Trends in drug overdose deaths in Mexico (1999-2019). A national descriptive analysis and interstate comparison.

BACKGROUND: We assess trends in overdose mortality rates in Mexico from 1999 to 2019 and identify the states with the highest overdose mortality rates over time. METHODS: The analysis using mortality statistics examined deaths related to drug use. We estimated general overdose mortality rates at the national and state levels and calculated specific mortality rates associated with opioid and stimulant use using central rate estimation. We used joinpoint regression to analyse national and state-specific trends in overdose mortality from 1999 to 2019. FINDINGS: Nationally, the general overdose mortality rate increased annually by 10.49 % (p < 0.01, CI=11.4-18.9) from 2015 to 2019. The northern states of Baja California and Chihuahua were the states with the higher annual increases (18.6 %, p < 0.01, CI=4.2-29.6; and 15.6 %, p < 0.01, CI=12.9-19.7, respectively). By substance type, the national opioid-related mortality rate increased by 29.82 % per year from 2014 to 2019 (p < 0.01; CI=20.1-40.3), compared with an annual decrease of 11.43 % in the previous period (2005-2014) (p < 0.01; CI=-14.7- 8.0). Baja California was the state with the highest rise in opioid-related mortality from 2013 to 2019, with an annual increase of 15.84 % (p < 0.01; CI=1.4-32.3). Stimulant-related mortality increased by 21.79 % per year since 2013 (p < 0.01; CI=16.9-26.9), but it was not possible to calculate state-level trends. CONCLUSIONS: Drug-related mortality rates have increased in Mexico since 2015, particularly in the northern states of Baja California, Chihuahua, Sonora and Sinaloa. Improving harm reduction programmes and local surveillance of fatal and non-fatal overdoses is essential to address the silent escalation of overdose mortality.

Study of suicide burden of mortality in México 1990-2017. / Estudio de la carga de la mortalidad por suicidio en México 1990-2017.

OBJECTIVE: The primary goal was to analyze the level and trend of the burden of suicide mortality in Mexico between 1990 and 2017 at a national and state scale. METHODS: A secondary analysis based on the 2017 global burden of disease study. Mortality rates and years of life lost due to premature death (YLL) were reported here. A joinpoint regression analysis based on a log-linear model was used to analyze the trend of YLL. RESULTS: The burden of disease due to suicides increased in Mexico, mainly in young males and females; though the raise that happened in the elderly is an additional challenge for the health system. The burden of disease varied substantially between states. The male mortality rates were higher than those of females during the whole period under study, nonetheless with a trend to reduce the difference between the sexes. A bimodal pattern of the burden of disease due to suicide in Mexico was also observed, with the higher rates located in those aged between 15 and 19 years, and an important increase in people older than 85 years of age. CONCLUSION: These results show a worrisome picture, not only from a social, economic and health point of view but also from the needs of public policies. This situation represents a wake-up call about the need to implement timely identification actions, a comprehensive multisectoral prevention strategy and the detailed study of suicide associated risk factors.

Estudio de la carga de la mortalidad por suicidio en México 1990-2017 / Study of suicide burden of mortality in México 1990-2017

RESUMEN: Objetivo: El principal objetivo fue analizar el nivel y la tendencia de la carga de mortalidad del suicidio en México entre 1990 y 2017, a escala nacional y estatal. Métodos: Análisis secundario basado en el estudio de la Carga Global de la Enfermedad de 2017. Se reportan tasas de mortalidad y los años de vida perdidos por muerte prematura (APMP). Para analizar la tendencia de los APMP se realizó un análisis de regresión joinpoint basado en el modelo log-lineal. Resultados: La carga de la enfermedad por suicidio se incrementó en México, principalmente en hombres y mujeres jóvenes; aunque el aumento en los adultos mayores es un reto adicional para los servicios de salud. La carga de la enfermedad varía sustancialmente entre los estados del país. Las tasas de mortalidad masculinas fueron mayores a las femeninas durante todo el periodo de estudio, aunque con una tendencia a reducir la diferencia entre ambos sexos. Se observó un patrón bimodal de la carga de la enfermedad por suicidio en México, con mayores tasas en los 15-19 años de edad y un importante incremento a partir de los 85 años de edad. Conclusión: los resultados obtenidos ponen de manifiesto un panorama preocupante, no solo desde el punto de vista social, económico y de salud, sino también en cuanto a las necesidades en materia de políticas públicas. Esto representa una llamada de atención sobre la necesidad de implementar acciones de identificación oportuna, una estrategia integral multisectorial de prevención y el estudio detallado de los factores de riesgo asociados.

