Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults.

BACKGROUND: Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS: The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS: Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS: Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.

Trends and effect of marginalization on diabetes mellitus-related mortality in Mexico from 1990 to 2019.

Diabetes mellitus (DM) is currently one of the leading causes of mortality worldwide. However, the disease evolves differently across countries. This study intends to characterize the trends and assess the potential effects of marginalization on DM mortality between 1990 and 2019 in Mexico. We analyzed death certificates that listed DM as the underlying cause of death (N = 1,907,173), as well as the extent to which DM mortality changes were associated with marginalization through an age-period-cohort analysis. DM mortality increased in Mexico between 1990 and 2019; the change was faster in the first half and slowed down after 2004. The highest marginalization quintiles drove the changes in DM mortality trends during the study period, with a higher risk of dying in these quintiles as age increased. In recent cohorts, the highest marginalization quintiles doubled the risk of dying from DM as compared to the lowest. Renal complications was the main death driver among persons with DM, with a marked increase between 1999 and 2001. In conclusion, Mexico continues to have a substantially high DM mortality, but its pace slowed over time. Moreover, subnational differences in marginalization can partially explain such a trend.

Terremotos y salud en México: atención de la emergencia en el Istmo de Tehuantepec / Earthquakes and health in Mexico: emergency care in the Isthmus of Tehuantepec

Resumen El día 7 de septiembre del 2017 se registró un sismo de intensidad 8.2 grados en la escala de Richter, con mayor afectación en la región del Istmo de Tehuantepec. El mecanismo de respuesta por parte del sector salud fue implementado de manera inmediata a través del Operativo para la Seguridad en Salud. Las acciones prioritarias estuvieron enfocadas en el restablecimiento de la capacidad local de atención médica, en la identificación de enfermedades prevalentes y en llevar a cabo acciones de salud pública. Sin embargo, pese a las experiencias obtenidas en 1985, aún se vislumbra escasez de planeación y asignación de responsabilidades.

Abstract On September 7, 2017, an earthquake measuring 8.2 on the Richter scale recorded, with the greatest impact in the Isthmus of Tehuantepec region. The response mechanism by the health sector implemented immediately through the Health Security Operative. The priority actions were focused on restoring the local capacity of medical attention, in the identification of prevalent diseases, and in carrying out public health actions. However, despite the experiences obtained in 1985, there is still a glimpse of a shortage of planning and assignment of responsibilities.

Tendencia de la mortalidad por cáncer en niños y adolescentes según grado de marginación en México (1990-2009) / Trends of cancer mortality rates in children and adolescents by level of marginalization in Mexico (1990-2009)

OBJETIVO: Determinar la tendencia de mortalidad por cáncer en niños y adolescentes por nivel de marginación en México. MATERIAL Y MÉTODOS: La información se obtuvo de certificados de defunción (1990-2009); se calcularon tasas estandarizadas por edad. Se obtuvo el porcentaje promedio anual de cambio (AAPC) calculados con Joinpoint Regression del National Cancer Institute para evaluar la tendencia. RESULTADOS: La mortalidad por cáncer en niños y adolescentes incrementó: en niños fue de 0.87% hombres y 0.96% mujeres y 1.22% hombres y 0.63% mujeres en adolescentes. El patrón de neoplasias en niños fue leucemias -sistema nervioso- linfomas, y en adolescentes leucemias -huesos y articulaciones- linfomas. Los incrementos de la mortalidad correspondieron a alta y muy alta marginalidad. CONCLUSIÓN: El incremento de mortalidad correspondiente a los estados de alta y muy alta marginalidad puede explicarse en parte por un mejor registro. Se requieren estudios de sobrevida para evaluar mejor la efectividad de los tratamientos en el país.

OBJECTIVE: To determine childhood and adolescent cancer mortality by the level of marginalization in Mexico. MATERIALS AND METHODS: We used 1990-2009 death certificates estimating age-standardized rates. We calculated the Average Annual Percent Change (AAPC) using the Joinpoint Regression program available at the National Cancer Institute to assess tendency. RESULTS: Cancer mortality rates increased. AAPC were 0.87% male and 0.96% female children, and for adolescents were: males 1.22% and females 0.63%. The neoplasm pattern in infants was leukemia -central nervous system- lymphomas; and in adolescents it was leukemia -bone and articulation- lymphomas. The increase in cancer mortality corresponded to the high and highest marginated areas of each state. CONCLUSION: The increase in highly marginated areas may be partly explained by well-documented local registration of deaths. Further studies focusing on survival are required in order to better assess the effectiveness of cancer detection and medical treatment in our country.

[Trends of cancer mortality rates in children and adolescents by level of marginalization in Mexico (1990-2009)]. / Tendencia de la mortalidad por cáncer en niños y adolescentes según grado de marginación en México (1990-2009).

OBJECTIVE: To determine childhood and adolescent cancer mortality by the level of marginalization in Mexico. MATERIALS AND METHODS: We used 1990-2009 death certificates estimating age-standardized rates. We calculated the Average Annual Percent Change (AAPC) using the Joinpoint Regression program available at the National Cancer Institute to assess tendency. RESULTS: Cancer mortality rates increased. AAPC were 0.87% male and 0.96% female children, and for adolescents were: males 1.22% and females 0.63%. The neoplasm pattern in infants was leukemia -central nervous system- lymphomas; and in adolescents it was leukemia -bone and articulation- lymphomas. The increase in cancer mortality corresponded to the high and highest marginated areas of each state. CONCLUSION: The increase in highly marginated areas may be partly explained by well-documented local registration of deaths. Further studies focusing on survival are required in order to better assess the effectiveness of cancer detection and medical treatment in our country.