Avoidable mortality in the states adjacent to the Mexico-United States border; 1999-2001 and 2009-2011

Marcela Agudelo Botero Raúl Sergio González Ramírez Ana María López Jaramillo About the authors

Abstract

The scope of this article is to measure the effect of avoidable mortality in changes in life expectancy in the states adjacent to both sides of the US-Mexico border between 1999-2001 and 2009-2011. The data used were the records of mortality and population censuses from official sources in each country. Standardized mortality rates were estimated and the expected years of life lost were calculated. Both in 1999-2001 and in 2009-2011 the states belonging to the southern border of the United States had lower rates of avoidable mortality rates than those observed in the northern states of Mexico. In the border region avoidable deaths have seen an averageincrease of 0.19 years of life for America and a loss of 0.47 years of life for Mexico. The states of the US-Mexico border have common features in their health profiles that make it necessary to address some problemson a global basis and consider the particularities of each, in order to reduce gaps and enhance social equity through strategies involving independent national actions and othersby cross-border coordination.

Mortality; Life expectancy; Border; Mexico; United States


Introduction

The United Stated (U.S.)-Mexico border is characterized by a wide variety of economic, political, social, cultural and demographic conditions, which have particular aspects in each country11. Ybañez E. La estructura por edad y sexo en los principales municipios y condados de la frontera entre México y Estados Unidos. Frontera Norte 2008; 21(42):31-52.

2. Ybañez E. Algunas características demográficas de la población de la frontera México-Estados Unidos. Frontera Norte 2000; 12(24):159-156.
- 33. González R. Aspectos sociodemográficos de la Frontera Norte. In: Rangel G, Hernández M, coordinadores. Condiciones de salud en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2009. p. 17-38.. This border has a strategic importance and unique dynamics and interrelationships due to the permanent flow of people, goods, and services44. Guillén T. Frontera norte: los contrastes de la calidad de vida. Revista Mexicana de Política Exterior 2007; 81:9-32.. However, despite the geographical proximity, the social gaps on both sides of the border are evident, mainly because they are two countries with different development degrees, which affect the demographic behavior of each population44. Guillén T. Frontera norte: los contrastes de la calidad de vida. Revista Mexicana de Política Exterior 2007; 81:9-32. , 55. Corona R. Tendencias demográficas en la Frontera Norte. In: Ordóñez G, Reyes M, coordinadores. Los retos de la política social en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2006. p. 41-60.. Moreover, these same differences are highlighted when comparing their respective bordering territories; so that in the case of the southern U.S. border, the level indicators associated with the quality and economics are below the national average, while in the northern Mexican border these values are higher than the country's average11. Ybañez E. La estructura por edad y sexo en los principales municipios y condados de la frontera entre México y Estados Unidos. Frontera Norte 2008; 21(42):31-52.

2. Ybañez E. Algunas características demográficas de la población de la frontera México-Estados Unidos. Frontera Norte 2000; 12(24):159-156.

3. González R. Aspectos sociodemográficos de la Frontera Norte. In: Rangel G, Hernández M, coordinadores. Condiciones de salud en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2009. p. 17-38.

4. Guillén T. Frontera norte: los contrastes de la calidad de vida. Revista Mexicana de Política Exterior 2007; 81:9-32.

5. Corona R. Tendencias demográficas en la Frontera Norte. In: Ordóñez G, Reyes M, coordinadores. Los retos de la política social en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2006. p. 41-60.
- 66. Ham R. Etnicidad y estructuras de la población en la frontera de Estados Unidos con México. Frontera Norte 1991; 3(5):119-140.. Although social disparities among the border states are becoming smaller in terms of environmental sanitation, employment and schooling, the Mexican side still needs to make progress on poverty indicators, maternal mortality, infant mortality and life expectancy77. Lara F. Calidad de vida en la región fronteriza México-EE.UU.: Estado actual y tendencias emergentes. In: Wilson CE, Lee E, editores. Resumen Ejecutivo. Reporte del estado de la frontera. Un análisis integral de la frontera México-Estados Unidos. Washington: Mexico Institute, Woodrow Wilson International Center for Scholars; 2013. p. 20-22. , 88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012.. Some figures presented in 2012 by thePan American Health Organization (PAHO)88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012. show that in 2009 the Gross Domestic Product (GDP) per capita was US$ 50.871 in California (United States) while in Baja California (Mexico) was significantly lower (US$ 7.501). In 2010, the poverty rate ranged from 21.1% to 39.4% for the northern Mexican border, and from 15.8% to 20.4% for the southern U.S. border. In that same year, the maximum life expectancy for the same Mexican region was 77.1 years and for the U.S. border region was 81 years.

In Mexico, the infant mortality (per 1 000 live births) and maternal mortality (per 100,000 live births) was from 10.6-13.4 to 30.1-62.9, respectively. In other words, they were well above that recorded in the U.S. where these values ranged from 5.1-6.3 (infant deaths) to 8.1-22.2 (maternal deaths)88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012.. Meanwhile, the southern U.S. border faces a serious problem of insufficient coverage and access to health services due to a high percentage of the population has no health insurance and the lack of doctors in the first care level, which results in a notorious mobility of American people in order to search medical attention on the Mexican side.

