González-Pérez Guillermo J, Vega-López María G, Romero-Valle Samuel, Vega-López Agustín, Cabrera-Pivaral Carlos E
Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México. ggonzal@ cencar.udg.mx
Rev Salud Publica (Bogota). 2008 Dec;10 Suppl:15-28. doi: 10.1590/s0124-00642008000600003.
Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years.
Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalization level and for municipalities grouped according to degree of marginalization. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity.
A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalization) in relationship to the 1st quartile (lowest marginalization); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalization; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality.
Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.
确定近年来墨西哥州和市层面社会排斥与健康不平等之间的关系。
计算2005年的调整死亡率（与儿童期、孕期、分娩期的传染性疾病以及被认为可能可避免的病因导致的死亡有关）；按州计算死亡率，将州按边缘化程度分为四分位数组，将市按边缘化程度分组。使用诸如率比、基尼系数和健康不平等指数（IHI）等指标来衡量这种不平等。
观察到处于第四四分位数组（最高边缘化程度）的州相对于第一四分位数组（最低边缘化程度）存在明显的死亡率过高情况；相反，第一四分位数组的资源和卫生服务明显高于第四四分位数组。在营养性贫血死亡率方面，基尼系数达到最高值（0.44）。在那些被认为边缘化程度非常高的市，过高死亡率很明显；在分析与儿童期、孕期、分娩期相关的死亡率以及可能可避免的死亡率时，处于第四四分位数组的州（恰帕斯州、瓦哈卡州和格雷罗州）的健康不平等指数最高。
墨西哥存在显著的健康不平等，这与该国不同地区社会排斥的高流行水平相关。需要进行深刻的结构性变革来改变这种状况，促进社会发展并减少重要人群面临的不公平劣势。
