Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents

Abstract

Background-Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents.

The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA–Mexico border region

“…Options for improving access to care in the USA-Mexico border region may be more complicated than in other regions 12 due to the availability of formal care in Mexico and informal care options, options that are not present in other regions. 17,18 What this study adds…”

“…15,16 Previous research found that increased homicide rates were negatively associated with legal border crossing from Mexico into the USA, but found no association between homicide rates and selfreported access for residents of border counties or changes in the composition of emergency department (ED) encounters. 17,18 However, markers of reduced access measured using administrative utilization data and well-established access indicators such as ACS admissions may be more sensitive than self-reported data and more reliable than changes in ED encounter ratios.…”

Emergency Department Use in the US‐Mexico Border Region and Violence in Mexico: Is There a Relationship?

“…Others have found, however, that the algorithm can be used to detect changes in ED use with changes in insurance status and rates and the presence of community health clinics or free health clinics . As the effect of homicides on health care access is relatively small as evidenced by other studies, it may be the case that this measure of access is not sensitive enough to detect any changes in access to care in Mexico. This study, combined with results from prior studies that found no change in access to care based on self‐reported measures but did find changes in access measured by ambulatory care‐sensitive conditions, suggests that there may be some substitution of ED care in the US for acute care in Mexico, and that there may be delays in care that lead to treatment in the ED or an inpatient admission as an ambulatory care‐sensitive condition.…”

“…Previous research on the association between violence in Mexico and health care access in the US-Mexico border region has found limited effects of violence on self-reported health care access, but it did find that there were negative effects on hospitalizations for ambulatory care-sensitive conditions. 14,15 This suggests that small but significant changes to health care access, particularly outpatient care, were happening in the border region during this period.…”