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BACKGROUND: Rheumatoid arthritis is a highly prevalent disease. Patients undergo various medical and pharmacological treatments, which have an economic impact on hospitals. The aim of this study was to estimate the direct economic costs of Mexican Social Security Institute (IMSS) resources used to provide healthcare to adult patients with rheumatoid arthritis in 2016-2017. METHODS: Data of patients aged > 18 years with Rheumatoid Arthritis (RA) were obtained from databases and public information sources to estimate the use of IMSS resources for the target population. Total costs were estimated by means of the macro-costing method, employing the diagnosis-related group (DRG). Each DRG of the IMSS was constructed with one of the diagnoses and the respective combination of clinical characteristics included in the ICD-9. This study was conducted from the national perspective of IMSS, the largest healthcare service administrator in the country. As such, it can be considered representative of the broader healthcare landscape in Mexico. RESULTS: The total cost per year of furnishing inpatient care to RA patients was found to be $170,099,794 MXN ($9,096,245.67 USD) for 2016 and $167,039,481 MXN ($8,932,592.57 USD) for 2017, implying an enormous economic impact on the government budget for Mexican public health services. CONCLUSIONS: Our results demonstrate that the direct costs of musculoskeletal and cardiovascular surgery represented the highest costs of RA in-hospital care at IMSS (the largest health institution in Mexico) in 2016 and 2017. Further studies are needed that include the cost of drugs and other indirect costs in addition to our results to get the most accurate approximation of the cost of living with RA.

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The study aims at estimating multidimensional poverty groups among children under five years of age in Mexico. Our analysis is based upon the framework on the Rights of the Child. For this purpose, we focus on identifying different types of child deprivation and the various risk factors that determine child poverty in Mexico, such as the type of locality, ethnicity and the region of Mexico where children live, among others. The study is based on the theoretical notion that children must realize their specific rights, established in the Mexican legal framework, in order to achieve an adequate standard of living and guarantee the well-being and development of children. For this reason, child development has been included as one of the analytical dimensions of poverty, because this has been often discarded in child poverty studies. We support the idea that any violation of social rights means deprivation. The method applied in this research is a conditional latent class analysis and we use covariates which have helped for better predicting the average probabilities of experiencing deprivations in each latent class. Thus, the main objective of the study is to identify groups of children experiencing extreme, moderate and no poverty. The results show that children under five years in Mexico, belonging to the poorest stratum have represented about twenty percent; however, fifty percent of them have experienced moderate poverty and only thirty percent are non-poor. We conclude that universal and targeted policies should be implemented to eradicate multidimensional child poverty.

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OBJECTIVES: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership. MATERIAL AND METHODS: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership. RESULTS: Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile. CONCLUSIONS: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.

OBJETIVO: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. MÉTODOS: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. RESULTADOS: Se identificaron tres grupos de clases basados en los nueve identificadores. "Adultos mayores activos" estaba compuesto por el 64%. "Relativamente independiente" y "Discapacidad física" comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de "Adultos mayores activos" y "Relativamente independiente" eran comparativamente más uniformes. El grupo de "discapacidad física" comprenden a los individuos más propensos a un perfil de dependencia. CONCLUSIONES: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional.

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OBJECTIVE: To assess the association between type 2 diabetes (DM2) and socioeconomic inequalities, mediated by the contribution of body mass index (BMI), physical activity (PA), and diet (diet-DII). MATERIALS AND METHODS: We conducted a cross-sectional analysis using data of adults participating in the Diabetes Mellitus Survey of Mexico City. Socioeconomic and demographic characteristics as well as height and weight, dietary intake, leisure time activity and the presence of DM2 were measured. We fitted a structural equation model (SEM) with DM2 as the main outcome, and BMI, diet-DII and PA served as mediator variables between socioeconomic inequalities index (SII) and DM2. RESULTS: The prevalence of DM2 was 13.6%. From the fitted SEM, each standard deviation increases in the SII was associated with increased scores of DM2 (ß=0.174, P<0.001). CONCLUSIONS: The results in the present study show how high scores in the index of SII may influence the presence of DM2.

OBJETIVO: Evaluar la asociación entre diabetes tipo 2 y las inequidades socioeconómicas (IS), mediada por la contribución del índice de masa corporal (IMC), actividad física (AF) y dieta (dieta-DII). MATERIAL Y MÉTODOS: Se realizó un análisis transversal utilizando datos de la Encuesta de Diabetes Mellitus de la Ciudad de México. Se midieron las características sociodemográficas, altura, peso, ingesta dietética, actividad de tiempo libre y presencia de diabetes. Se ajustó un modelo de ecuaciones estructurales (MEE) con diabetes como resultado principal, e IMC, dieta-DII y PA sirvieron como variables mediadoras entre el IS y la diabetes. RESULTADOS: La prevalencia de diabetes fue de 13.6%. A partir del MEE ajustado, cada aumento de la desviación estándar en el IS se asoció con un aumento en las puntuaciones de diabetes (ß=0.174, P<0.001). CONCLUSIONES: Los resultados en el presente estudio muestran cómo los puntajes altos en las IS pueden influir en la presencia de diabetes.

