The burden of disease, injuries, and risk factors in Mexico: 1990-2021 update.

BACKGROUND: For thirty years, Mexico has studied the burden of disease in order to inform health decisions. OBJECTIVE: To analyze the burden of disease, injuries, and risk factors in Mexico between 1990 and 2021. MATERIAL AND METHODS: Estimates from the Global Burden of Disease 2021 study were used to analyze mortality, years of life lost due to premature mortality, years lived with disability and disability-adjusted life years, as well as the burden attributable to risk factors by sex, age and state of the country. RESULTS: Infant mortality decreased by 39.4% from 1990 to 2000 and by 49.0% from 2000 to 2013. At the national level, mortality decreased by 27.5% between 1990 and 2019, but increased in 2020 and 2021 across all states, especially in adults aged from 35 to 64 years due to the COVID-19 pandemic, which contributed with 24.3% of deaths in 2021. Significant differences in mortality were observed according to age and sex. The burden attributable to metabolic risk factors did increase, while alcohol and tobacco consumption decreased. Access to drinking water and sanitation showed improvements. CONCLUSIONS: Assessing the burden of disease is crucial in order to design effective strategies to address current health needs and future healthcare challenges.

ANTECEDENTES: Desde hace treinta años, México ha estudiado la carga de la enfermedad para sustentar decisiones en salud. OBJETIVO: Analizar la carga de enfermedad, lesiones y factores de riesgo en México entre 1990 y 2021. MATERIAL Y MÉTODOS: Se utilizaron las estimaciones del Global Burden of Disease 2021 para analizar la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida saludable perdidos, así como la carga atribuible a los factores de riesgos por sexo, edad y entidad federativa. RESULTADOS: La mortalidad infantil disminuyó 39.4 % de 1990 a 2000, y 49.0 % de 2000 a 2019. En el ámbito nacional, la mortalidad decreció 27.5 % entre 1990 y 2019, pero ascendió en 2020 y 2021 en todos los estados, especialmente en adultos de 35 a 64 años, debido a la pandemia de COVID-19, que contribuyó con 24.3 % de las defunciones en 2019. Se observaron diferencias significativas en la mortalidad según la edad y el sexo. La carga atribuible a los factores de riesgo metabólicos se incrementó, mientras que la atribuible el consumo de alcohol y tabaco disminuyó. El acceso al agua potable y saneamiento mejoró. CONCLUSIONES: Evaluar la carga de enfermedad es crucial para diseñar estrategias eficaces para abordar las necesidades actuales y los futuros desafíos en salud.

Analysis of cancer mortality in Mexico using the results of the Global Burden of Disease 2021 study.

BACKGROUND: In Mexico, cancer mortality rates have undergone changes over the past decades. OBJECTIVE: To analyze the evolution of cancer mortality rates in Mexico between 1990 and 2021. MATERIALS AND METHODS: Based on the Global Burden of Disease study, the mortality rates for the 10 most prevalent types of cancer in Mexico were obtained, at the national and regional level and by states, considering different age groups and gender. Global Burden of Disease reassigns misclassified causes and distributes them among different types of cancer; subsequently, it models and adjusts the causes to the total number of deaths with a model of a set of causes of death and a cause corrector, which corrects INEGI's mortality records. RESULTS: The cancer mortality rate went from 117.87 in 1990 to 84.18 in 2021. In women, breast, cervical, stomach and lung cancers were the most frequent. In men, the most common were prostate, stomach, lung, and colon and rectum cancer. The decrease in cancer mortality for men and women stood out, particularly from lung and cervical cancer. CONCLUSIONS: The results provide information for the development of health policies and specific prevention and control strategies to address the impact of cancer in Mexico.

ANTECEDENTES: En México, las tasas de mortalidad por cáncer han experimentado cambios a lo largo de las últimas décadas. OBJETIVO: Analizar la evolución de las tasas de mortalidad por cáncer en México entre 1990 y 2021. MATERIALES Y MÉTODOS: Del Global Burden of Disease (GBD) se obtuvieron las tasas de mortalidad de los 10 tipos de cáncer más predominantes en México, en el ámbito nacional y por estados, considerando distintos grupos etarios y el sexo. En el GBD se reasignan las causas mal clasificadas y se distribuyen entre los distintos cánceres; posteriormente se modelan y ajustan las causas al total de fallecimientos con un modelo de conjunto de causas de muerte y un corrector de causas, con lo cual se corrigen registros de mortalidad del INEGI. RESULTADOS: La tasa de mortalidad por cáncer pasó de 117.87 en 1990 a 84.18 en 2021. En las mujeres, los cánceres de mama, cervicouterino, estómago y pulmón fueron los más frecuentes; en los hombres, de próstata, estómago, pulmón, colon y recto. Destacó la disminución de la mortalidad por cáncer en hombres y mujeres, en particular por cáncer de pulmón y cérvix uterino. CONCLUSIONES: Los resultados ofrecen información para desarrollar políticas de salud y estrategias de prevención y control específicas para enfrentar el impacto del cáncer en México.

