Disruption in essential health services in Mexico during COVID-19: an interrupted time series analysis of health information system data

Abstract

IntroductionThe COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020.MethodsWe used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico’s population—65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.ResultsThe study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.ConclusionSignificant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.

Accessibility to Non-COVID Health Services in the World During the COVID-19 Pandemic: Review

“…In South Africa, a retrospective study that included adults and children showed a decrease only in child health visits, and there was no change in primary care visits for adults ( 43 ). In Mexico, on the other hand, a decrease was found in sick child visits and contraceptive services by ~50%, the number of diabetes, hypertension, and antenatal care consultations by ~33.3%, and the number of deliveries attended at The Mexican Institute of Social Security by 10% ( 44 ). Authors from Romania found that the rate of continuous hospitalization decreased due to cardiovascular diseases by 46.99%, digestive diseases by 47.37%, respiratory diseases by 37.28%, and the rate of admission due to mental and behavioral disorders decreased by 55% for continuous hospitalization and ~67% for day hospitalization ( 45 ).…”

“…Similar outcomes were observed in Nepal, where the supply of medicines was the worst affected area of healthcare delivery next to immunization and maternity services ( 50 ). Furthermore, in Kenya, HPV vaccination was disrupted, and BCG, pentavalent, rotavirus, and pneumococcal vaccination were declined in Mexico ( 37 , 44 ). Significant declines in receipt of IFA supplements for pregnant women were observed in Bangladesh ( 42 ).…”

“…Healthcare services that have experienced the greatest decline in developed countries included areas such as admission to the hospital for non-communicable diseases or ED, the number of planned and urgent surgeries, the number of psychiatric consultations, or psychiatric admissions to hospitals, including psychiatric admissions to the ED, whereas in developing countries, a decrease in the number of first-time medical or specialist clinic appointments was found. There has also been a substantial decline in healthcare services in these countries in the area of the provision of medicines, and compulsory vaccinations have been postponed or canceled ( 26 – 42 , 44 – 51 ).…”

Overcoming disruptions in essential health services during the COVID-19 pandemic in Mexico

“…The vertical grey dashed line is the start of the IMSS national strategy for health services recovery (1 April 2021). The definitions of the indicators of services use presented in this figure can be found in the previously published article by Doubova et al 9 . For instance, the indicator on children vaccination included information on Bacillus Calmette-Guérin vaccine; the rotavirus vaccine; the pentavalent vaccine against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae type B; the pneumococcal vaccine; and the measles, mumps and rubella vaccine applied in children 0–9 years.…”

Diabetes-related excess mortality in Mexico: a comparative analysis of national death registries between 2017-2019 and 2020

“…Diabetes prevalence, as well as diabetes-related complications and mortality, are tightly associated with socio-demographic inequalities 2,3 . These inequalities were unmasked by the COVID-19 pandemic, in part due to a fragmented care infrastructure that preceded COVID-19 and interruptions in in-person care, which disproportionately impacted socioeconomically vulnerable populations 6,7 . As such, while the intersection of diabetes and COVID-19 and their compounded severity was an important contributor to all-cause excess mortality in Mexico in 2020 [8][9][10] , the pandemic had ripple effects that also impacted care continuity for people with diabetes independent of COVID-19 itself.…”