Health and economic impact associated with rheumatoid arthritis discharges: a cost analysis of a two-year cohort in Mexico.

BACKGROUND: Rheumatoid arthritis is a highly prevalent disease. Patients undergo various medical and pharmacological treatments, which have an economic impact on hospitals. The aim of this study was to estimate the direct economic costs of Mexican Social Security Institute (IMSS) resources used to provide healthcare to adult patients with rheumatoid arthritis in 2016-2017. METHODS: Data of patients aged > 18 years with Rheumatoid Arthritis (RA) were obtained from databases and public information sources to estimate the use of IMSS resources for the target population. Total costs were estimated by means of the macro-costing method, employing the diagnosis-related group (DRG). Each DRG of the IMSS was constructed with one of the diagnoses and the respective combination of clinical characteristics included in the ICD-9. This study was conducted from the national perspective of IMSS, the largest healthcare service administrator in the country. As such, it can be considered representative of the broader healthcare landscape in Mexico. RESULTS: The total cost per year of furnishing inpatient care to RA patients was found to be $170,099,794 MXN ($9,096,245.67 USD) for 2016 and $167,039,481 MXN ($8,932,592.57 USD) for 2017, implying an enormous economic impact on the government budget for Mexican public health services. CONCLUSIONS: Our results demonstrate that the direct costs of musculoskeletal and cardiovascular surgery represented the highest costs of RA in-hospital care at IMSS (the largest health institution in Mexico) in 2016 and 2017. Further studies are needed that include the cost of drugs and other indirect costs in addition to our results to get the most accurate approximation of the cost of living with RA.

[Early alert of COVID-19 outbreaks to plan the response in the IMSS]. / Alerta temprana de brotes COVID-19 para planear la respuesta en el IMSS.

The Instituto Mexicano del Seguro Social (IMSS) developed and implemented epidemic monitoring and modeling tools to support the organization and planning of an adequate and timely response to the COVID-19 health emergency. The aim of this article is to describe the methodology and results of the early outbreak detection tool called COVID-19 Alert. An early warning traffic light was developed that uses time series analysis and a Bayesian method of early detection of outbreaks from electronic records on COVID-19 for suspected cases, confirmed cases, disabilities, hospitalizations, and deaths. Through Alerta COVID-19, the beginning of the fifth wave of COVID-19 in the IMSS was detected in a timely manner, three weeks before the official declaration. The proposed method is aimed at generating early warnings before the start of a new wave of COVID-19, monitoring the serious phase of the epidemic, and supporting decision-making within the institution; unlike other tools that have an approach aimed at communicating risks to the community. We can conclude that the Alerta COVID-19 is an agile tool that incorporates robust methods for the early detection of outbreaks.

El Instituto Mexicano del Seguro Social (IMSS) desarrolló e implementó herramientas de monitoreo y modelación de la epidemia para apoyar la organización y planeación de la respuesta adecuada y oportuna a la emergencia sanitaria por COVID-19. El objetivo de este trabajo es describir la metodología y los resultados de la herramienta de detección temprana de brotes denominada Alerta COVID-19. Se desarrolló un semáforo de alertamiento temprano que utiliza análisis de series temporales, así como un método bayesiano de detección temprana de brotes a partir de los registros electrónicos sobre COVID-19 para casos sospechosos, confirmados, incapacidades, hospitalizaciones y defunciones. A través de la Alerta COVID-19 se detectó oportunamente, con tres semanas de anticipación a la declaratoria oficial, el inicio de la quinta ola de COVID-19 en el IMSS. El método propuesto está orientado a generar alertas tempranas ante el inicio de una nueva ola de COVID-19, monitorear la fase grave de la epidemia y apoyar la toma de decisiones al interior de la institución; a diferencia de otras herramientas que tienen un enfoque dirigido a la comunicación de riesgos a la comunidad. Podemos concluir que la Alerta COVID-19 es una herramienta ágil que incorpora métodos robustos para la detección temprana de brotes.

