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Butt MD, Ong SC, Rafiq A, Kalam MN, Sajjad A, Abdullah M, Malik T, Yaseen F, Babar ZUD. A systematic review of the economic burden of diabetes mellitus: contrasting perspectives from high and low middle-income countries. J Pharm Policy Pract 2024; 17:2322107. [PMID: 38650677 PMCID: PMC11034455 DOI: 10.1080/20523211.2024.2322107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Introduction Diabetes increases preventative sickness and costs healthcare and productivity. Type 2 diabetes and macrovascular disease consequences cause most diabetes-related costs. Type 2 diabetes greatly costs healthcare institutions, reducing economic productivity and efficiency. This cost of illness (COI) analysis examines the direct and indirect costs of treating and managing type 1 and type 2 diabetes mellitus. Methodology According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Cochrane, PubMed, Embase, CINAHL, Scopus, Medline Plus, and CENTRAL were searched for relevant articles on type 1 and type 2 diabetes illness costs. The inquiry returned 873 2011-2023 academic articles. The study included 42 papers after an abstract evaluation of 547 papers. Results Most articles originated in Asia and Europe, primarily on type 2 diabetes. The annual cost per patient ranged from USD87 to USD9,581. Prevalence-based cost estimates ranged from less than USD470 to more than USD3475, whereas annual pharmaceutical prices ranged from USD40 to more than USD450, with insulin exhibiting the greatest disparity. Care for complications was generally costly, although costs varied significantly by country and problem type. Discussion This study revealed substantial heterogeneity in diabetes treatment costs; some could be reduced by improving data collection, analysis, and reporting procedures. Diabetes is an expensive disease to treat in low- and middle-income countries, and attaining Universal Health Coverage should be a priority for the global health community.
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Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM, Penang, Malaysia
| | - Azra Rafiq
- Department of Biological Sciences, Middle East Technical University, Ankara, Turkey
- Department of Pharmacy, Riphah International University, Lahore, Pakistan
| | - Muhammad Nasir Kalam
- Department of Pharmacy, The Sahara University, Narowal, Pakistan
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ahsan Sajjad
- Ibn Sina Community Clinic, South Wilcrest Drive, Houston, Texas, USA
| | - Muhammad Abdullah
- Department of Pharmacy, Punjab University College of Pharmacy, Lahore, Pakistan
| | - Tooba Malik
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Fatima Yaseen
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
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Castillo-Hernandez KG, Espinosa A, Molina-Segui F, Ayuso-Peraza G, Mena-Macossay L, Mendez-Dominguez N, Bastarrachea RA, Laviada-Molina H. Lessons learned from a peer-supported diabetes education program in two dissimilar Mayan communities. Front Endocrinol (Lausanne) 2024; 14:1280539. [PMID: 38239980 PMCID: PMC10794663 DOI: 10.3389/fendo.2023.1280539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/16/2023] [Indexed: 01/22/2024] Open
Abstract
Background A steady rise in type 2 diabetes (T2D) in Mexico over the last 30 years has led to 11.5 million Mexicans being affected by this condition. There is an urgent need to develop interventions to prevent complications of T2D. Diabetes self-management education is the cornerstone of promoting self-care. Among all educational strategies, peer support has shown to be an effective method to encourage ongoing self-management. However, customization of interventions for distinct communities is imperative, as failure to do so can hinder the intervention's effectiveness. Methods We implemented a two-year prospective randomized controlled community-based trial in Conkal, a Mayan community from Yucatan, Mexico. The intervention consisted of receiving either a culturally sensitive peer support on top of a diabetes self-management education group (PLG); or a diabetes self-management education group only (EOG; control group). The primary outcome was changes in glycated hemoglobin, while secondary outcomes encompassed changes in systolic and diastolic blood pressure, body mass index, and diabetes self-care practices. Data collection was performed at baseline and every four months during the study period. Discussion Our experiences have highlighted the significance of peer-leader support in cultivating diabetes self-care skills, particularly within smaller, underserved communities characterized by strong social and cultural ties. However, when applied in larger or suburban settings, selecting peer leaders should be meticulous, considering sectorization within specific neighborhoods to foster a sense of belonging and familiarity among natural community clusters. In larger settlemnts, factors such as transportation challenges, time limitations, caregiving obligations, limited venue access, and changes in session locations can drive program discontinuation. Additionally, individuals with lower educational attainment are more susceptible to abandonment. Notably, those with lower education, uncontrolled diabetes, and extended diabetes duration exhibit a greater potential for improving glycemic control than their counterparts. Clinical registration https://www.isrctn.com/ISRCTN96897082.
