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The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This study aims to determine the possible relation between living in disordered and violent community environments and psychological distress in Mexican adolescents and youths regardless of their individual experience of victimization and to assess the potential modifying effect of sex and age on this association. Data come from a cross-sectional survey with a representative sample of adolescents and youths living in Mexican municipalities, including 39,639 participants aged from 12 to 29 years. Disordered and violent community environments were assessed using reports from a secondary sample of adults who lived in the same communities as participants. Using exploratory factor analysis, three contextual variables related to disordered and violent community environment were created: social disorder, vandalism, and criminality. Multilevel linear regression models with random intercept were estimated. Adolescents and youths who lived in environments with higher social disorder had more psychological distress. Men in environments with greater vandalism had a higher level of psychological distress. Unexpectedly, women from communities with higher levels of crime had fewer symptoms. It is necessary to address the violence that exists in these communities, creating strategies that reduce not only crime, but also the social disorder and vandalism that could contribute to developing negative effects on mental health.

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Abstract: The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This study aims to determine the possible relation between living in disordered and violent community environments and psychological distress in Mexican adolescents and youths regardless of their individual experience of victimization and to assess the potential modifying effect of sex and age on this association. Data come from a cross-sectional survey with a representative sample of adolescents and youths living in Mexican municipalities, including 39,639 participants aged from 12 to 29 years. Disordered and violent community environments were assessed using reports from a secondary sample of adults who lived in the same communities as participants. Using exploratory factor analysis, three contextual variables related to disordered and violent community environment were created: social disorder, vandalism, and criminality. Multilevel linear regression models with random intercept were estimated. Adolescents and youths who lived in environments with higher social disorder had more psychological distress. Men in environments with greater vandalism had a higher level of psychological distress. Unexpectedly, women from communities with higher levels of crime had fewer symptoms. It is necessary to address the violence that exists in these communities, creating strategies that reduce not only crime, but also the social disorder and vandalism that could contribute to developing negative effects on mental health.

Resumen: La asociación entre la violencia comunitaria y la salud mental se ha evaluado mediante informes de experiencias individuales, especialmente de adolescentes y jóvenes, pero poco se sabe sobre el efecto de residir en comunidades desordenadas y violentas. El objetivo de este estudio fue comprobar si existe una relación entre residir en entornos comunitarios desordenados y violentos y el distrés psicológico en adolescentes y jóvenes mexicanos, independientemente de su experiencia individual de victimización, así como evaluar el posible efecto modificador del sexo y la edad en esta asociación. Los datos provienen de una encuesta transversal que tomó como muestra representativa a 39.639 adolescentes y jóvenes de entre 12 y 29 años, residentes en ciudades mexicanas. Los entornos comunitarios desordenados y violentos se evaluaron mediante informes de una muestra secundaria de adultos que residían en las mismas comunidades donde vivían los participantes. El análisis exploratorio de datos posibilitó crear tres variables contextuales relacionadas con el entorno comunitario desordenado y violento: desorden social, vandalismo y delincuencia. Se estimaron modelos de regresión lineal multinivel con intercepto aleatorio. Los adolescentes y jóvenes que residían en ambientes con mayor desorden social presentaron mayor distrés psicológico. Los varones en entornos con más vandalismo tenían un mayor nivel de distrés psicológico. Inesperadamente, las mujeres que viven en comunidades con mayores niveles de delincuencia tuvieron menos síntomas. Es necesario enfrentar la violencia existente en las comunidades para generar estrategias que reduzcan no solo la delincuencia, sino también el desorden social y el vandalismo que pueden contribuir al desarrollo de efectos negativos en la salud mental.

