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Resumen Antecedentes: Desde hace treinta años, México ha estudiado la carga de la enfermedad para sustentar decisiones en salud. Objetivo: Analizar la carga de enfermedad, lesiones y factores de riesgo en México entre 1990 y 2021. Material y métodos: Se utilizaron las estimaciones del Global Burden of Disease 2021 para analizar la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida saludable perdidos, así como la carga atribuible a los factores de riesgos por sexo, edad y entidad federativa. Resultados: La mortalidad infantil disminuyó 39.4 % de 1990 a 2000, y 49.0 % de 2000 a 2019. En el ámbito nacional, la mortalidad decreció 27.5 % entre 1990 y 2019, pero ascendió en 2020 y 2021 en todos los estados, especialmente en adultos de 35 a 64 años, debido a la pandemia de COVID-19, que contribuyó con 24.3 % de las defunciones en 2019. Se observaron diferencias significativas en la mortalidad según la edad y el sexo. La carga atribuible a los factores de riesgo metabólicos se incrementó, mientras que la atribuible el consumo de alcohol y tabaco disminuyó. El acceso al agua potable y saneamiento mejoró. Conclusiones: Evaluar la carga de enfermedad es crucial para diseñar estrategias eficaces para abordar las necesidades actuales y los futuros desafíos en salud.

Abstract Background: For thirty years, Mexico has studied the burden of disease in order to inform health decisions. Objective: To analyze the burden of disease, injuries, and risk factors in Mexico between 1990 and 2021. Material and methods: Estimates from the Global Burden of Disease 2021 study were used to analyze mortality, years of life lost due to premature mortality, years lived with disability and disability-adjusted life years, as well as the burden attributable to risk factors by sex, age and state of the country. Results: Infant mortality decreased by 39.4% from 1990 to 2000 and by 49.0% from 2000 to 2019. At the national level, mortality decreased by 27.5% between 1990 and 2019, but increased in 2020 and 2021 across all states, especially in adults aged from 35 to 64 years due to the COVID-19 pandemic, which contributed with 24.3% of deaths in 2019. Significant differences in mortality were observed according to age and sex. The burden attributable to metabolic risk factors did increase, while alcohol and tobacco consumption decreased. Access to drinking water and sanitation showed improvements. Conclusions: Assessing the burden of disease is crucial in order to design effective strategies to address current health needs and future healthcare challenges.

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Resumen Antecedentes: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. Objetivo: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. Material y métodos: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. Resultados: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. Conclusiones: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

Abstract Background: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. Objective: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. Material and methods: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. Results: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. Conclusions: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

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Resumen Antecedentes: Durante décadas, México ha transitado de las enfermedades infecciosas a las crónicas y la violencia, debido a cambios en los estilos de vida y la urbanización. Objetivo: Describir el impacto en salud de los factores de riesgo en México entre 1990 y 2021. Material y métodos: Se utilizaron las estimaciones del Global Burden of Disease para analizar la mortalidad y años de vida saludable (AVISA) perdidos atribuibles a factores de riesgo, estratificados por edad, sexo y estado. Resultados: Los factores de riesgo representaron 14.9 millones de AVISA en 2021, 32.4 % del total nacional, con predominio de los riesgos metabólicos (19.8 %). La mortalidad estandarizada por edad debida a estos riesgos se incrementó 6.5 % de 1990 a 2021 y los riesgos conductuales y ambientales se redujeron en más de 50 %. Los factores predominantes cambiaron de desnutrición, problemas de acceso al agua potable y saneamiento en 1990 a altos niveles de glucosa y obesidad en 2021; la desnutrición fue el mayor riesgo en los niños menores de cinco años. Conclusiones: México afronta desafíos sanitarios dobles, la desnutrición infantil continúa y los riesgos metabólicos en adultos se incrementan, sobre todo en los estados menos desarrollados, por lo que se requieren intervenciones específicas para amenazas nuevas y existentes.