Issues related to the health of the border population are a subject of special interest for the two countries. Therefore, multiple joint actions have been conducted to understand and improve the health conditions of the population living in this region. Specifically, in March 2001, the United States-Mexico Border Health Commission (BHC) established the Healthy Border program (HB) 2010 as an initiative focused on disease prevention and health promotion, whose objectives are: 1.) Improve the quality and increase the years of healthy life; and 2.) Eliminate disparities in access to health. Some of the goals set out in this program include the following: Access to Health Care; Cancer; Diabetes Mellitus; Environmental Health; HIV/AIDS; Immunization and Infectious Diseases; Injury Prevention; Maternal, Infant and Child Health; Mental Health; Oral Health; and Respiratory Diseases99. Comisión de Salud Fronteriza México-Estados Unidos. Frontera Saludable 2010. Una agenda para mejorar la salud en la frontera México-Estados Unidos. Resumen Ejecutivo. 2010 [acceso 2014 ago 04] Disponible en: http://www.borderhealth.org/files/res_819.pdf
http://www.borderhealth.org/files/res_81...
.

Most health indicators for the U.S.-Mexico border have been restricted to the use of basic indicators, such as percentages and rates to estimate the level of mortality, even though these are insufficient to measure the aspects related to the magnitude and impact of mortality in life expectancy1010. Organización Panamericana de la Salud (OPS). Indicadores de Salud: Elementos Básicos para el Análisis de la Situación de Salud. Boletín Epidemiológico OPS 2001; 22(4):1-5.. However, thanks to the continuous improvement of the quality of mortality records is possible to calculate composite indices that show the relative importance of causes of death leading to the premature loss of life years1111. Arriaga E. Los años de vida perdidos: Su utilización para medir el nivel y cambio de la mortalidad. Notas de Población 1996; 24:7-38. , 1212. Arriaga E. Comentarios sobre algunos índices para medir el nivel y el cambio de la mortalidad. Estudios Demográficos y Urbanos 1996; 11:5-30..

This type of analysis can be conducted using the following two indicators: avoidable mortality (AM), and the years of life lost (YLL). The first concentrates on those premature deaths that should have not occurred in the presence of timely and effective health care1313. Nolte E, Scholz R, Shkolnikov V, McKee M. The contribution of medical care to changing life expectancy in Germany and Poland. Soc Sci Med 2002; 55(11):1905-1921.

14. Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited. London: The Nuffield Trust; 2004.

15. Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman AP, Perrin EB. Measuring the Quality of medical Care-A Clinical Method. N Engl J Med 1976; 294(11):582-588.
- 1616. Vlădescu C, Ciutan M, Mihăilă V. The role of avoidable mortality in health assessment. Journal of Health Management 2010; 14(3):4-10., regardless of the geographical area under study. Meanwhile, YLL measures the contribution of each cause of death and age group to the change observed in life expectancy, and they correspond to the difference between the maximum attainable life expectancy and the one actually achieved by a group of individuals1717. Consellería de Sanidade e Servicio Galego de Saúde. Epidat 4: Ayuda de demografía. 2014 [acceso 2013 jun 07] Disponible en: http://www.sergas.es/gal/documentacionTecnica/docs/SaudePublica/Apli/Epidat4/Ayuda/Demograf%C3%ADa.pdf
http://www.sergas.es/gal/documentacionTe...
.

The objective of this work is to measure the effect of AM in life expectancy changes in the U.S.-Mexico Border States between 1999-2001 and 2009-2011.

Methods

A cross-sectional descriptive study was carried out. Mortality and population data from the National Institute of Statistics and Geography(INEGI)1818. Instituto Nacional de Estadística y Geografía. Registros Administrativos Mortalidad. 2014 [acceso 2014 ago 12] Disponible en: http://www3.inegi.org.mx/sistemas/microdatos/encuestas.aspx?c=33398&s=est
http://www3.inegi.org.mx/sistemas/microd...
, 19 19. Instituto Nacional de Estadística y Geografía. Censos y Conteos. 2014 [acceso 2014 agosto 12] Disponible en: http://www.inegi.org.mx/est/contenidos/proyectos/ccpv/
http://www.inegi.org.mx/est/contenidos/p...
were used for Mexico|. Regarding the United States, mortality records were obtained from the Centers for Disease Control and Prevention (CDC) of the National Center for Health Statistics (NCHS)2020. Centers for Disease Control and Prevention. WONDER Online Databases. 2013 [acceso 2013 ago 24] Disponible en: http://wonder.cdc.gov/.
http://wonder.cdc.gov/...
, and the population data were obtained from the United States Census Bureau (USCB)2121. United States Census Bureau. American Fact Finder. 2013 [acceso 2014 ago 12] Disponible en: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2013_PEPAGESEX&prodType=table
http://factfinder2.census.gov/faces/tabl...
. The triennial deaths from 1999-2001 to 2009-2011 were considered. Statistical data were pooled into periods of three years in order to soften possible fluctuations in the records due to various causes of death. Information was divided by five-year age groups (from 0 to 74 years old), causes of AM, and states.