Resumo: A associação entre violência comunitária e saúde mental tem sido estudada por meio de relatos de experiências individuais, particularmente em adolescentes e jovens, mas pouco se sabe sobre o efeito de viver em comunidades desordenadas e violentas. O objetivo deste estudo é determinar se há relação entre viver em ambientes comunitários desordenados e violentos e estresse psicológico em adolescentes e jovens mexicanos, independentemente de sua experiência individual de vitimização, e avaliar o potencial efeito modificador do sexo e da idade sobre essa associação. Os dados são de uma pesquisa transversal com uma amostra representativa de adolescentes e jovens residentes em cidades mexicanas, incluindo 39.639 participantes com idades de 12 a 29 anos. Ambientes comunitários desordenados e violentos foram avaliados por meio de relatos de uma amostra secundária de adultos que viviam nas mesmas comunidades onde os participantes viviam. Por meio da análise exploratória de dados, foram criadas três variáveis contextuais relacionadas ao ambiente comunitário desordenado e violento: desordem social, vandalismo e criminalidade. Foram estimados modelos de regressão linear multinível com interceptação aleatória. Adolescentes e jovens que viviam em ambientes com maior desordem social apresentaram maior estresse psicológico. Homens em ambientes com mais vandalismo apresentaram maior nível de estresse psicológico. Inesperadamente, as mulheres de comunidades com níveis mais altos de criminalidade tiveram menos sintomas. É preciso enfrentar a violência existente nas comunidades, gerando estratégias que reduzam não só a criminalidade, mas também a desordem social e o vandalismo que possam contribuir para o desenvolvimento de efeitos negativos na saúde mental.

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OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.

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ABSTRACT OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.

RESUMEN OBJETIVO: Determinar si existen diferencias en el cambio de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos. MÉTODOS: Se analizaron las bases de datos de la Encuesta Nacional de Niveles de Vida de los Hogares en la que se siguieron a los miembros de los hogares entre el 2005 y 2009. Se seleccionaron a los participantes que tenían entre 20 y 40 años (n = 7,130). Se estimaron modelos multinivel con intercepto aleatorio para analizar diferencias en los cambios de la presión arterial de acuerdo con la estatura. Los modelos fueron ajustados por edad, tamaño de localidad, región geográfica, ingreso familiar per cápita, índice cintura-estatura, actividad física, consumo de alcohol, tabaquismo y uso de antihipertensivos. RESULTADOS: En ambos sexos, la presión arterial inicial tendió a ser menor conforme la estatura fuese menor. Las diferencias se mantuvieron tanto en los modelos crudos como en los modelos ajustados. En los varones los incrementos de la presión sistólica a lo largo del tiempo tendieron a ser mayores conforme la estatura era más alta. CONCLUSIONES: Contrario a lo observado en países de altos ingresos, en México la presión arterial se asoció positivamente con la estatura.

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INTRODUCTION: Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. OBJECTIVE: To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. METHOD: Data on ≥ 20-year-old confirmed cases (n = 159,017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. RESULTS: Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression, whereas chronic obstructive pulmonary disease was only related to an increase in the risk of dying. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. CONCLUSION: In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.

INTRODUCCIÓN: Se ha señalado que factores como obesidad, diabetes, hipertensión y edad influyen en la progresión de COVID-19; sin embargo, la evidencia para otras condiciones no es concluyente. OBJETIVO: Identificar qué antecedentes clínicos están relacionados con la gravedad de COVID-19 y si la edad funge como un modificador de efecto de la relación entre comorbilidades cardiometabólicas (CCM) y progresión de COVID-19. MÉTODO: Se analizaron los datos de casos confirmados ≥ 20 años (n = 155 017). La hospitalización, el desarrollo de neumonía, el requerimiento de intubación, el ingreso a la unidad de cuidados intensivos y la muerte constituyeron las variables dependientes en la estimación de modelos de regresión de Poisson y la interacción entre edad y CCM, las independientes. RESULTADOS: Tener CCM, así como otras comorbilidades, se relacionó directamente con la progresión de COVID-19. El riesgo de gravedad de COVID-19 asociado a las CCM fue menor conforme la edad era mayor. El asma y el tabaquismo no fueron factores de riesgo para la progresión de COVID-19. CONCLUSIÓN: En la población mexicana, el riesgo de progresión de COVID-19 asociada a comorbilidades fue mayor en los adultos jóvenes.