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Affiliation(s)
- Karen G. Castillo-Hernandez
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Alan Espinosa
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Fernanda Molina-Segui
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Giselle Ayuso-Peraza
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | - Leticia Mena-Macossay
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
| | | | - Raúl A. Bastarrachea
- Samsun Diabetes Research Institute, Santa Barbara, California, CA, United States
| | - Hugo Laviada-Molina
- Department of Human Nutrition and Metabolism Research, Health Sciences School, Universidad Marista de Mérida, Merida, Mexico
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Silverio-Murillo A, Hoehn-Velasco L, Balmori de la Miyar J, Méndez Méndez JS. The COVID-19 pandemic and non-COVID-19 healthcare utilization in Mexico. Public Health 2024; 226:99-106. [PMID: 38042128 DOI: 10.1016/j.puhe.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES This study aimed to analyze the effects of the COVID-19 pandemic on non-COVID-19 healthcare utilization in Mexico, including oral health, mental health, communicable disease visits, health checkups, chronic degenerative disease visits, postpartum care, prenatal care, and family planning visits. STUDY DESIGN This was a retrospective ecological analysis during the COVID-19 pandemic. During the pandemic, the Mexican government recommended non-essential consultations be suspended or rescheduled to accommodate the new demand for healthcare services from COVID-19 patients. METHODS This study uses administrative data from Mexico's Ministry of Health from January 2017 to December 2022. These data cover 14,299 consultation units and 775 hospitals from the 32 Mexican States, all of which are public institutions. A difference-in-differences strategy and an event study specification are used to study the impacts of the pandemic on non-COVID-19 healthcare utilization. RESULTS The findings reveal a decrease in the utilization of all healthcare services: oral health (69%), mental health (27%), communicable diseases (46%), chronic degenerative diseases (36%), health checkups (62%), family planning (45%), prenatal care (36%), and postpartum care (44%). Furthermore, the event study indicates that most services follow a U-shaped trend, although only mental health services clearly return to prepandemic levels. The remainder of services remain below prepandemic levels at the end of 2022. CONCLUSIONS The 2020 pandemic had detrimental effects on non-COVID-19 healthcare utilization. The healthcare interruptions will likely impact short- and long-term morbidity and mortality. Programs intended to remediate these negative consequences may be of interest to public health policymakers.
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Affiliation(s)
| | - L Hoehn-Velasco
- Andrew Young School of Policy Studies, Georgia State University, USA.
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Rojas Alvarez A, Vazquez CE, Lopez-Ortega M, Angel JL. A comparison of rural-urban differences in out-of-pocket expenses among older Mexicans with diabetes. Front Public Health 2022; 10:1025159. [PMID: 36339153 PMCID: PMC9634568 DOI: 10.3389/fpubh.2022.1025159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 01/28/2023] Open
Abstract
Objective To compare total out-of-pocket expenses for physician visits and medications among older adults living with diabetes in Mexico from urban, semi-urban, and rural areas. Methods The sample included 2,398 Mexicans aged 65 years and older with self-reported diabetes from the 2018 Mexican Health and Aging Study. Out-of-pocket expenses for physician visits and medications were regressed on locality, controlling for several factors. Results The profile of those with higher out-of-pocket medication expenditures included rural localities, higher education, unmarried, depressive symptoms, participation in Seguro Popular, and lacking insurance. In the multivariate analysis, rural older adults with diabetes paid a higher amount in medication expenditures compared with other localities. Conclusion Differences in locality are closely tied to the effective implementation of Seguro Popular. Although this program has improved access to care, participants have higher out-of-pocket expenditures for medications than those on employer-based plans across all localities. Among all groups, the uninsured bare the highest burden of expenditures, highlighting a continued need to address health inequities for the most underserved populations.