On the other hand, the causes proposed by Nolte and McKee2222. Nolte E, McKee M. In amenable mortality. Deaths avoidable through health care. Progress in the US lags that of three European countries. Health Aff 2012; 31(9):2114-2122., who classified the AM depending on the relative effectiveness of various medical interventions or the health care that could prevent death in predefined ages, were used. The classification includes 33 death causes redistributed into ten major groups of causes with their respective age range (Chart 1). Note that in the case of deaths from ischemic heart diseases, only 50% of them was considered because the evidence indicates that only half of such deaths are avoidable by medical care. Most causes of AM contemplates the population under 75 years old, except for intestinal infections (1-14), pertussis (0-14), measles (1-14), malignant neoplasms of cervix and non-specified uterus parts (0-44), leukemia (0-44), diabetes (0-49) and all the respiratory diseases (except for pneumonia and influenza) (1 -14)2222. Nolte E, McKee M. In amenable mortality. Deaths avoidable through health care. Progress in the US lags that of three European countries. Health Aff 2012; 31(9):2114-2122..

Chart 1.
Classification of causes of death considered amenable. Source: Nolte y Mckee, 201222.

Causes of death were selected considering the underlying cause of death according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)2323. Organización Mundial de la Salud (OMS). Clasificación Internacional de Enfermedades, 10ª Revisión, Segunda Edición (CIE-10). Ginebra: OMS; 2004..

Central death rates were calculated per 100 000 people, taking as reference the U.S. population of 20102121. United States Census Bureau. American Fact Finder. 2013 [acceso 2014 ago 12] Disponible en: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2013_PEPAGESEX&prodType=table
http://factfinder2.census.gov/faces/tabl...
, using the following method:

Where,

SMR: standardized mortality rate

mx: age-specific mortality rate for age x

Px: population age group x to the standard population

X: age group

mx = dx/px

Where,

dx: deaths in the age group x for the population of the A area

px: population age group x

Then, years of life lost (YLL)1717. Consellería de Sanidade e Servicio Galego de Saúde. Epidat 4: Ayuda de demografía. 2014 [acceso 2013 jun 07] Disponible en: http://www.sergas.es/gal/documentacionTecnica/docs/SaudePublica/Apli/Epidat4/Ayuda/Demograf%C3%ADa.pdf
http://www.sergas.es/gal/documentacionTe...
were calculated. This index represents the difference between the maximum years that a person can live between two ages, and those that a person actually live, i.e. the years not lived. It is based on mortality tables, as outlined below:

(1) l x: number of survivors at the exact age x;

(2) n L x: number of person-years lived divided by the ages x, and x+n;

(3) and e x: life expectancy at age x 1717. Consellería de Sanidade e Servicio Galego de Saúde. Epidat 4: Ayuda de demografía. 2014 [acceso 2013 jun 07] Disponible en: http://www.sergas.es/gal/documentacionTecnica/docs/SaudePublica/Apli/Epidat4/Ayuda/Demograf%C3%ADa.pdf
http://www.sergas.es/gal/documentacionTe...
, 1818. Instituto Nacional de Estadística y Geografía. Registros Administrativos Mortalidad. 2014 [acceso 2014 ago 12] Disponible en: http://www3.inegi.org.mx/sistemas/microdatos/encuestas.aspx?c=33398&s=est
http://www3.inegi.org.mx/sistemas/microd...
; and an indirect, the temporary life expectancy divided by two ages x and x+i (i e x), which is defined as the average number of years that survivors will live at age x divided by x andx+i, and is calculated as:

Where,

is the number of person-years lived from the exact age x) and ω is the inferior limit of the last open age group.

Data processing for the decomposition of the change in life expectancy was done using the free software Epidat, version 3.12424. Xunta de Galicia. Dirección Xeral de Innovación e Xestión da Saúde Pública/Organización Panamericana de la Salud. Epidat 3.1. 2013 [acceso 2013 nov 14] Disponible en: http://www.sergas.es/MostrarContidos_N3_T01.aspx?IdPaxina=62715
http://www.sergas.es/MostrarContidos_N3_...
.

Results

The proportion of avoidable deaths to the total number of deaths in the Northern Mexican border in the 1999-2001 and 2009-2011 periods was of 31.0% and 26.7%, respectively. On the southern border of the United States was 25.2% (1999-2001) and 24.7% (2009-2011). The adjusted mortality rate per 100 000 population showed a decrease from 104.8 to 84.9 (- 19%) in the U.S. border states, and 160.5 to 145.9 in the Mexican border states (- 9.1%).

