Self-Reported Diabetes in Older Adults: A Comparison of Prevalence and Related Factors in the Mexican Health and Aging Study (2015, 2018, and 2021).

Aim: To estimate the prevalence and factors associated with diabetes among older adults and compare the prevalence rate of a three-round national survey of the Mexican Health and Aging Study (MHAS). Methods: A cross-sectional study was conducted with data obtained from MHAS 2015 (n = 8167), 2018 (n = 7854), and 2021 (n = 8060), which comprised a nationally representative sample of older adults in Mexico. The measures included sociodemographic characteristics and health. A binary logistic regression model was used to identify the association between independent variables and self-reported diabetes. Results: The prevalence of diabetes was 26.3%, 27.7%, and 28.1% in 2015, 2018, and 2021, respectively. This prevalence decreased with age and was higher for female, urban older adults, those with multimorbidity, a lower level of education, and without social security coverage for the three years. Age was associated with a lower possibility of presenting diabetes ([OR = 0.79[0.71-0.89]] and [OR = 0.41[0.33-0.52]] in groups aged 75-84 years and ≥85 years, respectively). Females continue to be more likely to present diabetes than males (OR = 1.39 [95% CI 1.25-1.55]). Older adults living in rural areas are 20% less likely to present diabetes than those living in urban areas (OR = 0.80 [95% CI 0.69-0.93]). Uninsured older adults (OR = 1.35 [95% CI 1.20-1.53]), those who wear glasses (OR = 1.23 [95% CI 1.16-1.30]), those with multimorbidity (OR = 1.13 [95% CI 1.01-1.27]), and those who currently drink alcohol (OR = 1.12 [95% CI 1.00-1.25]) were significantly more likely to have diabetes. Conclusion: An elevated prevalence of diabetes was found in older adults in Mexico, while not having access to social security was associated with a higher possibility of presenting diabetes and living in a rural area was associated with a lower possibility of presenting diabetes. Detection, prevention, and control programs should be implemented to reduce the incidence and severity of the disease in older adults and, thus, prevent its associated complications.

Access to healthcare services between insured and uninsured adults aged ≥50 years with diabetes in Mexico: the Mexican Health and Aging Study (MHAS-2018).

OBJECTIVES: Analyze the association between health insurance coverage and the use of health care services, dentist visits, and self-medication in a national sample of Mexican adults aged ≥50 years with diabetes. METHODS: Participants with diabetes taken from a subsample of the Mexican Health and Aging Study (MHAS-2018) (n = 3667) were examined, with data pertaining to the frequency of their doctor and dentist visits, residence, years of education, self-medication, and health insurance coverage (insured/uninsured) also collected. A logistic regression model was used to identify the association between independent variables and health insurance coverage, whereas Poisson regression models were also estimated to ascertain whether health insurance coverage was associated with the number of doctor and dentist visits. RESULTS: The prevalence of self-reported diabetes was 24.6%, whereas approximately 93.3% of subjects had visited a doctor, 40.6% had visited a dentist, and 20.3% self-medicated. Individuals with insurance coverage were 75% (Odds ratio [OR] = 1.75 [95% confidence interval {CI}1.32-2.31]; P < 0.001) more likely to have visited a doctor and 57% more likely to have visited a dentist (OR = 1.57 [95% CI 1.35-1.83]; P < 0.001) than uninsured adult subjects, while adults living in rural areas were 77% less likely to be insured than adults living in urban areas. Doctor and dentist visits [rate ratio {RR} = 1.32 (95% CI 1.28-1.35); P < 0.001] and [RR = 1.47 (95% CI 1.37-1.58); P < 0.001, respectively] were found to be positively associated with the insured members of the study population. CONCLUSION: A positive association was found between doctor and dentist visits in the population insured with diabetes. A major public health challenge is the population of diabetics who report being uninsured, wherein this population requires coverage to access the necessary clinical follow-up and control to prevent complications.

Out of Sight and Uninsured: Access to Healthcare Among US-Born Minors in Mexico.

To examine health insurance coverage among the 550,000 U.S.-born minors living in Mexico. Representative data from Mexico's 2018 National Survey of Demographic Dynamics was used to describe health coverage among persons aged 0-17 living in Mexico (N = 78,370). Multinomial logistic regression models were estimated to identify the association between birthplace (Mexico versus the United States) and health insurance coverage in Mexico. 39% of U.S-born minors living in Mexico in 2018 lacked health insurance compared to just 13% of Mexican-born minors. Logistic regression found that, net of potential confounders, being born in the United States was associated with 87% lower odds of being insured among minors in Mexico. U.S.-born minors disproportionately rely on private insurance programs and are particularly likely to be uninsured in the first year back from the United States. Special attention is needed to ensure access to care among U.S.-born minors in Mexico.

Aging and the Hidden Costs of Going Home to Mexico.

Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.

Renouncing care in French Guiana: the national health barometer survey.

BACKGROUND: In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. METHODS: A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. RESULTS: In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. CONCLUSIONS: Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.

Did the Affordable Care Act's Dependent Coverage Expansion Affect Race/Ethnic Disparities in Health Insurance Coverage?

OBJECTIVE: To test the impact of the dependent coverage expansion (DCE) on insurance disparities across race/ethnic groups. DATA SOURCES/STUDY SETTING: Survey data from the National Survey of Drug Use and Health (NSDUH). STUDY DESIGN: Triple-difference (DDD) models were applied to repeated cross-sectional surveys of the U.S. adult population. DATA COLLECTION/EXTRACTION METHODS: Data from 6 years (2008-2013) of the NSDUH were combined. PRINCIPAL FINDINGS: Following the DCE, the relative odds of insurance increased 1.5 times (95 percent CI 1.1, 1.9) among whites compared to blacks and 1.4 times (95 percent CI 1.1, 1.8) among whites compared to Hispanics. CONCLUSIONS: Health reform efforts, such as the DCE, can have negative effects on race/ethnic disparities, despite positive impacts in the general population.

Identifying barriers to move to better health coverage: preferences for health insurance benefits among the rural poor population in La Guajira, Colombia.

Even though access to health insurance in Colombia has improved since the implementation of the 1993 health reforms (Law 100), universal coverage has not yet been accomplished. There is still a segment of the population under the low-income (subsidized) health insurance policy or without health insurance altogether. The purpose of this research was to identify preferences and behavior regarding health insurance among the subsidized rural population in La Guajira, Colombia, and to understand why that population remains under the subsidized health insurance policy. The field experiment gathered information from 400 households regarding their socioeconomic situation, health conditions, and preferences for health insurance characteristics. Results suggest that the surveyed population gives priority to expanded family coverage, physician and hospital choice, and access to specialists, rather than to attributes associated with co-payments or premiums. That indicates that people value healthcare benefits and family coverage more than health insurance expenses, and policy makers could use these preferences to enroll subsidized population into the contributory regime.