By Linda Morales, David Contreras Loya and Héctor Arreola Ornelas
In Mexico, diabetes and hypertension represent significant public health challenges, magnified by socioeconomic inequalities.
This article delves into the prevalence of these diseases across different socioeconomic groups, underscoring the need for a comprehensive approach to health policies.
Diabetes mellitus and hypertension are two of the most pressing public health issues in contemporary Mexico. These conditions are deeply connected to social determinants of health, as evidenced by recent findings from the 2022 National Health and Nutrition Survey (ENSANUT) [1] and the 2019 Global Burden of Disease Study (GBD) [2].
Unaware condition
ENSANUT 2022 reveals alarming statistics: the national prevalence of diabetes reached 18.3%, with one-third of affected individuals unaware of their condition [3]. Self-reported hypertension stands at 15.9%, with 31.9% of cases undiagnosed.
Nearly half the Mexican population (47.8%) faces elevated blood pressure levels.
The prevalence of diabetes and hypertension varies significantly with educational attainment and employment status.
ENSANUT 2022 data shows diabetes affects 20.7% of individuals without formal education, compared to 9.3% of those with higher education.
Similarly, hypertension is more prevalent among the less educated (31.3%) than their more educated counterparts (13.5%). These data highlight the link between education and chronic diseases.
Employment status also plays a critical role: hypertension impacts 24.1% of unemployed individuals versus 11% of the employed. Household income levels further highlight disparities, with hypertension affecting 24.9% of low-income households compared to 12.1% in higher-income households.
Interestingly, individuals without social security report a lower prevalence of hypertension (13%) compared to those with coverage (18.2%), likely reflecting differences in diagnostic access. Alarmingly, the proportion of Mexicans without access to healthcare services surged from 16.2% in 2018 to 39.1% in 2022, representing an increase from 20.1 million to 50.4 million individuals. [5]
Impact on Mortality and Morbidity
Diabetes and hypertension not only diminish the quality of life but also significantly impact mortality and morbidity. In 2019, diabetes accounted for 59.1 deaths per 100,000 people, an 88.7% increase since 1990.
Age-standardized mortality rates for diabetes were 65.41 per 100,000, with a slight 0.67% decline over 29 years.
Diabetes is also the leading cause of age-standardized Years Lived with Disability (YLDs, by its English acronym), with 927.59 YLDs per 100,000 inhabitants. It also tops the list for Disability-Adjusted Life Years (DALYs), totaling 2,328.32 years lived with disability per 100,000 people [2].
Hypertension’s toll is similarly grave, causing 118.4 deaths per 100,000 in 2019. It contributed to 2,200.88 Years of Life Lost (YLLs) per 100,000 nationally, underscoring its substantial mortality impact.
Total DALYs due to hypertension reached 2,455.8 per 100,000, reflecting its critical public health burden [2].
The Need for Targeted Interventions
The high prevalence of undiagnosed and poorly controlled cases underscores the urgency of enhancing detection and treatment strategies. Although treatment rates for diabetes and hypertension are relatively high (86.7% and 82.3%, respectively), control rates remain alarmingly low at 36.1% and 33.7%.
An integrated approach addressing the social and economic determinants of health is crucial.
This includes socioeconomic interventions, educational campaigns, and improved access to medical care. Policymaking that tackles these disparities can enhance the detection, prevention, and management of diabetes and hypertension nationwide.
Equity in Healthcare
The data analyzed highlights the pressing need to reassess Mexico’s healthcare model for managing diabetes and hypertension. A holistic, equitable approach is essential to reduce socioeconomic disparities and improve public health services.
Recent initiatives leveraging recommended systems and artificial intelligence in primary care to improve diagnosis and treatment are promising steps. However, barriers to large-scale adoption must be addressed.
Mexico’s health policies must prioritize equity in healthcare access and strengthen primary care. Achieving this requires robust early detection programs, expanded health insurance coverage, and community interventions targeting social and economic determinants of health.
Additionally, establishing monitoring and evaluation mechanisms is critical to timely and effective adjustments, ensuring better control of diabetes and hypertension in the country.
References
1. Lazcano-Ponce EC, Shamah-Levy T. Encuesta Nacional de Salud y Nutrición Continua 2022: recomendaciones de política pública. Salud Pública de México. 2023;65:s268-s274.
2. Institute for Health Metrics and Evaluation. GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington.
3. Escamilla-Núñez MC, Castro-Porras L, Romero-Martínez M, Zárate-Rojas E, Rojas-Martínez R. Detección, diagnóstico previo y tratamiento de enfermedades crónicas no transmisibles en adultos mexicanos. Ensanut 2022. Salud Pública de México. Published online 2023:1-10.
4. Campos-Nonato I, Oviedo-Solís C, Vargas-Meza J, et al. Prevalencia, tratamiento y control de la hipertensión arterial en adultos mexicanos: resultados de la Ensanut 2022. Salud Pública de México. 2023;65:1-12.
5. Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL). EL CONEVAL PRESENTA LAS ESTIMACIONES DE POBREZA MULTIDIMENSIONAL 2022 [COMUNICADO No. 7]. CONEVAL.; 2023.
6. Basto-Abreu A, López-Olmedo N, Rojas-Martínez R, et al. Prevalencia de prediabetes y diabetes en México: Ensanut 2022. Salud Pública de México. Published online 2023:1-6.
7. Knaul FM, Bhadelia A, Atun R, Frenk J. Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses. Health Affairs. 2015;34(9):1514-1522.
8. Mackenzie SC, Sainsbury CAR, Wake DJ. Diabetes and artificial intelligence beyond the closed loop: a review of the landscape, promise and challenges. Diabetologia. 2024;67(2):223-235.
Autors
Linda Morales. A medical doctor from Universidad Veracruzana with a master’s and Ph.D. in Epidemiological Sciences from the National Institute of Health. Since 2017, she has collaborated with the Global Burden of Disease and is a member of the Regional Network for Establishing Health Priorities in the 21st Century. She is currently a postdoctoral researcher at the Public Policy Unit of the Institute for Obesity Research at Tecnológico de Monterrey.
David Contreras Loya. Professor and researcher at the School of Government and Public Transformation at Tecnológico de Monterrey, affiliated with the Institute for Obesity Research. His work focuses on management, productivity, and skill transfer in health and education in low- and middle-income countries. He has researched topics such as diabetes, hypertension, obesity, and HIV in Mexico. Currently, he leads a pilot study on healthy environments in elementary schools in Mexico and teaches quantitative methods and health economics at the graduate level.
Héctor Arreola Ornelas. Economist from Instituto Tecnológico Autónomo de México. He holds an MBA in Health Economics from the Center for Research and Teaching in Economics and the National Institute of Public Health. He is a research professor at the Public Policy Unit of the Institute for Obesity Research and the School of Government and Public Transformation at Tecnológico de Monterrey. He is also a visiting professor at the Institute for Advanced Studies of the Americas at the University of Miami and the Executive Director of Tómatelo a Pecho A.C.