The adjusted mortality rate due to avoidable causes declined into all states in the analyzed periods. We found that, for both triennial periods, the U.S. Border States had AM rates lower than those observed in the Mexican Border States. For 2009-2011, Arizona was the state with the lowest AM rate, and Chihuahua had the highest AM rate (Figure 1).

Figure 1.
Adjusted mortality rates by avoidable causes on the United States-Mexico border 1999-2001 and 2009-2011. Source: INEGI (Mexico). CDC/US Census Bureau (United States). Own elaboration.

The analysis of cause of avoidable death showed data evidencing the variety of mortality profiles among adjacent states, which is presented briefly in Table 1.

Table 1.
Adjusted mortality rates by avoidable causes on the United States-Mexico border 1999-2001 and 2009-2011.

First, it was found that the mortality rate from infectious diseases was significantly higher in the Mexican states than in the U.S. states, although for the latter, the increased rates were found for Arizona and New Mexico.

Cancer mortality rate was similar for neighboring states, and a decreasing rate was observed in all states. This reduction was higher in the U.S. border region. Meanwhile, diabetes and ischemic heart diseases highlighted in the Mexican mortality profile, with rates exceeding the values obtained for the U.S. However, the mortality rate for diabetes increased on average 23% for the U.S. and 8% for Mexico. Moreover, death rates due ischemic heart diseases declined significantly on both sides of the Border States.

Regarding other circulatory diseases, higher rates were observed in Mexico as compared to the U.S. These differences are evident when analyzing the state of Coahuila, where a mortality rate 2.5 times higher than the one of Arizona and New Mexico (46.5 versus 17.9 per 100 000 people) for 2009-2011 was recorded. Additionally, respiratory diseases showed significant increases in their rates (more than 30%) in Coahuila (+ 51.5%), Sonora (+ 48.1%), Nuevo León (+ 42.8%) and Tamaulipas (+ 37.3%).

In the group of avoidable deaths due to surgical conditions, the southern U.S. border States had relatively lower rates of mortality compared to the northern Mexican border states. However, while nearly all states shown reduced mortality rates due to this cause, New Mexico and Texas shown increased mortality rates. As for adverse medical events, mortality rates were low for both sides of the border, although it should be noted that the number of reported cases is very small, making it impossible to see a clear trend for this cause of death.

Deaths from maternal, perinatal and congenital conditions descended on all the states of the U.S. southern border; in the case of the Northern Mexican border, both Coahuila and Tamaulipas shown increased rates. The mortality rate for this cause was higher in Mexico than in the United States. Thus, Chihuahua (mortality rate of 14.3 per 100 000 people) and California (mortality rate of 4.6 per 100 000 people) shown the highest values. Finally, avoidable deaths due to other causes, such as epilepsy and thyroid disease, were lower in all states, except those states that belong to Mexico.

On average, from 1999-2001 to 2009-2011, avoidable causes represented a gain of 0.19 years of life for the southern U.S. states and a loss of 0.49 years of life for the northern Mexican states. In those same periods, the United States had a positive balance in the years of life expectancy, although with different intensity: Arizona (+ 0.70), California (+ 0.74), New Mexico (+ 0.16) and Texas (+ 0.56). In contrast, Mexico had significant fluctuations among states: Baja California (+ 0.72), Coahuila (-0.29), Chihuahua (-3.04), Nuevo León (-0.13), Sonora (+ 0.22) and Tamaulipas (-0.44) (Figure 2).

Figure 2.
Life expectancy change by avoidable causes on the United States-Mexico border 1999-2001 and 2009-2011. Source: INEGI (Mexico). CDC/US Census Bureau (United States). Own elaboration.

In the U.S., California was the state with fewer years of life lost, while New Mexico lost -0.38 years in this indicator. In the U.S. border region, years of life decreased due to the following causes: diabetes (-0.09); surgical conditions (-0.05); adverse medical events (-0.04); and infectious diseases (-0.02). In contrast, years of life increased due to the following causes: other circulatory diseases (+ 1.00); congenital and perinatal maternal conditions (+ 0.80), and respiratory diseases (+ 0.47); and others various conditions (+ 0.10). In Mexico, the state of Chihuahua showed a life expectancy highly reduced by more than three years on its inhabitants, i.e., a reduction higher than that in the other adjacent Border States. The years of life were adversely impacted by all causes in this state. In the country, eight of the ten groups of avoidable deaths had decreased life years (from highest to lowest): other circulatory diseases (-1.39); maternal, congenital and perinatal conditions (-0.65); surgical conditions (-0.45); infectious diseases (-0.29); ischemic heart diseases (-0.24); diabetes (-0.19); other conditions (-0.13) and tumors (-0.03) (Table 2).

Table 2.
Life expectancy change by groups of avoidable causes on the United States-Mexico border, 1999-2001 and 2009-2011.

Discussion

The U.S.-Mexico Border States show a very different picture of mortality, as mentioned in previous research2525. Molina CA, López MV. Mortalidad evitable. El caso de la Frontera Norte de México, 1980-1990. Cad Saude Publica 1995; 11(35):395-407.