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Abstract: Objective: To assess the association between type 2 diabetes (DM2) and socioeconomic inequalities, mediated by the contribution of body mass index (BMI), physical activity (PA), and diet (diet-DII). Materials and methods: We conducted a cross-sectional analysis using data of adults participating in the Diabetes Mellitus Survey of Mexico City. Socioeconomic and demographic characteristics as well as height and weight, dietary intake, leisure time activity and the presence of DM2 were measured. We fitted a structural equation model (SEM) with DM2 as the main outcome, and BMI, diet-DII and PA served as mediator variables between socioeconomic inequalities index (SII) and DM2. Results: The prevalence of DM2 was 13.6%. From the fitted SEM, each standard deviation increases in the SII was associated with increased scores of DM2 (β=0.174,P<0.001). Conclusion: The results in the present study show how high scores in the index of SII may influence the presence of DM2.

Resumen: Objetivo: Evaluar la asociación entre diabetes tipo 2 y las inequidades socioeconómicas (IS), mediada por la contribución del índice de masa corporal (IMC), actividad física (AF) y dieta (dieta-DII). Material y métodos: Se realizó un análisis transversal utilizando datos de la Encuesta de Diabetes Mellitus de la Ciudad de México. Se midieron las características sociodemográficas, altura, peso, ingesta dietética, actividad de tiempo libre y presencia de diabetes. Se ajustó un modelo de ecuaciones estructurales (MEE) con diabetes como resultado principal, e IMC, dieta-DII y PA sirvieron como variables mediadoras entre el IS y la diabetes. Resultados: La prevalencia de diabetes fue de 13.6%. A partir del MEE ajustado, cada aumento de la desviación estándar en el IS se asoció con un aumento en las puntuaciones de diabetes (β=0.174,P<0.001). Conclusión: Los resultados en el presente estudio muestran cómo los puntajes altos en las IS pueden influir en la presencia de diabetes.

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Abstract Objectives: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership. Material and methods: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership. Results: Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile. Conclusions: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.

Resumen Objetivo: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. Métodos: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. Resultados: Se identificaron tres grupos de clases basados en los nueve identificadores. "Adultos mayores activos" estaba compuesto por el 64%. "Relativamente independiente" y "Discapacidad física" comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de "Adultos mayores activos" y "Relativamente independiente" eran comparativamente más uniformes. El grupo de "discapacidad física" comprenden a los individuos más propensos a un perfil de dependencia. Conclusiones: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional.

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BACKGROUND: Because living arrangements have many implications for the well-being of older adults, knowledge regarding typical age-related developmental changes in living arrangements is of a major concern for public health policymakers, particularly in low- and middle-income countries dealing with growing aging populations. However, the much-needed empirical analysis of living arrangement dynamics is hindered by a lack of proper data. OBJECTIVE: To exploit often-available short-term longitudinal data in the study of long-term phenomena, in this paper we accelerate the Mexican Health and Aging Study (MHAS) panel as a means to explore, over a broad age span, the household dynamics of Mexican older adults. METHODS: Instead of working with a priori definitions of different household structures when analyzing transitions between them, we introduce a novel approach that estimates latent classes of developmental trends in the household composition of older people as they age. RESULTS: We show how accelerated longitudinal designs, coupled with latent class analysis, can offer new insights into living arrangement dynamics. Our findings suggest that in Mexico the typical living arrangements at 50 years old serve as an important predictor of future living arrangements, and that typical living-arrangement trajectories are strongly gendered in Mexico. This new approach may prove to be indispensible when determining the social support needed by high-risk population groups and as a means to better anticipate the necessary financial resources to do so.

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This study examines changes over time in ethnic affirmation/belonging and ethnic identity achievement, Spanish language use, English language use, Mexican/Mexican-American affiliation/identification and Anglo affiliation/identification in a sample of Mexican-American adolescents participating in a longitudinal study of juvenile offenders. The Multigroup Ethnic Identity Measure and the Acculturation Rating Scale for Mexican Americans-II were completed by the Mexican-American adolescents 7 times over a 3-year period. The findings from longitudinal growth modeling analyses and growth mixture modeling analyses indicate that there is heterogeneity in the initial scores and changes over time on these variables that are related to markers for the cultural qualities of the home environment (i.e., generational status and mother's most frequent language use). In contrast to expectations, marginalized or assimilated acculturation trajectories/types were not overrepresented in this sample of adolescent offenders. Implications for our understanding of the nature of acculturation and enculturation processes and the way these processes are studied are discussed.

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This study examines the longitudinal relations of multiple dimensions of acculturation and enculturation to heavy episodic drinking and marijuana use in a sample of 300 male, Mexican-American, serious juvenile offenders. We track trajectories between ages 15 and 20 and also consider the effects of participants' time spent residing in supervised settings during these years. Results showed some (although not entirely consistent) support for the hypothesis that bicultural adaptation is most functional in terms of lowered substance use involvement. The current findings demonstrate the importance of examining these relations longitudinally and among multiple dimensions of acculturation and enculturation, and they call into question simple models that suggest that greater acculturation is associated with greater substance use among Mexican-American adolescents.