COVID-19 impact on life expectancy in Mexico. An analysis based on the Global Burden of Disease 2021 study.

BACKGROUND: Between 2020 and 2021, Mexico documented 2.21 million fatalities, out of which 25.3% were attributable to SARS-COV-2 infection. OBJECTIVES: To evaluate COVID-19 mortality during 2020-2021, determine its impact on national- and state-level life expectancy at birth, and in a group of selected countries of the region, as well as to analyze it according to sociodemographic profiles. MATERIAL AND METHODS: Data from the Global Burden of Disease 2021 study were used to report mortality, the impact on life expectancy and underlying causes between 2019 and 2021. These data were evaluated from the perspective of response to the pandemic and according to the sociodemographic structure based on a quadratic regression model. RESULTS: Between 2020 and 2021, 708,971 excess deaths were recorded, which decreased life expectancy at birth by 4.6 years; 76% of this reduction was attributed to COVID-19. The COVID-19 mortality rate was higher than expected according to the sociodemographic conditions of the states. CONCLUSIONS: In Mexico and the countries of the region, the pandemic was devastating and generated regressions in life expectancy at birth, which varied from two to nine years. It is not clear why the effect was so different between countries and within Mexico.

ANTECEDENTES: Entre 2020 y 2021, México experimentó 2.21 millones de defunciones, de las cuales 25.3 % estuvo relacionado con infección por SARS-COV-2. OBJETIVOS: Evaluar la mortalidad por COVID-19 en 2020-2021, determinar su influencia en la esperanza de vida al nacer a nivel nacional, estatal y en países seleccionados de la región, así como analizarla en función del perfil sociodemográfico. MATERIAL Y MÉTODOS: Se utilizaron datos del Global Burden of Disease 2021 para reportar la mortalidad, el impacto en la esperanza de vida y las causas subyacentes entre 2019 y 2021. Se usó una regresión cuadrática para evaluar la mortalidad en exceso como indicador de la respuesta de los estados a la pandemia, considerando su estructura sociodemográfica. RESULTADOS: Entre 2020 y 2021, se registraron 708 971 muertes en exceso, que disminuyeron la esperanza de vida al nacer en 4.6 años; 76 % de esta reducción se atribuyó a COVID-19. La tasa de mortalidad por COVID-19 fue superior a la esperada conforme a las condiciones sociodemográficas de las entidades. CONCLUSIONES: En México y los países de la región, la pandemia fue devastadora y generó regresiones en la esperanza de vida al nacer, que variaron de dos a nueve años. Se requiere más investigación para entender las variaciones en sus efectos.

Analysis of the burden of disease attributable to environmental risk factors in Mexico in the 1990-2021 period. Identification of advances, lags and emergencies.

BACKGROUND: It is estimated that environmental risk factors (ERF) were responsible for nine million deaths worldwide in 2019. OBJECTIVE: Using data from the Global Burden of Disease study, indicators of health loss associated with exposure to ERF in Mexico were analyzed. MATERIAL AND METHODS: Absolute numbers and population percentages of deaths and disability-adjusted life years (DALY) lost attributed to selected ERFs were analyzed at the national and state level and by sex, as well as age-standardized trends from 1990 to 2021. RESULTS: In 2021, ambient particulate matter pollution showed the highest mortality and DALYs lost attributed to selected ERFs (42.2 and 38.1% respectively), followed by lead exposure (20.6 and 13.4%) and low temperature (19.8 and 12.3%). Both indicators have decreased for all selected ERAs by different magnitudes between 1991 and 2021, except for high temperature. CONCLUSIONS: Despite decreases in the last 32 years, outdoor environment particulate matter showed the highest mortality and DALYs lost, followed by lead exposure. It is essential to strengthen air quality and lead exposure policies in Mexico.