Hypertension, Diabetes and Obesity, Major Risk Factors for Death in Patients with COVID-19 in Mexico.

BACKGROUND: Mexico has reported high death and case fatality rates due to COVID-19. Several comorbidities have been related to mortality in COVID-19, as hypertension, diabetes, coronary heart disease, chronic obstructive lung disease and chronic kidney disease. AIMS: To describe the main clinical characteristics of COVID-19 in the major social security institution in Mexico, as well as the contribution of chronic comorbidities and the population attributable fraction related to them. METHODS: Data for all patients with a positive test for SARS-CoV-2 in the institutional database was included for analysis. Demographic information, the presence of pneumonia and whether the patient was hospitalized or treated at home as an outpatient as well as comorbidities were analyzed. Case fatality rate was estimated for different groups. Odds ratios with 95% confidence intervals from a logistic regression model were estimated, as well as the population attributable fraction. RESULTS: By November 13, 2020, 323,671 subjects with COVID-19 infection have been identified. Case fatality rate is higher in males (20.2%), than in females (13.0%), and increases with age. Case fatality rate increased with the presence of obesity, hypertension and/or diabetes. Age and sex were major independent risk factors for mortality, as well as the presence of pneumonia, diabetes, hypertension, obesity, immunosuppression, and end-stage kidney disease. The population attributable fraction due to obesity in outpatients was 16.8%. CONCLUSIONS: Major cardiovascular risk factors and other comorbidities increase the risk of dying in patients with COVID-19. Identification of populations with high fatality in COVID-19, provides insight to deal with this pandemic by health services in Mexico.

The Impact of a History of Pre-maturity on Viral Respiratory Infections in Children Under 2 Years of Age: A Propensity Score-Matching Analysis of in-hospital Complications and Mortality.

Introduction: A history of pre-maturity may be a risk factor for complications in patients under 24 months of age hospitalized for viral respiratory infections (VRIs). Objective: To identify the impact of a history of pre-maturity on in-hospital complications and mortality in patients under 24 months of age who were hospitalized for VRIs over a period of 5 years. Material and Methods: This was a propensity score-matched study. The database was compiled by physicians, electronically validated by engineers, and analyzed by statisticians. Patients diagnosed with VRIs (based on International Classification of Diseases [ICD-10]) codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219, J22X, and J189) from 2013 to 2017 were enrolled in the study. The subjects were classified into two groups according to the absence or presence of a history of pre-maturity (P070, P072, P073). Patients with congenital heart disease (CHD) (Q20-Q26) were excluded. Length of hospital stay, in-hospital complications, surgical procedures, and mortality were analyzed. Statistical Analysis: Patients were matched according to age. For comparisons between groups, Student's t-tests and chi2 tests were applied. A logistic regression model was constructed to identify factors related to in-hospital complications and mortality. Results: In total, 5,880 patients were eligible for inclusion in the analysis. The average patient age was 14.25 weeks. The presence of pre-maturity (coefficient = 1.16), male sex, bronchopulmonary dysplasia (BPD), in-hospital infectious complications (coefficient = 11.31), and invasive medical procedures (coefficient = 18.4) increased the number of days of hospitalization. Invasive medical procedures (OR = 6.13), a history of pre-maturity (OR = 2.54), and male sex (OR = 1.78) increased the risk for in-hospital complications. In-hospital infectious complications (OR = 84.2) and invasive medical procedures (OR = 58.4) were risk factors for mortality. Conclusions: A history of pre-maturity increased the length of hospital stay and the rate of in-hospital complications but did not increase mortality in patients under 24 months of age hospitalized for VRIs.

Hospitalizations for viral respiratory infections in children under 2 years of age: epidemiology and in-hospital complications.