Abstract Background: Over the past decades, Mexico's health landscape has shifted from infectious to non-communicable diseases and violence, mirroring lifestyle, urbanization, and developmental changes. Objective: To describe the impact of risk factors on health in Mexico from 1990 to 2021. Material and methods: Using the Global Burden of Diseases, Injuries, and Risk Factors Study estimates, we describe risk factor-related mortality and disability adjusted life years (DALYs) in Mexico (1990-2021) by age, sex, and state of the country. Results: In 2021, risk factors led to 14.9 (12.9-16.7) million DALYs, which accounted for 32.4 % of Mexico's burden. Metabolic risks, with 19.8% (17.0-21.9 %) were the main contributors. From 1990 to 2021, the age-standardized all-cause mortality rate associated with metabolic risks increased by 6.5%, while behavioral and environmental risks decreased by more than 50%, with marked variations between states. The predominant risk factors shifted from malnutrition and unsafe water and sanitation in 1990 to high glucose and body mass index in 2021. Malnutrition-related risks have the highest impact on health loss in children younger than 5 years. Conclusions: Mexico faces a dual health challenge: childhood malnutrition persists, and adult metabolic risks are on the rise, particularly in less developed states, with targeted interventions for traditional and emerging health threats being required.

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Resumen Antecedentes: Se estima que los factores de riesgo ambientales (FRA) fueron responsables en 2019 de nueve millones de muertes en el mundo. Objetivo: A partir de datos del estudio Global Burden of Disease, se analizaron indicadores de pérdida de salud asociada a la exposición a FRA en México. Material y métodos: Se analizaron números absolutos y porcentajes poblacionales de muertes y años de vida saludable (AVISA) perdidos según sexo atribuidos a FRA seleccionados en los ámbitos nacional y estatal, así como las tendencias estandarizadas por edad de 1990 a 2021. Resultados: En 2021, la contaminación por material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos por los FRA seleccionados (42.2 y 38.1 %, respectivamente), seguida de la exposición a plomo (20.6 y 13.4 %) y temperatura baja (19.8 y 12.3 %). Ambos indicadores han disminuido en todos los FRA seleccionados, en magnitudes diferentes entre 1991 y 2021, excepto la temperatura alta. Conclusiones: A pesar de las disminuciones en los últimos 32 años, el material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos, seguido de la exposición a plomo. Es fundamental fortalecer las políticas de calidad del aire y exposición a plomo en México.

Abstract Background: It is estimated that environmental risk factors (ERF) were responsible for nine million deaths worldwide in 2019. Objective: Using data from the Global Burden of Disease study, indicators of health loss associated with exposure to ERF in Mexico were analyzed. Material and methods: Absolute numbers and population percentages of deaths and disability-adjusted life years (DALY) lost attributed to selected ERFs were analyzed at the national and state level and by sex, as well as age-standardized trends from 1990 to 2021. Results: In 2021, ambient particulate matter pollution showed the highest mortality and DALYs lost attributed to selected ERFs (42.2 and 38.1% respectively), followed by lead exposure (20.6 and 13.4%) and low temperature (19.8 and 12.3%). Both indicators have decreased for all selected ERAs by different magnitudes between 1991 and 2021, except for high temperature. Conclusions: Despite decreases in the last 32 years, outdoor environment particulate matter showed the highest mortality and DALYs lost, followed by lead exposure. It is essential to strengthen air quality and lead exposure policies in Mexico.

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Resumen Antecedentes: Las enfermedades respiratorias (ER) se analizan individualmente, posiblemente con subestimación de su carga total. Objetivo: Analizar la carga de las ER en México para población de 20 años o más de 1990 a 2021. Material y métodos: Se presenta la carga de ER en México a partir de estimaciones del estudio Global Burden of Disease en cuanto a mortalidad y años de vida saludable (AVISA) perdidos que comprenden recuentos, tasas por 100 000 y tasas estandarizadas por edad. Las ER se categorizaron en enfermedades respiratorias crónicas (ERC), infecciones respiratorias y cánceres respiratorios. Resultados: En 2021, las ER causaron la muerte de 336 728 adultos mayores de 20 años, lo que representó 30.5 % del total de defunciones, incremento cercano al triple respecto a 2019, principalmente debido a COVID-19. Las ERC contribuyeron con 3.4 % del total de muertes, las infecciones respiratorias con 25.9 % y los cánceres respiratorios con 1.2 %. La mortalidad y AVISA perdidos por ERC se incrementaron persistentemente, con variaciones entre los estados. Las tasas de mortalidad ajustadas por edad de las ERC disminuyeron desde 1990, excepto las enfermedades pulmonares intersticiales, que se incrementaron constantemente. Conclusión: Los significativos niveles de mortalidad y discapacidad debidos a enfermedades respiratorias en México exigen mejorar la prevención, investigación y abordar factores de riesgo como tabaquismo y contaminación, además de fomentar la capacitación médica continua.