ANTECEDENTES: Se estima que los factores de riesgo ambientales (FRA) fueron responsables en 2019 de nueve millones de muertes en el mundo. OBJETIVO: A partir de datos del estudio Global Burden of Disease, se analizaron indicadores de pérdida de salud asociada a la exposición a FRA en México. MATERIAL Y MÉTODOS: Se analizaron números absolutos y porcentajes poblacionales de muertes y años de vida saludable (AVISA) perdidos según sexo atribuidos a FRA seleccionados en los ámbitos nacional y estatal, así como las tendencias estandarizadas por edad de 1990 a 2021. RESULTADOS: En 2021, la contaminación por material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos por los FRA seleccionados (42.2 y 38.1 %, respectivamente), seguida de la exposición a plomo (20.6 y 13.4 %) y temperatura baja (19.8 y 12.3 %). Ambos indicadores han disminuido en todos los FRA seleccionados, en magnitudes diferentes entre 1991 y 2021, excepto la temperatura alta. CONCLUSIONES: A pesar de las disminuciones en los últimos 32 años, el material particulado en ambiente exterior mostró la mayor mortalidad y AVISA perdidos, seguido de la exposición a plomo. Es fundamental fortalecer las políticas de calidad del aire y exposición a plomo en México.

Type 2 diabetes epidemic in Mexico. Burden of disease 1990-2021 analysis and implications for public policies.

BACKGROUND: Mexico faces a challenge due to the burden imposed by type 2 diabetes (T2D). OBJECTIVE: To analyze T2D epidemiology and burden in Mexico from 1990 to 2021, at the national and state levels. MATERIAL AND METHODS: Estimates from the Global Burden of Disease 2021 study were used to evaluate the prevalence, incidence, mortality, fatal and non-fatal burden. Metabolic, environmental and behavioral factors were considered. Comparative analyses were carried out by gender, age and state of the country. RESULTS: The prevalence of T2D increased by 25%. The incidence increased in those younger than 45 years, with a mortality decrease being found among women. The rate of disability-adjusted life years (DALY) showed an increase in all states, from 45.2% in Nuevo León to 237.6% in Tabasco. In 2021, T2D caused the loss of 3.1 million DALYs, which accounted for 6.6% of total burden in Mexico, out of which 64% was due to premature deaths. Diabetic neuropathy affected 47%, and there were 270,000 cases of visual impairment; 66.3% of the burden was attributed to obesity. CONCLUSIONS: Comprehensive policies are urgently needed in order to reduce the burden of T2D in Mexico, through standardized guidelines, evidence-based strategies and technological resources that improve medical care accessibility and efficiency.

ANTECEDENTES: México enfrenta un desafío por la carga que representa la diabetes tipo 2 (DT2). OBJETIVO: Analizar la epidemiología y la carga de DT2 en México de 1990 a 2021 en los ámbitos nacional y estatal. MATERIAL Y MÉTODOS: Se empleó el Global Burden of Disease 2021 para evaluar prevalencia, incidencia, mortalidad, carga letal y no letal. Se consideraron factores metabólicos, ambientales y de comportamiento. Se realizó análisis comparativo por sexo, edad y entidad federativa. RESULTADOS: Se incrementó la prevalencia de DT2 en 25 % y la incidencia en menores de 45 años; la mortalidad en mujeres disminuyó. La tasa de años de vida saludable (AVISA) perdidos se incrementó en todos los estados, entre 45.2 % en Nuevo León y 237.6 % en Tabasco. En 2021, la DT2 ocasionó 3.1 millones de AVISA perdidos, que representaron 6.6 % de la carga total en México, de la cual 64 % se atribuyó a muertes prematuras. La neuropatía diabética afectó a 47 % y las afecciones visuales a 270 000 personas; 66.3 % de la carga se atribuyó a obesidad. CONCLUSIONES: Urgen políticas integrales para reducir la carga de DT2 en México, mediante pautas estandarizadas, estrategias basadas en evidencia y recursos tecnológicos que mejoren la accesibilidad y eficiencia de la atención médica.

Burden of overweight and obesity in Mexico from 1990 to 2021.

BACKGROUND: Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem. OBJECTIVE: To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period. MATERIAL AND METHODS: The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico. RESULTS: In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost. CONCLUSIONS: The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system.