BACKGROUND: Viral respiratory infections (VRIs) are a frequent cause of hospitalization in children under 24 months of age. A history of prematurity or heart disease may be a risk factor for complications in patients hospitalized for VRI. The objective was to describe epidemiological data for children hospitalized for IRV and aged 1 to 24 months and to identify risk factors for the presence of in-hospital complications and mortality over a period of 5 years. METHODS: This was a cross-sectional study. Patients registered with VRI codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219 (based on International Classification of Diseases [ICD-10]) from 2013 to 2017 were included. Three subanalyses were performed to compare [1] patients with pathological history (prematurity, bronchopulmonary dysplasia [BPD] and congenital heart disease [CHD]), [2] diagnoses (pneumonia, acute bronchitis, and acute bronchiolitis), and [3] admission to the pediatric intensive care unit. Days of hospital stay, in-hospital complications, invasive medical procedure and mortality were analyzed. STATISTICAL ANALYSIS: VRI hospitalization prevalence was described. For comparison between groups, Student's t-test, ANOVA and the Chi2 test were applied. To identify factors related to days of hospital stay, in-hospital complications and mortality, a linear and logistic regression model was performed. RESULTS: A total of 66,304 hospitalizations were reported. The average age was 14.7 weeks; hospitalization events were higher in winter (39%), followed by autumn (27.3%). A total of 371 (0.56%) patients died. A total of 7068 (10.6%) hospitalized patients with pathological histories were identified. The presence of BPD (coefficient = 1.6), CHD (coefficient = 1.2), diagnosis of pneumonia (coefficient = 1.2), in-hospital complications (coefficient = 2.1) and invasive medical procedures (coefficient = 15.7) were the most common factors that increased the length of hospital stay. Risk factors for in-hospital complications and mortality were invasive medical procedure (OR = 3.3 & 11.7), BPD (OR = 1.8 & 1.6), CHD (OR = 4.6 & 3.4) and diagnosis of pneumonia (OR = 1.8 & 4.2). CONCLUSIONS: Risk factors for morbidity and mortality in patients hospitalized for VRIs are BPD and CHD, diagnosis of pneumonia and invasive medical procedure.

Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes.

BACKGROUND: Permanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000-2013 at the Mexican Institute of Social Security. METHODS: A cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013). RESULTS: There were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29-1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15-1.73) and renal complications (HR, 3.49; 95 % CI, 3.18-3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %). CONCLUSIONS: Mexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.

The burden of disease of cancer in the Mexican Social Security Institute.

OBJECTIVE: To estimate the disease burden of cancer in the affiliate population of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in 2010 by delegation. MATERIALS AND METHODS: The Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability/Disease (YLD) for 21 specific cancers and a subgroup of other malignant neoplasms were calculated based on the methodology of the Global Burden of Disease Study (GBD) for each of the 35 delegations of the IMSS. RESULTS: In 2010, cancer represented the fifth overall leading cause of disease burden in IMSS affiliates (16.72 DALYs/1000 affiliates). A total of 75% of the cancer disease burden in each delegation is due to ten specific cancers, particularly breast cancer, which ranks first in 82% of the delegations. Prostate cancer; tracheal, bronchial, and lung cancers; leukemia, and colorectal and stomach cancers occupy the second to fourth positions in each delegation. With the exception of breast and prostate cancer, for which the contribution of YLD to the DALYs was higher than 50%, the greatest contribution to the DALYs of the other cancers was premature mortality, which accounted for more than 90% of the DALYs in some cases. CONCLUSION: The results obtained in this study allow for the identification of intervention priorities with regard to cancer at the institutional level and also for the focus at the delegation level to be placed on cancers ranking in the top positions for disease burden.

Cancer mortality in the Mexican Social Security Institute, 1989-2013.