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Affiliation(s)
- Alfonso Rojas Alvarez
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States,*Correspondence: Alfonso Rojas Alvarez
| | - Christian E. Vazquez
- School of Social Work, University of Texas at Arlington, Arlington, TX, United States,Christian E. Vazquez
| | | | - Jacqueline L. Angel
- Lyndon B. Johnson School of Public Affairs, University of Texas at Austin, Austin, TX, United States
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Colchero MA, Gómez R, Bautista-Arredondo S. A systematic review of the literature on the impact of the Seguro Popular. Health Res Policy Syst 2022; 20:42. [PMID: 35436938 PMCID: PMC9014564 DOI: 10.1186/s12961-022-00839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/09/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The Seguro Popular (SP) was launched in 2004 to increase access to healthcare and reduce catastrophic expenditures among the Mexican population. To document the evidence on its effectiveness, we conducted a systematic review of impact evaluations of the SP. METHODS We included papers using rigorous quasi-experimental designs to assess the effectiveness of the SP. We evaluated the quality of each study and presented the statistical significance of the effects by outcome category. RESULTS We identified 26 papers that met the inclusion criteria. Sixteen studies that evaluated the impact of SP on financial protection found consistent and statistically significant positive effects in 55% of the 65 outcomes analyzed. Nine studies evaluating utilization of health services for the general and infant populations found effectiveness on 40% of 30 outcomes analyzed. Concerning screening services for hypertension, diabetes, and cervical and prostate cancer, we found three studies evaluating 14 outcomes and finding significant effects on 50% of them. Studies looking at the impact of SP on diabetes, hypertension, and general health care and treatment evaluated 19 outcomes and found effects on 21% of them. One study assessed five diabetes monitoring services and found positive effects on four of them. The only study on morbidity and mortality found positive results on three of the four outcomes of interest. CONCLUSION We found mixed evidence on the impact of SP on financial protection, healthcare utilization, morbidity and mortality. In the 26 studies included in this review, researchers found positive effects in roughly half of the outcomes and null results on the rest.
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Affiliation(s)
- M A Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - R Gómez
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - S Bautista-Arredondo
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico.
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Vidaña-Pérez D, Braverman-Bronstein A, Zepeda-Tello R, Camacho-García-Formentí D, Colchero MA, Rivera-Dommarco JA, Popkin BM, Barrientos-Gutierrez T. Equitability of Individual and Population Interventions to Reduce Obesity: A Modeling Study in Mexico. Am J Prev Med 2022; 62:105-113. [PMID: 34446315 DOI: 10.1016/j.amepre.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. METHODS Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. RESULTS The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. CONCLUSIONS Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.