26. López AM, Uribe FJ. Principales casusas de muerte evitable en el estado de Coahuila: implicaciones para los servicios de salud. Ciencias de la Salud de la UAdeC 2012; 3(2):13-19.
- 2727. Franco F, Lozano R, Villa B, Soliz P. La Mortalidad en México, 2000-2004. Muertes evitables: magnitud, distribución y tendencias. México: Dirección General de Información en Salud; 2006.. This territorial heterogeneity has been explained by many factors such as the specific socio-economic and social structure that determines how people get sick and die2828. Franzini L, Spears W. Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA". Soc Sci Med 2003; 57(10):1847-1861.

29. Rodríguez J. Desigualdades socioeconómicas entre departamentos y su asociación con indicadores de mortalidad en Colombia en 2000. Rev Panam Salud Publica 2007; 21(2/3):111-124.

30. Gattini C, Sanderson C, Castillo-Salgado C. Variación de los indicadores de mortalidad evitable entre comunas chilenas como aproximación a las desigualdades de salud. Rev Panam Salud Publica 2002; 12(6):454-461.
- 3131. Godínez V, Burns R. Desarrollo Regional y Salud. In: Cordera R, Murayama C, coordinadores. Los determinantes sociales de la salud en México. México: Fondo de Cultura Económica; 2012. p. 168-243.; the organization and performance of each country's health systems1313. Nolte E, Scholz R, Shkolnikov V, McKee M. The contribution of medical care to changing life expectancy in Germany and Poland. Soc Sci Med 2002; 55(11):1905-1921.

14. Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited. London: The Nuffield Trust; 2004.

15. Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman AP, Perrin EB. Measuring the Quality of medical Care-A Clinical Method. N Engl J Med 1976; 294(11):582-588.
- 1616. Vlădescu C, Ciutan M, Mihăilă V. The role of avoidable mortality in health assessment. Journal of Health Management 2010; 14(3):4-10.; the influence of national and local policies3232. Ortega H. Problemas prioritarios de salud en la frontera México-Estados Unidos. Salud Publica Mex 1991; 33(4):356-359.

33. Canales A, Martínez J, Reboiras L, Rivera F. Migración y salud en zonas fronterizas: informe comparativo sobre cinco fronteras seleccionadas. Santiago de Chile: CELADE; 2010.

34. Gómez RD, Nolasco A, Pereyra P, Arias S, Rodríguez FL, Aguirre C. Diseño y análisis comparativo de un inventario de indicadores de mortalidad evitable adaptado a las condiciones sanitarias de Colombia. Rev Panam Salud Pública 2009; 26(5):385-397.
- 3535. Gómez RD. La mortalidad evitable como indicador de desempeño de la política sanitaria. Colombia. 1985-2001. Medellín: Universidad de Antioquia; 2008., the individual and community response to health events; the distribution of the prevalence, the incidence and mortality of the diseases3030. Gattini C, Sanderson C, Castillo-Salgado C. Variación de los indicadores de mortalidad evitable entre comunas chilenas como aproximación a las desigualdades de salud. Rev Panam Salud Publica 2002; 12(6):454-461.; and ambient environment3636. Provencio E. Medio ambiente, hábitat y salud. In: Cordera R, Murayama C, coordinadores. Los determinantes sociales de la salud en México. México: Fondo de Cultura Económica; 2012. p. 321-349.. Regarding the U.S., the slow progress in reducing deaths in general is a matter of growing interest, especially since this phenomenon has coincided with an increase of people without social security and the stagnation in reducing deaths by ischemic heart diseases and other circulatory diseases (mainly strokes)88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012. , 2222. Nolte E, McKee M. In amenable mortality. Deaths avoidable through health care. Progress in the US lags that of three European countries. Health Aff 2012; 31(9):2114-2122. , 3737. Hoyert DL. 75 Years of Mortality in the United States, 1935-2010. NCHS Data Brief 2012; 88:1-8.. During 2008-2009, the population without the right to private health services in the southern U.S. border states ranged from 19% in California to 26% in Texas (higher than the national average: 17%). In contrast, in Mexico's northern border people without social security represented 20% (Nuevo León) and 28% (Baja California) (less than the overall average of the country: 34%) in 200988. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012..

Although a decrease in rates of avoidable deaths has been observed, the level of this reduction is different on both sides of the border, creating inequalities more marked. About this point, the findings of this study are consistent, but not directly comparable, with other studies reporting slightly decreased AM. This AM decreased by 4% in the U.S. from 1997-1998 to 2002-20032222. Nolte E, McKee M. In amenable mortality. Deaths avoidable through health care. Progress in the US lags that of three European countries. Health Aff 2012; 31(9):2114-2122., and it decreased by 5% from 1995-1999 to 2000-2004 in Mexico2727. Franco F, Lozano R, Villa B, Soliz P. La Mortalidad en México, 2000-2004. Muertes evitables: magnitud, distribución y tendencias. México: Dirección General de Información en Salud; 2006.. This same pattern has occurred in countries such as Spain3838. Vergara M, Benach J, Martínez J, Buxó Pujolràs M, Yutaka Y. La mortalidad evitable y no evitable: distribución geográfica en áreas pequeñas de España (1990-2001). Gac Sanit. 2009; 23(1):16-22., Canada3939. Douglas GM, Mao Y. Avoidable Mortality in the United States and Canada, 1980-1996. Am J Public Health 2002; 92(9):1481-1484. and Colombia3535. Gómez RD. La mortalidad evitable como indicador de desempeño de la política sanitaria. Colombia. 1985-2001. Medellín: Universidad de Antioquia; 2008..