Abstract Background: Respiratory diseases (RD) are often analyzed separately rather, possibly leading to an underestimation of their total burden. Objective: To analyze the burden of RD in Mexico for population aged 20 or older from 1990 to 2021. Material y methods: We present the burden of RD in Mexico based on estimates of the Global Burden of Disease study for mortality and disability-adjusted life years (DALYs), comprising counts, rates per 100,000, as well as age-standardized rates. RDs were categorized into three key groups: chronic respiratory diseases (CRD), respiratory infections (RI), and respiratory cancers. Results: In 2021, among those aged 20+, RDs were responsible for 336,728 deaths, which accounts for 30.5% of total deaths— a nearly threefold increase since 2019, primarily due to the COVID-19 pandemic. CRDs contributed with 3.4% of total deaths; RIs, with 25.9%; and respiratory cancers, with 1.2%. CRDs showed a continuous rise in deaths, crude mortality, and DALY rates across genders, with no signs of leveling. RD burden varied widely across states. Age-standardized CRD mortality rates have generally declined since 1990, except for interstitial lung diseases, which have consistently increased. Conclusion: The significant burden of mortality and disability due to RDs in Mexico underscores the necessity for enhanced prevention, research, and for addressing risk factors such as smoking and pollution. Ongoing healthcare training can help reduce RD burden.

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BACKGROUND: It is estimated that environmental risk factors (ERF) were responsible for nine million deaths worldwide in 2019. OBJECTIVE: Using data from the Global Burden of Disease study, indicators of health loss associated with exposure to ERF in Mexico were analyzed. MATERIAL AND METHODS: Absolute numbers and population percentages of deaths and disability-adjusted life years (DALY) lost attributed to selected ERFs were analyzed at the national and state level and by sex, as well as age-standardized trends from 1990 to 2021. RESULTS: In 2021, ambient particulate matter pollution showed the highest mortality and DALYs lost attributed to selected ERFs (42.2 and 38.1% respectively), followed by lead exposure (20.6 and 13.4%) and low temperature (19.8 and 12.3%). Both indicators have decreased for all selected ERAs by different magnitudes between 1991 and 2021, except for high temperature. CONCLUSIONS: Despite decreases in the last 32 years, outdoor environment particulate matter showed the highest mortality and DALYs lost, followed by lead exposure. It is essential to strengthen air quality and lead exposure policies in Mexico.

ANTECEDENTES: Se estima que los factores de riesgo ambientales (FRA) fueron responsables en 2019 de nueve millones de muertes en el mundo. OBJETIVO: A partir de datos del estudio Global Burden of Disease, se analizaron indicadores de pérdida de salud asociada a la exposición a FRA en México. MATERIAL Y MÉTODOS: Se analizaron números absolutos y porcentajes poblacionales de muertes y años de vida saludable (AVISA) perdidos según sexo atribuidos a FRA seleccionados en los ámbitos nacional y estatal, así como las tendencias estandarizadas por edad de 1990 a 2021. RESULTADOS: En 2021, la contaminación por material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos por los FRA seleccionados (42.2 y 38.1 %, respectivamente), seguida de la exposición a plomo (20.6 y 13.4 %) y temperatura baja (19.8 y 12.3 %). Ambos indicadores han disminuido en todos los FRA seleccionados, en magnitudes diferentes entre 1991 y 2021, excepto la temperatura alta. CONCLUSIONES: A pesar de las disminuciones en los últimos 32 años, el material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos, seguido de la exposición a plomo. Es fundamental fortalecer las políticas de calidad del aire y exposición a plomo en México.

