Vargas Sofia Castro, Rios-Zertuche Diego, Bauhoff Sebastian
Health, Nutrition and Population Division, Inter-American Development Bank, Washington, DC, USA.
Salud Mesoamerica Initiative/Regional Malaria Elimination Initiative, Washington, DC, USA.
Lancet Reg Health Am. 2025 Mar 29;45:101061. doi: 10.1016/j.lana.2025.101061. eCollection 2025 May.
Low quality of care has emerged as key policy concern in low and middle-income countries. This study explores the changes and heterogeneity in preventable and healthcare-amenable excess mortality across regions and demographic groups in Mexico for 2012, 2018, and 2021.
We estimate excess mortality for the top ten healthcare amenable causes of death in Mexico. Excess mortality is categorized into preventable mortality, which could be avoided by preventing disease onset, and amenable mortality, which could be avoided through timely and effective healthcare. In broad terms, amenable mortality is derived by comparing case fatality rates in Mexico from those in a group of benchmark countries. This amenable mortality is further split into low quality and non-utilization amenable. The analysis used data from the Global Burden of Disease (GBD) study and the Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys.
The findings indicate that healthcare-amenable mortality attributed to low quality was 52·5% in 2012 and 57·2% in 2021. Diabetes mellitus and chronic kidney disease were the predominant causes of amenable deaths, with an estimated 28,953 and 23,772 deaths in 2021, respectively. In 2021, an estimated 25·41 per 100,000 males died due to poor quality compared to 17·31 per 100,000 females. The of share of quality-amenable mortality for some conditions was also different between males and females in 2021. For diabetes mellitus, 38·7% of amenable mortality in males was due to poor quality, compared to 52·4% for females and for chronic kidney disease the percentage for males was 35·1% as opposed to 49·4% for females.
The large share of healthcare-amenable deaths attributable to poor quality underscores the persistent deficiencies in healthcare delivery processes. Despite efforts to improve healthcare quality, substantive disparities remain, particularly across factors such as sex and age. The findings highlight the need for targeted healthcare policies aimed at improving quality for all groups. Future policies should prioritize addressing the specific needs of high-risk groups to improve the overall performance of the healthcare system.
This study received no external funding.
医疗服务质量低下已成为低收入和中等收入国家关键的政策关注点。本研究探讨了2012年、2018年和2021年墨西哥各地区及人口群体中可预防和医疗可及性过高死亡率的变化及异质性。
我们估算了墨西哥十大医疗可及性死因的过高死亡率。过高死亡率分为可预防死亡率（可通过预防疾病发生来避免）和可及性死亡率（可通过及时有效的医疗保健来避免）。广义而言，可及性死亡率是通过比较墨西哥与一组基准国家的病死率得出的。这种可及性死亡率进一步细分为低质量可及性和未利用可及性。分析使用了全球疾病负担（GBD）研究和全国健康与营养调查（ENSANUT）的数据。
研究结果表明，2012年因低质量导致的医疗可及性死亡率为52.5%，2021年为57.2%。糖尿病和慢性肾脏病是可及性死亡的主要原因，2021年估计分别有28953例和23772例死亡。2021年，每10万男性中估计有25.41人因质量差死亡，而每10万女性中这一数字为17.31人。2021年，某些疾病的质量可及性死亡率在男性和女性之间也存在差异。对于糖尿病，男性中38.7%的可及性死亡率是由于质量差，而女性为52.4%；对于慢性肾脏病，男性的这一比例为35.1%，女性为49.4%。
因质量差导致的医疗可及性死亡占比很大，这凸显了医疗服务提供过程中持续存在的缺陷。尽管努力提高医疗质量，但实质性差距仍然存在，尤其是在性别和年龄等因素方面。研究结果强调需要制定有针对性的医疗政策，以提高所有群体的医疗质量。未来的政策应优先满足高危群体的特定需求，以改善医疗系统的整体绩效。
本研究未获得外部资金。
Zotero 插件