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Affiliation(s)
- Dèsirée Vidaña-Pérez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Rodrigo Zepeda-Tello
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - M Arantxa Colchero
- Center for Health Services Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hidayat B, Ramadani RV, Rudijanto A, Soewondo P, Suastika K, Siu Ng JY. Direct Medical Cost of Type 2 Diabetes Mellitus and Its Associated Complications in Indonesia. Value Health Reg Issues 2021; 28:82-89. [PMID: 34839111 DOI: 10.1016/j.vhri.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/26/2021] [Accepted: 04/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To estimate the direct medical cost of type 2 diabetes mellitus (T2DM) and its complications in the Indonesian population from a payer perspective using a prevalence-based approach. METHODS The direct medical costs in 2016 were estimated using the database of Indonesia's National Health Insurance, known as Jaminan Kesehatan Nasional, which included diagnosis-related group costs and unbundled costs for patients accessing advanced care. The study population included people aged 30 years or older having a diagnosis of T2DM. T2DM and its related complications were identified using the International Classification of Diseases, 10th Revision, code. Hypoglycemia and all complications listed in the Diabetes Severity Complications Index were included. Descriptive analysis was conducted. Costs were converted to 2016 US dollar equivalent. RESULTS Of the 18.9 million Jaminan Kesehatan Nasional members who accessed secondary and tertiary care, 812 204 (4%) were identified with T2DM, of which 57% had complications. The most common complication was cardiovascular diseases (24%). The total direct medical cost was US $576 million, with 56% spent on hospitalization, 38% on specialist visits, 4% on unbundled non-diabetes-related medication, and 2% on unbundled anti-hyperglycemic medications. Approximately 74% of the total costs was used for the management of people with complications. People with complications (US $930/person/year ± US $1480/person/year) incurred twice the cost of those without complications (US $421/person/year ± US $745/person/year). CONCLUSION The direct medical cost for management of people with T2DM in Indonesia was high. Early diagnosis and optimal management of T2DM to prevent complications may reduce the costly sequelae and have a possibility of cost savings.
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Affiliation(s)
- Budi Hidayat
- Center for Health Economics and Policy Studies, Universitas Indonesia, Jawa Barat, Indonesia
| | - Royasia Viki Ramadani
- Center for Health Economics and Policy Studies, Universitas Indonesia, Jawa Barat, Indonesia
| | - Achmad Rudijanto
- Endocrine and Metabolic Division of Internal Medicine Department, Faculty of Medicine Brawijaya University-Saiful Anwar Hospital, Malang, Indonesia
| | - Pradana Soewondo
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ketut Suastika
- Department of Internal Medicine, Faculty of Medicine, Udayana University/RSUP Denpasar, Denpasar, Indonesia
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Sosa-Rubí SG, Seiglie JA, Chivardi C, Manne-Goehler J, Meigs JB, Wexler DJ, Wirtz VJ, Gómez-Dantés O, Serván-Mori E. Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages. Diabetes Care 2021; 44:373-380. [PMID: 33208487 PMCID: PMC7818336 DOI: 10.2337/dc20-2192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission. RESULTS Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization. CONCLUSIONS Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.
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Affiliation(s)
- Sandra G Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Carlos Chivardi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Gutierrez JP, Bertozzi SM. Non-communicable diseases and inequalities increase risk of death among COVID-19 patients in Mexico. PLoS One 2020; 15:e0240394. [PMID: 33031467 PMCID: PMC7544063 DOI: 10.1371/journal.pone.0240394] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/27/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic compounds Mexico's pre-existing challenges: very high levels of both non-communicable diseases (NCD) and social inequity. METHODS AND FINDINGS Using data from national reporting of SARS-CoV-2 tested individuals, we estimated odds of hospitalization, intubation, and death based on pre-existing non-communicable diseases and socioeconomic indicators. We found that obesity, diabetes, and hypertension are positively associated with the three outcomes in a synergistic manner. The municipal poverty level is also positively associated with hospitalization and death. CONCLUSIONS Mexico's response to COVID-19 is complicated by a synergistic double challenge: raging NCDs and extreme social inequity. The response to the current pandemic must take both into account both to be effective and to ensure that the burden of COVID-19 not falls disproportionately on those who are already disadvantaged.