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Resumen Introducción: Se ha señalado que factores como obesidad, diabetes, hipertensión y edad influyen en la progresión de COVID-19; sin embargo, la evidencia para otras condiciones no es concluyente. Objetivo: Identificar qué antecedentes clínicos están relacionados con la gravedad de COVID-19 y si la edad funge como un modificador de efecto de la relación entre comorbilidades cardiometabólicas (CCM) y progresión de COVID-19. Método: Se analizaron los datos de casos confirmados ≥ 20 años (n = 155 017). La hospitalización, el desarrollo de neumonía, el requerimiento de intubación, el ingreso a la unidad de cuidados intensivos y la muerte constituyeron las variables dependientes en la estimación de modelos de regresión de Poisson y la interacción entre edad y CCM, las independientes. Resultados: Tener CCM, así como otras comorbilidades, se relacionó directamente con la progresión de COVID-19. El riesgo de gravedad de COVID-19 asociado a las CCM fue menor conforme la edad era mayor. El asma y el tabaquismo no fueron factores de riesgo para la progresión de COVID-19. Conclusión: En la población mexicana, el riesgo de progresión de COVID-19 asociada a comorbilidades fue mayor en los adultos jóvenes.

Abstract Introduction: Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. Objective: To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts as a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. Method: Data on ≥ 20-year-old confirmed cases (n = 155 017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. Results: Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. Conclusion: In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.

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OBJECTIVE: To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2. METHOD: We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models. RESULTS: People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45). CONCLUSIONS: The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.

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Objetivo. Determinar si existen disparidades asociadas a la estratificación socioeconómica, la etnicidad, los servicios médicos y la región geográfica en la progresión de la enfermedad por coronavirus (COVID-19) en adultos mexicanos infectados por SARS-CoV-2. Método. Se analizaron los datos registrados por la Dirección General de Epidemiología de la Secretaría de Salud del Gobierno Federal de México respecto de los casos confirmados de infección por SARS-CoV-2. El análisis se limitó a los datos de adultos de 20 años o más registrados hasta el 10 de julio del 2020 (n=234 870). Los indicadores de severidad de la COVID-19 fueron hospitalización, desarrollo de neumonía, requerimiento de intubación o ingreso a la unidad de cuidados intensivos, y muerte. Se estimaron diferencias de acuerdo con el nivel de marginación municipal, la pertenencia a un grupo indígena, la región geográfica y el sector de los servicios. A partir de modelos de regresión multinivel se estimaron razones de prevalencias (RP). Resultados. Las personas que residían en municipios con mayor marginación tuvieron mayor riesgo de presentar los cuatro indicadores de formas severas de COVID-19 (RP=1,05 o 1,06). Las personas indígenas tuvieron mayor riesgo de neumonía (RP=1,22), hospitalización (RP=1,14) y muerte (RP=1,23). Entre los casos atendidos en servicios privados fue menor el riesgo de muerte (RP=0,40), pero mayor el uso de intubación o ingreso a la unidad de cuidados intensivos (RP=4,45). Conclusiones. Las tendencias observadas indican que los efectos de la COVID-19 no solo se deben a las características biológicas del SARS-CoV-2, sino también a los recursos (o falta de ellos) para enfrentarlo, los cuales están distribuidos por procesos sociales.

Objective. To determine if there are disparities associated with socioeconomic stratification, ethnicity, medical services, and geographic region in the progression of coronavirus disease (COVID-19) in Mexican adults infected with SARS-CoV-2. Method. We analyzed data registered by the General Direction of Epidemiology of the Ministry of Health of the Federal Government of Mexico regarding the confirmed cases of SARS-CoV-2 infection. The analysis was limited to data from adults 20 years and older recorded up to July 10, 2020 (n=234 870). Indicators of severity of COVID-19 were hospitalization, development of pneumonia, requirement for intubation or admission to the intensive care unit, and death. Differences were estimated according to the level of municipal marginalization, belonging to an indigenous group, geographic region, and service sector. Prevalence ratios (PR) were estimated using multilevel regression models. Results. People who lived in municipalities with greater marginalization were at greater risk of presenting the four indicators of severe forms of COVID-19 (PR=1.05 or 1.06). Indigenous people were at greater risk of pneumonia (PR=1.22), hospitalization (PR=1.14) and death (PR=1.23). Among the cases treated in the private health sector, the risk of death was lower (PR=0.40), but the use of intubation or admission to the intensive care unit was higher (PR=4.45). Conclusions. The trends observed indicate that the effects of COVID-19 are not only related to the biological characteristics of SARS-CoV-2, but also to the resources (or lack thereof) to deal with it, which are distributed by social processes.

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