Objective. To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. Materials and methods. The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. Results. Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. Conclusions. The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.Keywords: cancer; burden of disease; mortality; incidence; social condition; cause of death; epidemiology ResumenObjetivo. Analizar la incidencia y la mortalidad de 28 tipos de cáncer por nivel de marginación, grupos de edad y sexo, de 1990 a 2013. Material y métodos. Los datos utilizados provienen del estudio de la Carga Global de Enfermedades (2013). Las entidades federativas se clasificaron de acuerdo con el índice de marginación del Consejo Nacional de Población. Resultados. Los datos muestran una tendencia decreciente para algunos cánceres (pulmón y cervical), mientras otros aparecen como prioritarios y relevantes (próstata, mama, estómago, colon e hígado). En el norte se observan incrementos regionales mayores en las tasas de incidencia y mortalidad estandarizadas por edad, mientras que en los estados del centro se observa una tendencia decreciente de la tasa de mortalidad. Conclusiones. La epidemiología del cáncer en México (en su mayoría basada en datos de mortalidad) presentan patrones regionales complejos por edad, sexo, tipo de cáncer e índice de marginación. Es vital la creación de un registro nacional para mejorar el seguimiento y evaluación de intervenciones preventivas y curativas.
BackgroundMexico City prisons are characterized by overcrowded facilities and poor living conditions for housed prisoners. Chronic disease profile is characterized by low prevalence of self reported hypertension (2.5%) and diabetes (1.8%) compared to general population; 9.5% of male inmates were obese. There is limited evidence regarding on the exposure to prison environment over prisoner’s health status; particularly, on cardiovascular disease risk factors. The objective of this study is to assess the relationship between length of incarceration and selected risk factors for non-communicable chronic diseases (NCDs).Methods and FindingsWe performed a cross-sectional analysis using data from two large male prisons in Mexico City (n = 14,086). Using quantile regression models we assessed the relationship between length of incarceration and selected risk factors for NCDs; stratified analysis by age at admission to prison was performed. We found a significant negative trend in BMI and WC across incarceration length quintiles. BP had a significant positive trend with a percentage change increase around 5% mmHg. The greatest increase in systolic blood pressure was observed in the older age at admission group.ConclusionsThis analysis provides insight into the relationship between length of incarceration and four selected risk factors for NCDs; screening for high blood pressure should be guarantee in order to identify at risk individuals and linked to the prison’s health facility. It is important to assess prison environment features to approach potential risk for developing NCDs in this context.
ObjectiveWe estimated the average annual cost per patient of ART per facility (unit cost) in Nigeria, described the variation in costs across facilities, and identified factors associated with this variation.MethodsWe used facility-level data of 80 facilities in Nigeria, collected between December 2014 and May 2015. We estimated unit costs at each facility as the ratio of total costs (the sum of costs of staff, recurrent inputs and services, capital, training, laboratory tests, and antiretroviral and TB treatment drugs) divided by the annual number of patients. We applied linear regressions to estimate factors associated with ART cost per patient.ResultsThe unit ART cost in Nigeria was $157 USD nationally and the facility-level mean was $231 USD. The study found a wide variability in unit costs across facilities. Variations in costs were explained by number of patients, level of care, task shifting (shifting tasks from doctors to less specialized staff, mainly nurses, to provide ART) and provider´s competence. The study illuminated the potentially important role that management practices can play in improving the efficiency of ART services.ConclusionsOur study identifies characteristics of services associated with the most efficient implementation of ART services in Nigeria. These results will help design efficient program scale-up to deliver comprehensive HIV services in Nigeria by distinguishing features linked to lower unit costs.
HIV prevalence was estimated among migrants in transit through Mexico. Data were collected on 9108 Central American migrants during a cross-sectional study performed in seven migrant shelters from 2009 to 2013. Considerations focused on their sociodemographic characteristics, sexual and reproductive health, and experience with violence. Based on a sample of 46.6 % of respondents who agreed to be HIV tested, prevalence of the virus among migrants came to 0.71 %, reflecting the concentrated epidemic in their countries of origin. A descriptive analysis was performed according to gender: the distribution of the epidemic peaked at 3.45 % in the transvestite, transgender and transsexual (TTT) population, but fell to less than 1 % in men and women. This gender differential is characteristic of the epidemic in Central America. Furthermore, 23.5 % of TTTs and 5.8 % of women experienced sexual violence. The predominant impact of sexual violence on TTTs and women will influence the course of the AIDS epidemic.
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