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Affiliation(s)
- Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- * E-mail:
| | - Stefano M. Bertozzi
- University of California, Berkeley, California, United States of America
- University of Washington, Seattle, Washington, United States of America
- National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
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Mendoza-Velázquez A, Aguirre Sedeño D. [Special excise tax on food and beverages and its impact on inflation in Mexico in terms of dynamics, persistence, and change of regimeImposto especial para alimentos e bebidas e seu impacto na inflação no México: dinâmica, persistência e mudança de regime]. Rev Panam Salud Publica 2019; 43:e88. [PMID: 31772564 PMCID: PMC6854876 DOI: 10.26633/rpsp.2019.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/20/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of this research is to study the strength of transfer, the transitions, and the persistence of the special excise tax on products and services (known by its Spanish acronym, IEPS) applicable since January 2014 to high-energy foods and soft drinks, and the effect of the tax on the annual inflation rates for these foods and beverages. METHODS Annual inflation rates for each food and beverage were calculated from January 2010 to December 2016, based on monthly data from the national consumer price index. A model of variable regimes was used to estimate the impact of the tax on the inflationary dynamics of the foods and beverages, as well as its transitions, persistence, and the possible ruptures. RESULTS There was high variance in the inflationary dynamics of the high-calorie foods and soft drinks subject to the tax. The tax contributed gradually to price inflation for some high-calorie products, before returning to pre-tax inflation levels. The continuity of the tax did not affect the inflationary dynamics of the food after 2015. CONCLUSIONS The tax should be accompanied by measures that facilitate its persistence and transfer to the inflationary dynamics of the taxed products. The taxes collected should be used to promote and facilitate the consumption of healthy alternatives, and this should be accompanied by educational measures aimed at continuing to change consumption habits in the medium and long term.
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Affiliation(s)
- Alfonso Mendoza-Velázquez
- Centro de Investigación e Inteligencia Económica (CIIE)Universidad Popular Autónoma del Estado de Puebla (UPAEP)PueblaMéxicoCentro de Investigación e Inteligencia Económica (CIIE), Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México.
| | - Dillan Aguirre Sedeño
- Centro de Investigación e Inteligencia Económica (CIIE)Universidad Popular Autónoma del Estado de Puebla (UPAEP)PueblaMéxicoCentro de Investigación e Inteligencia Económica (CIIE), Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla, México.
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Whittemore R, Vilar-Compte M, De La Cerda S, Marron D, Conover R, Delvy R, Lozano-Marrufo A, Pérez-Escamilla R. Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study. Int J Equity Health 2019; 18:133. [PMID: 31443659 PMCID: PMC6708131 DOI: 10.1186/s12939-019-1035-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City. Methods This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach. Results The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers. Conclusions Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.
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Affiliation(s)
- Robin Whittemore
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA.
| | - Mireya Vilar-Compte
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
| | - Selene De La Cerda
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
| | - Denise Marron
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Rosabelle Conover
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Roberta Delvy
- Yale School of Nursing, 400 West Campus Drive, West Haven, CT, 06516, USA
| | - Annel Lozano-Marrufo
- Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Álvaro Obregón, Mexico City, Mexico
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Dávila-Cervantes CA, Agudelo-Botero M. Sex disparities in the epidemic of type 2 diabetes in Mexico: national and state level results based on the Global Burden of Disease Study, 1990-2017. Diabetes Metab Syndr Obes 2019; 12:1023-1033. [PMID: 31360070 PMCID: PMC6625746 DOI: 10.2147/dmso.s205198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To analyze the type 2 diabetes (T2D) health burden in Mexico by sex at the national and state levels from 1990 to 2017. METHODS This was a secondary analysis based on data from the Global Burden of Disease Study, 1990-2017. We used the indicators of mortality rates, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). RESULTS At the national level, there was an increase in the standardized mortality rates, YLLs, YLDs and DALYs, especially in the male group. At the state level, the health impacts of T2D varied within the population and did not exhibit any clearly defined geographic pattern. However, the most pronounced increases in the various indicators occurred in the poorer states of the country. CONCLUSION T2D continues to have a dominant impact on Mexican public health, with marked disparities between the states. Working to reduce these health inequalities is necessary, and resources must be focused on the priority groups, for example, men, young and middle-aged adults, and individuals living in the states with the highest index of marginalization.
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Affiliation(s)
| | - Marcela Agudelo-Botero
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
- Correspondence: Marcela Agudelo-BoteroPolitics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Circuito Centro Cultural 20, Insurgentes Cuicuilco, Coyoacán, Mexico City04510, MexicoTel +52 1 554 374 5473Email
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