ANTECEDENTES: El sobrepeso y la obesidad constituyen un grave desafío en México, con efectos en la salud, sociedad y economía. Factores demográficos, epidemiológicos, nutricionales, sociales y económicos han agravado esta problemática. OBJETIVO: Analizar la mortalidad y los años de vida saludable perdidos en México por sobrepeso y obesidad en el período de 1990 a 2021. MATERIAL Y MÉTODOS: Se utilizó el Global Burden of Disease 2021 para analizar los datos sobre índice de masa corporal elevado como factor de riesgo y su evolución en México. RESULTADOS: En 2021 se registraron 118 mil muertes atribuibles a índice de masa corporal elevado, que representaron 10.6 % del total de muertes y más de 4.2 millones de años de vida perdidos ajustados por discapacidad. CONCLUSIONES: El ambiente obesogénico, influido por determinantes sociales, ha tenido un impacto significativo en la mortalidad, la carga de enfermedad y los costos económicos. Abordar el sobrepeso y la obesidad requiere intervenciones multisectoriales para fortalecer el sistema de salud mexicano.

Burden of disease due to liver cirrhosis in Mexico.

BACKGROUND: Liver cirrhosis is a major cause of morbidity and mortality worldwide. In Mexico, it is one of the six leading causes of death. OBJECTIVE: To analyze epidemiological data derived from the Global Burden of Disease study and their relationship with risk factors associated with the development of chronic liver diseases in Mexico. MATERIAL AND METHODS: An analysis of data from the Institute for Health Metrics and Evaluation and the National Institute of Geography and Statistics was carried out. RESULTS: Liver cirrhosis has a high prevalence in Mexico, with significant burden of disease translating into lost years of healthy life, premature death and disability. Mortality due to cirrhosis ranked sixth (3.6%) in 2021 and was the eighth cause of years of healthy life lost (2.8%). From 1990 to 2021, the mortality rate increased from 26.7 to 34.2 per 100,000 population. CONCLUSIONS: The burden of disease due to liver cirrhosis continues to be caused by alcohol consumption and hepatitis C; cirrhosis caused by steatotic liver disease has increased in terms of prevalence over the past decade. There are epidemiological changes in the frequency and burden of chronic liver disease that show territorial variations in Mexico.

ANTECEDENTES: La cirrosis hepática es una causa importante de morbilidad y mortalidad en el mundo. En México, constituye una las primeras seis causas de muerte. OBJETIVO: Analizar los datos epidemiológicos derivados del estudio de Global Burden of Disease y su relación con los factores de riesgo asociados al desarrollo de hepatopatías crónicas en México. MATERIAL Y MÉTODOS: Se realizó el análisis de datos provenientes del Instituto para la Medición y Evaluación de la Salud y del Instituto Nacional de Estadística y Geografía. RESULTADOS: La cirrosis hepática tiene una prevalencia alta en México, con una carga de enfermedad importante traducida en años perdidos de vida saludable, por muerte prematura y por discapacidad. La mortalidad por cirrosis ocupó el sexto lugar (3.6 %) en 2021 y fue la octava causa de años de vida saludable perdidos (2.8 %). De 1990 a 2021, la tasa de mortalidad se incrementó de 26.7 a 34.2 por 100 000 habitantes. CONCLUSIONES: La carga de enfermedad por cirrosis hepática se continúa derivando del consumo de alcohol y de la hepatitis C; la prevalencia de la cirrosis causada por enfermedad hepática esteatósica se ha incrementado en la última década. Existen cambios epidemiológicos en la frecuencia y carga de la hepatopatía crónica que muestra variaciones territoriales en México.

Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain. / [Artículo traducido] Necesidades clínicas no satisfechas y patrones de tratamiento de los pacientes pediátricos con psoriasis: estudio de evidencia en el mundo real en España.

BACKGROUND AND OBJECTIVE: Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines. MATERIAL AND METHOD: This retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020. RESULTS: Survey data from 57 treating physicians were included (71.9% [N = 41] dermatologists, 17.6% [N = 10] general practitioners/primary care physicians, and 10.5% [N = 6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively. CONCLUSIONS: These real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of patients with paediatric PsO could be improved by further educating healthcare professionals and developing regional guidelines.

Clinical Unmet Needs and Treatment Patterns of Paediatric Psoriasis Patients: A Real-World Evidence Study in Spain.

