RESUMO
BACKGROUND: Estimates of SARS-CoV-2 infection fatality rates (IFRs) in developing countries remain poorly characterized. Mexico has one of the highest reported COVID-19 case-fatality rates worldwide, although available estimates do not consider serologic assessment of prior exposure nor all SARS-CoV-2-related deaths. We aimed to estimate sex- and age-specific IFRs for SARS-CoV-2 in Mexico. METHODS: The total number of people in Mexico with evidence of prior SARS-CoV-2 infection was derived from National Survey of Health and Nutrition-COVID-19 (ENSANUT 2020 Covid-19)-a nationally representative serosurvey conducted from August to November 2020. COVID-19 mortality data matched to ENSANUT's dates were retrieved from the death-certificate registry, which captures the majority of COVID-19 deaths in Mexico, and from the national surveillance system, which covers the subset of COVID-19 deaths that were identified by the health system and were confirmed through a positive polymerase chain reaction test. We analysed differences in IFRs by urbanization and region. RESULTS: The national SARS-CoV-2 IFR was 0.47% (95% CI 0.44, 0.50) using death certificates and 0.30% (95% CI 0.28, 0.33) using surveillance-based deaths. The IFR increased with age, being close to zero at age <30 years, but increasing to 1% at ages 50-59 years in men and 60-69 years in women, and being the highest at ≥80 years for men (5.88%) and women (6.23%). Across Mexico's nine regions, Mexico City (0.99%) had the highest and the Peninsula (0.26%) the lowest certificate-based IFRs. Metropolitan areas had higher certificate-based IFR (0.63%) than rural areas (0.17%). CONCLUSION: After the first wave of the COVID-19 pandemic, the overall IFR in Mexico was comparable with those of European countries. The IFR in Mexico increased with age and was higher in men than in women. The variations in IFRs across regions and places of residence within the country suggest that structural factors related to population characteristics, pandemic containment and healthcare capabilities could have influenced lethality at the local level.
Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Estudos SoroepidemiológicosRESUMO
INTRODUCTION: Universal coverage of highly active antiretroviral therapy (HAART) for HIV/AIDS in Mexico was achieved in a staggered fashion. First, HAART was made available in 1997 for employees in the formal sector and subsequently, in 2003, for informal sector workers and the unemployed population. We evaluated the impact of this free universal HAART program on HIV/AIDS mortality in the Mexican population aged 15 years or older. METHODS: Time-series cross-sectional data analysis of standardized HIV/AIDS mortality rates (1990-2011) using marginal linear models with inflection points at 1994, 1997, and 2003. RESULTS: Men employed in the formal sector experienced the greatest effect of access to HAART, with a 32% reduction in mortality from 1997 to 2011 (P < 0.01). For men in this sector, mortality increased from 1990 to 2003, then stabilizing at 7 deaths per 100,000. For women in the informal sector, mortality increased from 1990 to 2011. We found large between-state variability: mortality decreased by 59% in Mexico City while it increased by 245% in Tabasco during the study period. Six of 32 states achieved statistically significant reductions in mortality while 5 states continued to experience increasing mortality rates despite universal HAART. CONCLUSIONS: Access to universal HAART has had relative success in Mexico. The heterogeneity of HIV/AIDS mortality by employment status, gender, and state of residence highlight urgent needs to improve health equity with pro-poor and gender-responsive programs and a call for country-specific operational research in HIV/AIDS prevention and treatment. Our results may apply to other countries seeking to implement universal access to antiretroviral therapy.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/mortalidade , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Modelos Lineares , Masculino , México/epidemiologia , Programas Nacionais de Saúde , Fatores SocioeconômicosRESUMO
Objetivo Evaluar el impacto del seguro de salud subsidiado, sobre el acceso a la citología cervical en Medellín-Colombia. Material y Métodos Se utilizó el método de apareamiento por índice de propensión para obtener un grupo de control comparable a un grupo de tratamiento, usando la Encuesta de Calidad Vida de Colombia 2008. La estimación de impactos se realizó con el uso de los indicadores de estratificación por segmentos, vecino más cercano y densidad de Kernel. Resultados El acceso a la citología para las mujeres entre 19 y 49 años del seguro subsidiado fue entre 2,2 % y 2,9 % menor en comparación con las mujeres que no cuentan con ningún seguro. Para las mujeres mayores de 50 años ninguna estimación fue estadísticamente significativa. Discusión. El mayor acceso a la citología que tienen las mujeres sin aseguramiento en salud podría explicarse gracias a instituciones de beneficencia o programas sociales que realizan acciones en salud en la población sin aseguramiento.(AU)
Objective Assessing the impact of subsidized healthcare insurance on access to cervical cytology in Medellin, Colombia. Materials and Methods Propensity score matching (PSM) was used with 2008 Life Quality Survey in Colombia figures to obtain a control group comparable to a treatment group. This involved using stratification estimates, the k-nearest-neighbor algorithm and kernel density for calculating impact size Results Access to cytology for 19 to 49 year-old women having subsidized healthcare insurance were 2.2 % to 2.9 % lower compared to women who did not have any healthcare insurance. Estimates were not statistically significant for women over 50 years-old. Discussion Women lacking healthcare insurance having increased access to cytology could be explained by charities or social programs aiding the population lacking healthcare insurance.(AU)
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Humanos , Feminino , Avaliação em Saúde , Neoplasias do Colo do Útero/diagnóstico , Teste de Papanicolaou/métodos , Colômbia , Pesquisa Comparativa da EfetividadeRESUMO
OBJECTIVE: Assessing the impact of subsidized healthcare insurance on access to cervical cytology in Medellin, Colombia. MATERIALS AND METHODS: Propensity score matching (PSM) was used with 2008 Life Quality Survey in Colombia figures to obtain a control group comparable to a treatment group. This involved using stratification estimates, the k-nearest-neighbor algorithm and kernel density for calculating impact size RESULTS: Access to cytology for 19 to 49 year-old women having subsidized healthcare insurance were 2.2 % to 2.9 % lower compared to women who did not have any healthcare insurance. Estimates were not statistically significant for women over 50 years-old. DISCUSSION: Women lacking healthcare insurance having increased access to cytology could be explained by charities or social programs aiding the population lacking healthcare insurance.