The U.S.-Mexico border states have common features in their health profiles88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012. that make it necessary to address some problems on a global basis and others by considering their own peculiarities in order to reduce the gaps and enhance social equity through strategies that involve independent national actions and others that involve cross-border coordination77. Lara F. Calidad de vida en la región fronteriza México-EE.UU.: Estado actual y tendencias emergentes. In: Wilson CE, Lee E, editores. Resumen Ejecutivo. Reporte del estado de la frontera. Un análisis integral de la frontera México-Estados Unidos. Washington: Mexico Institute, Woodrow Wilson International Center for Scholars; 2013. p. 20-22. , 88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012.. These efforts should be aimed at preventing and reducing AM to meet or exceed the levels observed in states with better performance in health indicators. Such actions shall include the promotion of healthy lifestyles that encourage people to reduce the alcohol and tobacco consumption, increase physical activity on a regular basis, as well as monitoring conditions associated with the metabolic syndrome88. Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012..

The structure of AM in the study region is a combination of mixed epidemiological regimes, where communicable and non-communicable diseases coexist2525. Molina CA, López MV. Mortalidad evitable. El caso de la Frontera Norte de México, 1980-1990. Cad Saude Publica 1995; 11(35):395-407.

26. López AM, Uribe FJ. Principales casusas de muerte evitable en el estado de Coahuila: implicaciones para los servicios de salud. Ciencias de la Salud de la UAdeC 2012; 3(2):13-19.
- 2727. Franco F, Lozano R, Villa B, Soliz P. La Mortalidad en México, 2000-2004. Muertes evitables: magnitud, distribución y tendencias. México: Dirección General de Información en Salud; 2006. , 4040. Organización Panamericana de la Salud (OPS). Perfiles de mortalidad de las comunidades hermanas fronterizas México-Estados Unidos. Edición 2000. Washington: OPS; 2000.. Most causes of death analyzed are characterized by being chronic, long lasting causes and a burden of permanent disability and dependence4141. Córdova JA, Barriguete JA, Lara A, Barquera S, Rosas M, Hernández M, de León-May ME, Aguilar-Salinas CA. Las enfermedades crónicas no transmisibles en México: sinopsis epidemiológica y prevención integral. Salud Publica Mex 2008; 50(5):419-427. , 4242. Lozano R, Murray CJL, Frenk J, Bobadilla JL, Fernández S. El peso de la enfermedad en México: un doble reto. DF: Fundación Mexicana para la Salud; 1994., which leads to rethink the role of quality medical care, the adherence and controlled management of these conditions.

The impact of health problems on the population of the ten U.S.-Mexico Border States has not been sufficiently comparatively analyzed due to the limited sources of systematic and standardized information, among other things, and also their quality and coverage. However, U.S.-Mexico's mortality data are considered of good quality, according to previous assessments, and appropriate for the death analysis by causes, as performed in this article4343. Lozano R. ¿Es posible seguir mejorando los registros de las defunciones en México? Gac Med Mex 2008; 144(6):525-534.

44. División de Estadística de las Naciones Unidas. Coverage of Birth and Death Registration. 2014 [acceso 2014 ene 8] Disponible en: http://unstats.un.org/unsd/demographic/CRVS/CR_coverage.htm.
http://unstats.un.org/unsd/demographic/C...
- 4545. Mathers CD, Ma Fat D, Inoue M, Rao C, López AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bulletin of the World Health Organization 2005; 83(3):171-177..

Finally, this research provides key evidence for planning and prioritizing health interventions, but it is insufficient to explain the complexity of factors that influence the health - disease - death process of the population of the U.S.-Mexico Border States. Accordingly, we suggest to incorporate other individual, social, cultural and economic variables in future analyses in order to measure the contribution of each of them for health indicators, as well as the policies influence and the organization of the health systems profiles. Another key aspect shall be the use of sex and age disaggregated data in order to identify the most vulnerable subgroups and to focus actions depending on the specific characteristics of each them.