BACKGROUND AND OBJECTIVE: Real-world evidence of paediatric psoriasis (PsO) is lacking in Spain. The purpose of this study was to identify physician-reported disease burden and current treatment patterns in a real-world paediatric PsO patient cohort in Spain. This will enhance our understanding of the disease and contribute to the development of regional guidelines. MATERIAL AND METHOD: This retrospective analysis of a cross-sectional market research survey assessed the clinical unmet needs and treatment patterns in patients with paediatric PsO in Spain, as reported by their primary care and specialist physicians, using data collected as part of the Adelphi Real World Paediatric PsO Disease-Specific Program (DSP™) between February and October 2020. RESULTS: Survey data from 57 treating physicians were included (71.9% [N=41] dermatologists, 17.6% [N=10] general practitioners/primary care physicians, and 10.5% [N=6] paediatricians); the final analysis included 378 patients. At sampling, 84.1% (318/378) of patients had mild disease, 15.3% (58/378) had moderate disease and 0.5% (2/378) had severe disease. Retrospectively reported physician-judged severity at the time of PsO diagnosis recorded 41.8% (158/378) of patients with mild disease, 51.3% (194/378) with moderate disease and 6.9% (26/378) with severe disease. Overall, 89.3% (335/375) of patients were currently receiving topical PsO therapy, while 8.8% (33/375), 10.4% (39/375) and 14.9% (56/375) of patients were currently receiving phototherapy, conventional systemics and biologics, respectively. CONCLUSIONS: These real-world data reflect the current burden and treatment landscape of paediatric PsO in Spain. The management of patients with paediatric PsO could be improved by further educating healthcare professionals and developing regional guidelines.

THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH.

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth -3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.

[Clostridium difficile infections in Spanish Internal Medicine departments during the period 2005-2010: the burden of the disease]. / Infección por Clostridium difficile en el período 2005-2010 en los Servicios de Medicina Interna españoles: el peso de la enfermedad.

INTRODUCTION: Clostridium Difficile infection (CDI) is increasing in Spain. A review is presented of this infection in order to evaluate the burden of the disease in this country. MATERIAL: An analytical retrospective and descriptive study was conducted by analyzing the Minimum Basic Data Set of patients admitted to Internal Medicine Departments and with and without CDI between the years 2005-2010. Clinical and demographical variables were compared. RESULTS: Mean age was 75.5 years (SD 15.4), 54.9% were women and mean stay was 22.2 days (SD 24.8). The Cost [(€ 5,001 (SD 4,985) vs [€ 3,934 (SD 2,738)] and diagnostic complexity [2.04 (SD 2.62) vs [1.67 (SD 1.47)] were also different. Mortality for all causes was 12.5% vs 9.8%. Death risk showed a 30% increase (odds ratio 1.30, 95% confidence interval;1.21-1.39) and readmission rate was 30.4% vs 13.5%. Distribution of cases showed season variations (more cases in winter), and annual incidence increased during the study period. Comorbidities associated to increased risk of acquiring CDI were: anemia, human immunodeficiency virus, dementia, malnutrition, chronic renal failure, and living in a nursing home. CONCLUSION: The results showed a clear negative impact of CDI on hospital admissions. A trend towards progression in its incidence without changes in mortality or readmission rates was observed, in common with the rest of Europe and the Western World.

[Burden of COVID-19 variant omicron in immunocompromised patients in Spain: systematic review]. / Carga de la COVID-19 variante ómicron en pacientes inmunocomprometidos en España: revisión sistemática.

After the COVID-19 pandemic, the omicron variant of the SARS-CoV-2 virus became the dominant lineage in Spain in 2022. Although it possesses a milder pathogenicity than previous variants, it still poses a high risk of causing severe COVID-19 for immunocompromised populations. A systematic review was conducted to assess the burden of COVID-19 in Spain among immunocompromised patients during the omicron predominance (1/04/2022-1/04/2023), using PubMed, Cochrane Library, and EPICOVIDEHA between May and July 2023. The search retrieved 217 articles, of which a total of 5 were included. Upon analysis, it was observed that immunocompromised patients during the omicron lineage predominance continue to exhibit higher rates of hospitalizations, ICU admissions, and mortality compared to the general population affected by COVID-19. Although the pandemic has ended, the risk persists for immunocompromised individuals.

Neuropsychological performance and disease burden in individuals at risk of developing Huntington disease.

