probability of lack of control of blood pressure; receiving dietary recommendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS: CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

Potential savings in Mexico from screening and prevention for early diabetes and hypertension.

This study analyzes the potential economic benefits of identifying and treating patients with so-called prediabetes and prehypertension through the Mexican prevention program known by its Spanish acronym PREVENIMSS. The results show that for each US dollar invested in prevention, $84-$323 would be saved over a twenty-year period. For this and other reasons, providing preventive care for prediabetes and prehypertension patients is better than the current routine care model, in which care is provided in most cases when the disease has progressed substantially. Yet data show that screening and preventive care services are still not being used widely enough in Mexico, are provided too late, or are not sufficiently targeted to the most at-risk individuals. Investing in preventive care for patients with prediabetes and prehypertension is cost saving.

Necesidades de atención social a la salud de los niños y adolescentes con VIH-SIDA: perspectivas del Hospital Infantil de México Federico Gómez / Social care needs to the health of child and adolescents with HIV-AIDS: perspectives of the Hospital Infantil de Mexico Federico Gomez

Introducción. Objetivo: analizar las necesidades de atención social a la salud de pacientes atendidos en la Clínica para niños con Inmunodeficiencias/VIH-SIDA del Hospital Infantil de México Federico Gómez. Métodos. En el año 2008 se condujo un estudio transversal con niños y adolescentes usuarios de la clínica para niños con inmunodeficiencias. Se analizó la información demográfica, familiar y económica contenida en los expedientes sociales. Resultados. Se analizaron 177 pacientes: 25% menores de 5 años de edad, 48% tenían entre 5 y 10 años, 13% de 10 a 15 años y 13% mayores de 15 años; 53% recibía cuidado parental, 28% por familiares cercanos y 17.5% estaba en albergues. La escolaridad se observó por debajo del promedio esperado; 70% de los padres (madre, padre o ambos) tenía VIH-SIDA. El ingreso promedio mensual de 87.8% de las familias fue de $2 644.00 MN; del cual, 62% se destinaba para gastos de alimentación y 9% para servicios médicos. Los ingresos provenían del mercado informal. Todos los pacientes recibían los medicamentos gratuitamente a través del Sistema de Protección Social en Salud (Seguro Popular). Conclusión. Los pacientes y sus familias tenían severas condiciones de vulnerabilidad social y escasa posibilidad para desarrollar competencias educativas y laborales. Por lo que es indispensable incrementar la capacidad institucional de la Clínica de Inmunodeficiencia/VIH-SIDA para otorgar atención social.

Introduction. We undertook this study in order to analyze the social care needs of users of the Immunodeficiency/HIV clinic of Hospital Infantil de Mexico Federico Gomez in Mexico City. Methods. A cross-sectional study was conducted with chil-dren and adolescents attending the clinic. Demographic, family and economic information were analyzed from the clinical files. Results. Included in the study were 177 patients: 25% were <5 years of age, 48% between 5 and 10 years, 13% between 10 and 15 years and 13% >15 years. Their educational level was below the expected average. Of these children, 53% are cared for by their parents, 28% by close relatives and 17% reside in shelters; 70% of parents suffer from HIV-AIDS and 87% of families have a monthly average income of MXN$2 644.00, from which 62% is allocated for food and 9% for medical care. Most of the "breadwinners" are marginally employed. All patients receive free medication covered by the Sistema de Protección Social en Salud. Conclusion. Children and adolescents with AIDS and their families have severe conditions of social vulnerability and little possibility for developing their educational and occupational capabilities. Expanding the capacity of the Immunodeficiency/ HIV clinic to provide social care will fulfill an unmet need.

[An evaluation of a continuing medical education program for primary care services in the prescription of hypoglycemic agents in diabetes mellitus type 2]. / Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos.

OBJECTIVE: To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS: An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period. RESULTS: the program increases 0.6% the probability of appropriate prescription and 11% the probability of appropriate choice of the hypoglycemic drug in obese patients.

Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos / An evaluation of a continuing medical education program for primary care services in the hypoglycemic agent’s prescription in diabetes mellitus type 2

OBJETIVO: Evaluar el efecto en la prescripción de hipoglucémicos de un programa de educación médica continua en unidades de medicina familiar (UMF). MATERIAL Y MÉTODOS: Se realizó un estudio observacional que comparó dos grupos (con y sin programa) con dos cortes transversales (antes y después). La unidad de análisis fue la consulta. El periodo de análisis comprendió seis meses anteriores y seis posteriores a la institución del programa. La principal variable de resultado fue la prescripción adecuada, evaluada mediante dos criterios: elección e indicación correctas. El análisis incluyó modelos de regresión logística, se aplicó la técnica de dobles diferencias y se ajustó por variables relativas al paciente, la consulta y la UMF; las más relevantes fueron sexo, obesidad, otras afecciones, número de consultas, número de medicamentos, tamaño de la clínica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6 por ciento en la probabilidad de prescripción adecuada y de 11 por ciento en la elección correcta en pacientes obesos.

OBJECTIVE: To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS: An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period. RESULTS: the program increases 0.6 percent the probability of appropriate prescription and 11 percent the probability of appropriate choice of the hypoglycemic drug in obese patients.

Direct medical costs for partial refractory epilepsy in Mexico.

BACKGROUND: The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. METHODS: We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). RESULTS: We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. CONCLUSIONS: Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.

[Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute]. / Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social.

OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS. MATERIAL AND METHODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. A random sample of clinical files (n= 1,596) was reviewed to estimate the human resources and medical supplies's utilization according to the health care facilities. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2004 Mexican pesos (MP). RESULTS: The estimated annual total cost of medical care was 7114 million MP for acute myocardial infarction (AMI); 3424 million MP for Cerebrovascular Disease, 1469 million MP for chronic obstructive pulmonary disease (COPD) and 102 million MP for lung cancer (LC). The annual total cost of medical care for IMSS was 12100 million MP. The total annual cost of medical care attributable to tobacco consumption corresponds to 7100 million MP, which is equivalent to 4.3% of the annual expenditures of the IMSS during 2004. CONCLUSIONS: These results confirm the high medical costs associated with smoking. This information would be used to reinforce the tobacco control preventive actions at IMSS and support decision-makers in strengthening public policies to control tobacco use in Mexico.

Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social / Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute

OBJETIVO: Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en términos epidemiológicos (morbilidad) y económicos (costos de atención médica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. MATERIAL Y MÉTODOS: Los costos de la atención médica se estimaron desde la perspectiva del proveedor y se empleó la metodología del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades médicas se estableció la frecuencia de utilización de servicios en los tres niveles de atención. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculó la fracción atribuible al consumo de tabaco para cada enfermedad, misma que se usó para atribuir los costos al tabaco. RESULTADOS: Los costos totales anuales de atención médica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva crónica y 102 millones para el cáncer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3 por ciento del gasto de operación de la institución en el año 2004. CONCLUSIONES: Estos resultados confirman el elevado costo de la atención médica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan información de primera mano necesaria para impulsar las medidas de prevención en esa institución y reforzar las políticas de control del tabaquismo ya aplicadas en México.