UNLABELLED: Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. MATERIALS AND METHODS: A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. RESULTS: The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. CONCLUSION: The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Cancer mortality in the Mexican Social Security Institute, 1989-2013 / Mortalidad por cáncer en el Instituto Mexicano del Seguro Social, 1989-2013

Abstract Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. Materials and Methods: A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. Results: The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. Conclusion: The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Resumen Objetivo: Analizar la frecuencia de las defunciones por cáncer en la población derechohabiente (DH) del Instituto Mexicano del Seguro Social, así como la tendencia temporal en el riesgo de muerte por esta causa de 1989 a 2013. Material y métodos: Se realizó análisis descriptivo del comportamiento de la mortalidad por cáncer en población derechohabiente del IMSS. Las tasas de mortalidad ajustadas por edad y sexo se obtuvieron con el método directo utilizando la población mundial estándar de la OMS. Los cambios en el riesgo de morir por cáncer a través del tiempo se evaluaron mediante regresión de Poisson. Resultados: El número absoluto de defunciones por cáncer se duplicó de1989 a 2013 debido a un aumento y al envejecimiento de la población derechohabiente. El riesgo de muerte en los DH disminuyó para la mayoría de los diferentes tipos de cáncer, excepto para el cáncer de colon y recto. Conclusión: El riesgo de morir por cáncer en DH del IMSS muestra una discreta disminución, posiblemente debido a la mejora en la detección y tratamiento oportuno.

The burden of disease of cancer in the Mexican Social Security Institute / La carga de la enfermedad debida al cáncer en el Instituto Mexicano del Seguro Social

Abstract: Objective: To estimate the disease burden of cancer in the affiliate population of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in 2010 by delegation. Materials and methods: The Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability/Disease (YLD) for 21 specific cancers and a subgroup of other malignant neoplasms were calculated based on the methodology of the Global Burden of Disease Study (GBD) for each of the 35 delegations of the IMSS. Results: In 2010, cancer represented the fifth overall leading cause of disease burden in IMSS affiliates (16.72 DALYs/1000 affiliates). A total of 75% of the cancer disease burden in each delegation is due to ten specific cancers, particularly breast cancer, which ranks first in 82% of the delegations. Prostate cancer; tracheal, bronchial, and lung cancers; leukemia, and colorectal and stomach cancers occupy the second to fourth positions in each delegation. With the exception of breast and prostate cancer, for which the contribution of YLD to the DALYs was higher than 50%, the greatest contribution to the DALYs of the other cancers was premature mortality, which accounted for more than 90% of the DALYs in some cases. Conclusion: The results obtained in this study allow for the identification of intervention priorities with regard to cancer at the institutional level and also for the focus at the delegation level to be placed on cancers ranking in the top positions for disease burden.

Resumen: Objetivo: Estimar, por delegación, la carga de enfermedad debida al cáncer en la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS) para el año 2010. Material y métodos: Se calcularon los años de vida perdidos ajustados por discapacidad (AVISA), los años perdidos por muerte prematura (APMP) y los años vividos con discapacidad (AVD) para 21 cánceres específicos y un subgrupo de otras neoplasias malignas, con base en la metodología del Global Burden of Disease Study (GBD) para cada una de las 35 delegaciones en las que se divide el IMSS al interior del país. Resultados: En el año 2010, el cáncer representó la quinta causa de carga de enfermedad en derechohabientes del IMSS (16.72 AVISA/1000 derechohabientes). El 75% de la carga de enfermedad por cáncer en cada delegación se debe a diez cánceres específicos entre los que destaca el cáncer de mama, que ocupa el primer lugar de importancia en 82% de las delegaciones. Los cánceres de próstata, tráquea, bronquios y pulmón, leucemias, de colon y recto, así como el de estómago, se ubican entre las segundas y cuartas posiciones en cada delegación. Con excepción del cáncer de mama y de próstata, cuya contribución de los AVD a los AVISA fue superior a 50%, en los demás cánceres la mayor contribución fue debida a la mortalidad prematura, en algunos superior a 90% de los AVISA. Conclusión: Los resultados obtenidos en este estudio permiten identificar las prioridades de intervención en materia de cáncer a nivel institucional y focalizarlas a nivel delegacional para los cánceres que ocupan los primeros lugares de carga de enfermedad.