INTRODUCTION: Huntington disease (HD) is a hereditary neurodegenerative disorder. Thanks to predictive diagnosis, incipient clinical characteristics have been described in the prodromal phase. OBJECTIVE: To compare performance in cognitive tasks of carriers (HDC) and non-carriers (non-HDC) of the huntingtin gene and to analyse the variability in performance as a function of disease burden and proximity to the manifest stage (age of symptom onset). METHOD: A sample of 146 participants in a predictive diagnosis of HD programme were divided into the HDC (41.1%) and non-HDC groups (58.9%). Mathematical formulae were used to calculate disease burden and proximity to the manifest stage in the HDC group; these parameters were correlated with neuropsychological performance. RESULTS: Significant differences were observed between groups in performance on the Mini-Mental State Examination (MMSE), Stroop-B, Symbol-Digit Modalities Test (SDMT), and phonological fluency. In the HDC group, correlations were observed between disease burden and performance on the MMSE, Stroop-B, and SDMT. The group of patients close to the manifest stage scored lowest on the MMSE, Stroop-B, Stroop-C, SDMT, and semantic verbal fluency. According to the multivariate analysis of covariance, the MMSE effect shows statistically significant differences in disease burden and proximity to onset of symptoms. CONCLUSIONS: Members of the HDC group close to the manifest phase performed more poorly on tests assessing information processing speed and attention. Prefrontal cognitive dysfunction appears early, several years before the motor diagnosis of HD.

Psychological discomfort in carriers and non-carriers of the Huntington disease mutation and its relationship with disease burden.

INTRODUCTION: Huntington's disease (HD) is a neurodegenerative and hereditary disorder. Due to the predictive diagnosis, incipient clinical characteristics have been described in the prodromal phase. Several studies have reported an increase in psychiatric symptoms in carriers of the HD gene without motor symptoms. OBJECTIVE: To identify psychological distress in carriers of the mutation that causes HD, without motor symptoms, utilizing the Symptom Checklist 90 (SCL-90), and to correlate with the burden and proximity of the disease. METHOD: A sample of 175 participants in a HD Predictive Diagnostic Program (PDP-HD) was divided into HEP carriers (39.4%) and NPEH non-carriers (61.6%) of the HD-causing mutation. By means of mathematical formulas, the disease burden and proximity to the manifest stage in the PEH group were obtained and it was correlated with the results of the SCL-90-R. RESULTS: Comparing the results obtained in the SCL-90-R of the PEH and NPEH, the difference is observed in the positive somatic male index, where the PEH obtains higher average scores. The correlations between disease burden and psychological distress occur in the domains; obsessions and compulsions, interpersonal sensitivity, hostility, global severity index and positive somatic distress index. A low correlation is observed between the burden of disease and the scores obtained in psychological discomfort. CONCLUSIONS: In general, we found that the PEH group obtained a higher score in the dimensions evaluated with the SCL-90-R, showing a relationship with the burden and differences due to the proximity of the disease. Higher scores on the SCL-90-R dimensions in carriers of the HD gene may suggest an early finding of psychological symptoms in the disease.

The burden of mental disorders in Mexico, 1990-2019: Mental and neurological disorders, substance use, suicides, and related somatic disorders. / La carga de la enfermedad mental en México, 1990-2019: trastornos mentales, neurológicos, uso de sustancias, suicidio y trastornos somáticos relacionados.

INTRODUCTION: Mental, neurological, substance use, suicide, and related somatic disorders (TMNS, for the Spanish acronym) have a negative impact on the quality-of-life of people and the Mexican economy, but updated information is lacking. The objective of this work is to analyze the disability adjusted life years (DALYs) of the TMNS in Mexico by sex, age, state, and degree of marginalization between 1990 and 2019. METHODS: The data and methodology of the «Global Burden of Disease Group¼ (GBD) are used. The GBD calculates DALYs as the sum of two components: years of life lost due to premature mortality (YLL) and years lived with disability (YLD). Likewise, the data on the degree of marginalization from the National Population Council in Mexico are used. RESULTS: TMNS represented 16.3% of the disease burden in the Mexican population in 2019. The trend of the age-standardized rates of DALYs of the TMNS has increased little from 1990 to 2019. The highest increase has been for women. Mental (depression) and neurological (headache) disorders contribute the most to the disease burden among TMNS. In the interior of the country, Baja California Sur presented the highest increase in the period. DISCUSSION: The results show a complex panorama of the TMNS and its subtypes by sex, age groups and territory. More resources are needed to improve mental health care.

Determining the burden of infectious diseases caused by carbapenem-resistant gram-negative bacteria in Spain.