ABSTRACT: Objective: The primary goal was to analyze the level and trend of the burden of suicide mortality in Mexico between 1990 and 2017 at a national and state scale. Methods: A secondary analysis based on the 2017 global burden of disease study. Mortality rates and years of life lost due to premature death (YLL) were reported here. A joinpoint regression analysis based on a log-linear model was used to analyze the trend of YLL. Results: The burden of disease due to suicides increased in Mexico, mainly in young males and females; though the raise that happened in the elderly is an additional challenge for the health system. The burden of disease varied substantially between states. The male mortality rates were higher than those of females during the whole period under study, nonetheless with a trend to reduce the difference between the sexes. A bimodal pattern of the burden of disease due to suicide in Mexico was also observed, with the higher rates located in those aged between 15 and 19 years, and an important increase in people older than 85 years of age. Conclusion: These results show a worrisome picture, not only from a social, economic and health point of view but also from the needs of public policies. This situation represents a wake-up call about the need to implement timely identification actions, a comprehensive multisectoral prevention strategy and the detailed study of suicide associated risk factors.

Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010.

The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.

Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010 / Promedio de años de vida perdidos por cáncer de mama y cervicouterino según índice de marginación estatal en México, 2000 y 2010 / Média de anos de vida perdidos por câncer de mama e câncer de colo uterino no México pelo índice de marginalização estadual, 2000 e 2010

The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.

El objetivo fue calcular el promedio de años de vida perdidos por cáncer de mama y cáncer cervicouterino en México para los años 2000 y 2010. Se utilizaron registros de mortalidad del Instituto Nacional de Geografía y Estadística, de mujeres entre 20 y 84 años de edad. Se estimaron tasas específicas de mortalidad y el promedio de años de vida perdidos por ambos padecimientos, los cuales determinan los años que deberían haber vivido las personas que fallecieron, en relación con la esperanza de vida. Los datos se agruparon según el índice de marginación estatal del Consejo Nacional de Población del 2010. Se observó un descenso en el promedio de años de vida perdidos por cáncer cervicouterino (37,4%) y un incremento de los años de vida perdidos por cáncer de mama (8,9%). Las mujeres que viven en estados con un índice de marginación alto y muy alto perdieron más años de vida por cáncer cervicouterino, mientras que mujeres de áreas más desarrolladas perdieron más años de vida por cáncer de mama. Se evidenciaron variaciones por grupos de marginación estatal y tipos de cáncer.

O objetivo foi calcular a média de anos de vida perdidos por câncer de mama e câncer de colo uterino no México para os anos 2000 e 2010. Foram utilizados os registros do Instituto Nacional de Geografia e Estatística do México sobre a mortalidade das mulheres entre 20 e 84 anos de idade. Foram estimadas as taxas específicas de mortalidade e a média de anos de vida perdidos pelas duas condições, as quais determinam os anos que deveriam ter vivido as pessoas que faleceram, em relação à expectativa de vida. Os dados foram desagregados por grupos quinquenais de idade e de acordo com o índice de marginalidade estadual. Nos anos estudados, foi observado um declínio na média de anos de vida perdidos devido ao câncer de colo uterino (37,4%) e um aumento de anos de vida perdidos devido ao câncer de mama (8,9%). As mulheres que vivem em estados com um índice de marginalização alto e muito alto perderam mais anos de vida devido ao câncer de colo uterino, enquanto as que vivem em áreas mais desenvolvidas perderam mais anos de vida devido ao câncer de mama. Foram evidenciadas variações por grupos de marginalização estadual e pelo tipo de câncer.