References

  • 1
    Ybañez E. La estructura por edad y sexo en los principales municipios y condados de la frontera entre México y Estados Unidos. Frontera Norte 2008; 21(42):31-52.
  • 2
    Ybañez E. Algunas características demográficas de la población de la frontera México-Estados Unidos. Frontera Norte 2000; 12(24):159-156.
  • 3
    González R. Aspectos sociodemográficos de la Frontera Norte. In: Rangel G, Hernández M, coordinadores. Condiciones de salud en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2009. p. 17-38.
  • 4
    Guillén T. Frontera norte: los contrastes de la calidad de vida. Revista Mexicana de Política Exterior 2007; 81:9-32.
  • 5
    Corona R. Tendencias demográficas en la Frontera Norte. In: Ordóñez G, Reyes M, coordinadores. Los retos de la política social en la Frontera Norte de México. Tijuana: El Colegio de La Frontera Norte; 2006. p. 41-60.
  • 6
    Ham R. Etnicidad y estructuras de la población en la frontera de Estados Unidos con México. Frontera Norte 1991; 3(5):119-140.
  • 7
    Lara F. Calidad de vida en la región fronteriza México-EE.UU.: Estado actual y tendencias emergentes. In: Wilson CE, Lee E, editores. Resumen Ejecutivo. Reporte del estado de la frontera. Un análisis integral de la frontera México-Estados Unidos. Washington: Mexico Institute, Woodrow Wilson International Center for Scholars; 2013. p. 20-22.
  • 8
    Organización Panamericana de la Salud (OPS). Salud en las Américas: edición de 2012. Panorama regional y perfiles de país. Washington: OPS; 2012.
  • 9
    Comisión de Salud Fronteriza México-Estados Unidos. Frontera Saludable 2010. Una agenda para mejorar la salud en la frontera México-Estados Unidos. Resumen Ejecutivo. 2010 [acceso 2014 ago 04] Disponible en: http://www.borderhealth.org/files/res_819.pdf
    » http://www.borderhealth.org/files/res_819.pdf
  • 10
    Organización Panamericana de la Salud (OPS). Indicadores de Salud: Elementos Básicos para el Análisis de la Situación de Salud. Boletín Epidemiológico OPS 2001; 22(4):1-5.
  • 11
    Arriaga E. Los años de vida perdidos: Su utilización para medir el nivel y cambio de la mortalidad. Notas de Población 1996; 24:7-38.
  • 12
    Arriaga E. Comentarios sobre algunos índices para medir el nivel y el cambio de la mortalidad. Estudios Demográficos y Urbanos 1996; 11:5-30.
  • 13
    Nolte E, Scholz R, Shkolnikov V, McKee M. The contribution of medical care to changing life expectancy in Germany and Poland. Soc Sci Med 2002; 55(11):1905-1921.
  • 14
    Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited. London: The Nuffield Trust; 2004.
  • 15
    Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman AP, Perrin EB. Measuring the Quality of medical Care-A Clinical Method. N Engl J Med 1976; 294(11):582-588.
  • 16
    Vlădescu C, Ciutan M, Mihăilă V. The role of avoidable mortality in health assessment. Journal of Health Management 2010; 14(3):4-10.
  • 17
    Consellería de Sanidade e Servicio Galego de Saúde. Epidat 4: Ayuda de demografía. 2014 [acceso 2013 jun 07] Disponible en: http://www.sergas.es/gal/documentacionTecnica/docs/SaudePublica/Apli/Epidat4/Ayuda/Demograf%C3%ADa.pdf
    » http://www.sergas.es/gal/documentacionTecnica/docs/SaudePublica/Apli/Epidat4/Ayuda/Demograf%C3%ADa.pdf
  • 18
    Instituto Nacional de Estadística y Geografía. Registros Administrativos Mortalidad. 2014 [acceso 2014 ago 12] Disponible en: http://www3.inegi.org.mx/sistemas/microdatos/encuestas.aspx?c=33398&s=est
    » http://www3.inegi.org.mx/sistemas/microdatos/encuestas.aspx?c=33398&s=est
  • 19
    Instituto Nacional de Estadística y Geografía. Censos y Conteos. 2014 [acceso 2014 agosto 12] Disponible en: http://www.inegi.org.mx/est/contenidos/proyectos/ccpv/
    » http://www.inegi.org.mx/est/contenidos/proyectos/ccpv/
  • 20
    Centers for Disease Control and Prevention. WONDER Online Databases. 2013 [acceso 2013 ago 24] Disponible en: http://wonder.cdc.gov/.
    » http://wonder.cdc.gov/
  • 21
    United States Census Bureau. American Fact Finder. 2013 [acceso 2014 ago 12] Disponible en: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2013_PEPAGESEX&prodType=table
    » http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2013_PEPAGESEX&prodType=table
  • 22
    Nolte E, McKee M. In amenable mortality. Deaths avoidable through health care. Progress in the US lags that of three European countries. Health Aff 2012; 31(9):2114-2122.
  • 23