OBJECTIVE: To estimate the burden of nosocomial infections induced by carbapenem resistant Gram-negative (CRGN) pathogens in Spain, focusing on both the clinical and economic impact. METHODS: The burden of disease was estimated using data from 2017 according to the availability of data sources. The impact, both clinical and economic, of the most frequent CRGN nosocomial infections (those produced by Klebsiella pneumoniae, Pseudomonasaeruginosa and Acinetobacter baumannii) was analysed. Incidence and mortality of CRGN nosocomial infections were estimated, as well as the direct and indirect costs produced by this health problem. RESULTS: Approximately 376,346 patients are believed to have suffered a nosocomial infection in Spain in 2017; 3.2% of them due to CRGN bacilli. Infections by carbapenem-resistant P. aeruginosa produced the highest mortality rates (2578 deaths) when compared with A. baumannii (1571) and K. pneumoniae (415). Total economic costs of CRGN nosocomial infections in Spain were estimated to be €472 million in 2017, with 83% of the total cost caused by direct costs. CONCLUSION: CRGN nosocomial infections have a high clinical impact on patients' lives, high mortality rates, and represent one of the hospitalisation episodes with the most associated costs. Efforts should be focussed to implement preventive policies in order to avoid infections due to CRGN pathogens and the resulting burden, and to reduce direct costs due to morbimortality, specifically in those infections produced by P. aeruginosa.

Neuropsychological performance and disease burden in individuals at risk of developing Huntington disease. / Ejecución neuropsicológica y carga de enfermedad en sujetos en riesgo de desarrollar enfermedad de Huntington.

INTRODUCTION: Huntington disease (HD) is a hereditary neurodegenerative disorder. Thanks to predictive diagnosis, incipient clinical characteristics have been described in the prodromal phase. OBJECTIVE: To compare performance in cognitive tasks of carriers (HDC) and non-carriers (non-HDC) of the huntingtin gene and to analyse the variability in performance as a function of disease burden and proximity to the manifest stage (age of symptom onset). METHOD: A sample of 146 participants in a predictive diagnosis of HD programme were divided into the HDC (41.1%) and non-HDC groups (58.9%). Mathematical formulae were used to calculate disease burden and proximity to the manifest stage in the HDC group; these parameters were correlated with neuropsychological performance. RESULTS: Significant differences were observed between groups in performance on the Mini-Mental State Examination (MMSE), Stroop-B, Symbol-Digit Modalities Test (SDMT), and phonological fluency. In the HDC group, correlations were observed between disease burden and performance on the MMSE, Stroop-B, and SDMT. The group of patients close to the manifest stage scored lowest on the MMSE, Stroop-B, Stroop-C, SDMT, and semantic verbal fluency. According to the multivariate analysis of covariance, the MMSE effect shows statistically significant differences in disease burden and proximity to onset of symptoms. CONCLUSIONS: Members of the HDC group close to the manifest phase performed more poorly on tests assessing information processing speed and attention. Prefrontal cognitive dysfunction appears early, several years before the motor diagnosis of HD.

Atlas of axial spondyloarthritis in Spain 2017: Study design and population.

OBJECTIVE: Atlas of Axial Spondyloarthritis in Spain 2017 aims to better understand the reality of the patients suffering from this disease from an integrated approach. METHODS: The Atlas 2017 based its results on an extensive cross-sectional patient survey conducted in Spain (2016), validated by a multidisciplinary group of experts on spondyloarthritis. RESULTS: Data from 680 patients with axSpA were obtained, most of them suffered from AS, were HLA-B27 positive, older than 45 years, and live as part of a couple. A large percentage had university studies, were disabled and members of a patient association. Patients reported a diagnostic delay of 8.5 years, high disease activity (BASDAI 5.5±2.2), moderate-important stiffness (61.0%), medium-high functional limitation (74.9%), and psychological distress (GHQ 5.7±4.5). A total of 54.7% reported taking NSAIDs, 28.4% DMARDs, 36.3% biological therapy and 32.2% were not receiving pharmacological treatment. CONCLUSIONS: The Atlas survey data reveals still a long diagnostic delay, high disease activity, psychological distress, while an important proportion could be undertreated.

La carga de la enfermedad, lesiones y factores de riesgo en México. Actualización del período 1990-2021 / The burden of disease, injuries, and risk factors in Mexico: 1990-2021 update