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BACKGROUND: Musculoskeletal disorders (MSD) affect 1.71 billion people worldwide and are the leading cause of disability. OBJECTIVE: To analyze the years lived with disability (YLD) attributed to MSD in Mexico between 1990 and 2021. MATERIAL AND METHODS: With estimates from the Global Burden of Disease 2021 study, the YLDs due to MSD and their six categories were analyzed, including osteoarthritis, rheumatoid arthritis, gout, neck pain, low back pain, as well as other MSDs. Patterns and trends in the number, crude rate, and YLD age-standardized rate were evaluated at the national and state levels, as well as by age group and gender. RESULTS: MSDs were the main cause of YLDs in Mexico between 1990 and 2021, with an increase of 57.3%, going from 1,458.4 to 2,293.7 per 100,000 population. Low back pain (840.6 YLD) showed the highest rate in 2021, while osteoarthritis had the largest increase. MSDs increased with age and, and except for gout, affected women more often. CONCLUSIONS: From 1990 to 2021, MSDs were the main cause of YLDs in Mexico, with a higher impact on adults and women. MSDs can appear early in life, hence the need for continuous interventions in order to preserve quality of life.

ANTECEDENTES: Los trastornos musculoesqueléticos (TME) afectan a 1710 millones de personas en todo el mundo y es la principal causa de discapacidad. OBJETIVO: Analizar los años vividos con discapacidad (AVD) por TME en México entre 1990 y 2021. MATERIAL Y MÉTODOS: Con las estimaciones del estudio de la Carga Global de la Enfermedad 2021 se analizaron los AVD por TME y sus seis categorías: osteoartritis, artritis reumatoide, gota, dolor cervical, lumbalgia y otros TME. Se evaluaron patrones y tendencias del número, tasa cruda y tasa estandarizada por edad de los AVD a nivel nacional, estatal, por grupos de edad y sexo. RESULTADOS: Los TME constituyeron la principal causa de AVD en México entre 1990 y 2021, con un incremento de 57.3 %; pasaron de 1458.4 a 2293.7 por 100 000 habitantes. La lumbalgia (840.6 AVD) destacó con la mayor tasa en 2021 y la osteoartritis, con el mayor incremento. Los TME se incrementaron con la edad y, con excepción de la gota, afectaron más a las mujeres. CONCLUSIONES: De 1990 a 2021, los TME constituyeron la principal causa de AVD en México, con mayor impacto en adultos y mujeres. Los TME se evidencian desde edades tempranas, de ahí la necesidad de intervenciones continuas para preservar la calidad de vida.

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Background: Incidence of inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is increasing worldwide; nevertheless, it is still unknown if this is the case in Mexico. Thus, the aim of this study was to analyze the distribution and trends of hospital discharges (HD) (for the period between 2004 and 2015) and deaths (for the period between 2004 and 2013) reported for UC and CD in Mexico. Methods: Quantitative cross-sectional study was performed. Secondary data sources analysis was performed through Dynamic Cubes of the General Direction of Health Information; variables were categorized by diagnosis, age, sex, and state. The Mann-Whitney U test was used to analyze the differences between the first and last years that were studied. Statistical analysis was performed in SPSS v.24. Results: The number of HD increased by 98.9% between 2004 and 2015 (IBD: p=0.033, CD: p=0.009, UC: p=0.051); it was more frequent, for both sexes and diagnoses, between 15 and 44 years, with a second peak for men with UC (between 45 and 64 years). Deaths increased by 96.2% from 2004 to 2011 (IBD: p=0.056, CD: p=0.064, UC: p=0.04). UC is three times more frequent than CD. Mexico City has the highest number of HD (4,179; 22.7%) while the state of Veracruz has the highest number of deaths (273; 38.2%). Conclusions: HD for IBD in Mexico is increasing significantly; the number of deaths increased until 2011, but from then on, they are apparently decreasing. IBD affects Mexican people without any gender predominance, often affecting patients between 15 and 44 years of age. UC is three times more frequent than CD.

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BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

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