    Organización Mundial de la Salud (OMS). Clasificación Internacional de Enfermedades, 10ª Revisión, Segunda Edición (CIE-10). Ginebra: OMS; 2004.
  • 24
    Xunta de Galicia. Dirección Xeral de Innovación e Xestión da Saúde Pública/Organización Panamericana de la Salud. Epidat 3.1. 2013 [acceso 2013 nov 14] Disponible en: http://www.sergas.es/MostrarContidos_N3_T01.aspx?IdPaxina=62715
    » http://www.sergas.es/MostrarContidos_N3_T01.aspx?IdPaxina=62715
  • 25
    Molina CA, López MV. Mortalidad evitable. El caso de la Frontera Norte de México, 1980-1990. Cad Saude Publica 1995; 11(35):395-407.
  • 26
    López AM, Uribe FJ. Principales casusas de muerte evitable en el estado de Coahuila: implicaciones para los servicios de salud. Ciencias de la Salud de la UAdeC 2012; 3(2):13-19.
  • 27
    Franco F, Lozano R, Villa B, Soliz P. La Mortalidad en México, 2000-2004. Muertes evitables: magnitud, distribución y tendencias. México: Dirección General de Información en Salud; 2006.
  • 28
    Franzini L, Spears W. Contributions of social context to inequalities in years of life lost to heart disease in Texas, USA". Soc Sci Med 2003; 57(10):1847-1861.
  • 29
    Rodríguez J. Desigualdades socioeconómicas entre departamentos y su asociación con indicadores de mortalidad en Colombia en 2000. Rev Panam Salud Publica 2007; 21(2/3):111-124.
  • 30
    Gattini C, Sanderson C, Castillo-Salgado C. Variación de los indicadores de mortalidad evitable entre comunas chilenas como aproximación a las desigualdades de salud. Rev Panam Salud Publica 2002; 12(6):454-461.
  • 31
    Godínez V, Burns R. Desarrollo Regional y Salud. In: Cordera R, Murayama C, coordinadores. Los determinantes sociales de la salud en México. México: Fondo de Cultura Económica; 2012. p. 168-243.
  • 32
    Ortega H. Problemas prioritarios de salud en la frontera México-Estados Unidos. Salud Publica Mex 1991; 33(4):356-359.
  • 33
    Canales A, Martínez J, Reboiras L, Rivera F. Migración y salud en zonas fronterizas: informe comparativo sobre cinco fronteras seleccionadas. Santiago de Chile: CELADE; 2010.
  • 34
    Gómez RD, Nolasco A, Pereyra P, Arias S, Rodríguez FL, Aguirre C. Diseño y análisis comparativo de un inventario de indicadores de mortalidad evitable adaptado a las condiciones sanitarias de Colombia. Rev Panam Salud Pública 2009; 26(5):385-397.
  • 35
    Gómez RD. La mortalidad evitable como indicador de desempeño de la política sanitaria. Colombia. 1985-2001. Medellín: Universidad de Antioquia; 2008.
  • 36
    Provencio E. Medio ambiente, hábitat y salud. In: Cordera R, Murayama C, coordinadores. Los determinantes sociales de la salud en México. México: Fondo de Cultura Económica; 2012. p. 321-349.
  • 37
    Hoyert DL. 75 Years of Mortality in the United States, 1935-2010. NCHS Data Brief 2012; 88:1-8.
  • 38
    Vergara M, Benach J, Martínez J, Buxó Pujolràs M, Yutaka Y. La mortalidad evitable y no evitable: distribución geográfica en áreas pequeñas de España (1990-2001). Gac Sanit. 2009; 23(1):16-22.
  • 39
    Douglas GM, Mao Y. Avoidable Mortality in the United States and Canada, 1980-1996. Am J Public Health 2002; 92(9):1481-1484.
  • 40
    Organización Panamericana de la Salud (OPS). Perfiles de mortalidad de las comunidades hermanas fronterizas México-Estados Unidos. Edición 2000. Washington: OPS; 2000.
  • 41
    Córdova JA, Barriguete JA, Lara A, Barquera S, Rosas M, Hernández M, de León-May ME, Aguilar-Salinas CA. Las enfermedades crónicas no transmisibles en México: sinopsis epidemiológica y prevención integral. Salud Publica Mex 2008; 50(5):419-427.
  • 42
    Lozano R, Murray CJL, Frenk J, Bobadilla JL, Fernández S. El peso de la enfermedad en México: un doble reto. DF: Fundación Mexicana para la Salud; 1994.
  • 43
    Lozano R. ¿Es posible seguir mejorando los registros de las defunciones en México? Gac Med Mex 2008; 144(6):525-534.
  • 44
    División de Estadística de las Naciones Unidas. Coverage of Birth and Death Registration. 2014 [acceso 2014 ene 8] Disponible en: http://unstats.un.org/unsd/demographic/CRVS/CR_coverage.htm.
    » http://unstats.un.org/unsd/demographic/CRVS/CR_coverage.htm
  • 45
    Mathers CD, Ma Fat D, Inoue M, Rao C, López AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bulletin of the World Health Organization 2005; 83(3):171-177.

Publication Dates

  • Publication in this collection
    Apr 2015

History

  • Received
    17 Mar 2014
  • Accepted
    19 Oct 2014
ABRASCO - Associação Brasileira de Saúde Coletiva Rio de Janeiro - RJ - Brazil
E-mail: revscol@fiocruz.br