Resumen Antecedentes: Desde hace treinta años, México ha estudiado la carga de la enfermedad para sustentar decisiones en salud. Objetivo: Analizar la carga de enfermedad, lesiones y factores de riesgo en México entre 1990 y 2021. Material y métodos: Se utilizaron las estimaciones del Global Burden of Disease 2021 para analizar la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida saludable perdidos, así como la carga atribuible a los factores de riesgos por sexo, edad y entidad federativa. Resultados: La mortalidad infantil disminuyó 39.4 % de 1990 a 2000, y 49.0 % de 2000 a 2019. En el ámbito nacional, la mortalidad decreció 27.5 % entre 1990 y 2019, pero ascendió en 2020 y 2021 en todos los estados, especialmente en adultos de 35 a 64 años, debido a la pandemia de COVID-19, que contribuyó con 24.3 % de las defunciones en 2019. Se observaron diferencias significativas en la mortalidad según la edad y el sexo. La carga atribuible a los factores de riesgo metabólicos se incrementó, mientras que la atribuible el consumo de alcohol y tabaco disminuyó. El acceso al agua potable y saneamiento mejoró. Conclusiones: Evaluar la carga de enfermedad es crucial para diseñar estrategias eficaces para abordar las necesidades actuales y los futuros desafíos en salud.

Abstract Background: For thirty years, Mexico has studied the burden of disease in order to inform health decisions. Objective: To analyze the burden of disease, injuries, and risk factors in Mexico between 1990 and 2021. Material and methods: Estimates from the Global Burden of Disease 2021 study were used to analyze mortality, years of life lost due to premature mortality, years lived with disability and disability-adjusted life years, as well as the burden attributable to risk factors by sex, age and state of the country. Results: Infant mortality decreased by 39.4% from 1990 to 2000 and by 49.0% from 2000 to 2019. At the national level, mortality decreased by 27.5% between 1990 and 2019, but increased in 2020 and 2021 across all states, especially in adults aged from 35 to 64 years due to the COVID-19 pandemic, which contributed with 24.3% of deaths in 2019. Significant differences in mortality were observed according to age and sex. The burden attributable to metabolic risk factors did increase, while alcohol and tobacco consumption decreased. Access to drinking water and sanitation showed improvements. Conclusions: Assessing the burden of disease is crucial in order to design effective strategies to address current health needs and future healthcare challenges.

Impacto de COVID-19 en la esperanza de vida en México. Un análisis basado en el estudio Global Burden of Disease 2021 / COVID-19 impact on life expectancy in Mexico. An analysis based on the Global Burden of Disease 2021 study

Resumen Antecedentes: Entre 2020 y 2021, México experimentó 2.21 millones de defunciones, de las cuales 25.3 % estuvo relacionado con infección por SARS-COV-2. Objetivos: Evaluar la mortalidad por COVID-19 en 2020-2021, determinar su influencia en la esperanza de vida al nacer a nivel nacional, estatal y en países seleccionados de la región, así como analizarla en función del perfil sociodemográfico. Material y métodos: Se utilizaron datos del Global Burden of Disease 2021 para reportar la mortalidad, el impacto en la esperanza de vida y las causas subyacentes entre 2019 y 2021. Se usó una regresión cuadrática para evaluar la mortalidad en exceso como indicador de la respuesta de los estados a la pandemia, considerando su estructura sociodemográfica. Resultados: Entre 2020 y 2021, se registraron 708 971 muertes en exceso, que disminuyeron la esperanza de vida al nacer en 4.6 años; 76 % de esta reducción se atribuyó a COVID-19. La tasa de mortalidad por COVID-19 fue superior a la esperada conforme a las condiciones sociodemográficas de las entidades. Conclusiones: En México y los países de la región, la pandemia fue devastadora y generó regresiones en la esperanza de vida al nacer, que variaron de dos a nueve años. Se requiere más investigación para entender las variaciones en sus efectos.

Abstract Background: Between 2020 and 2021, Mexico documented 2.21 million fatalities, out of which 25.3% were attributable to SARS-COV-2 infection. Objectives: To evaluate COVID-19 mortality during 2020-2021, determine its impact on national- and state-level life expectancy at birth, and in a group of selected countries of the region, as well as to analyze it according to sociodemographic profiles. Material and methods: Data from the Global Burden of Disease 2021 study were used to report mortality, the impact on life expectancy and underlying causes between 2019 and 2021. A quadratic regression model was used to evaluate excess mortality as an indicator of the response of the states to the pandemic, considering their sociodemographic structure. Results: Between 2020 and 2021, 708,971 excess deaths were recorded, which decreased life expectancy at birth by 4.6 years; 76% of this reduction was attributed to COVID-19. The COVID-19 mortality rate was higher than expected according to the sociodemographic conditions of the states. Conclusions: In Mexico and the countries of the region, the pandemic was devastating and generated regressions in life expectancy at birth, which varied from two to nine years. Further investigation is required for understanding the variations on its effects.