Cuantificación de la carga de la enfermedad renal crónica en América Latina: una epidemia invisibilizada / Quantification of the burden of chronic kidney disease in Latin America: an invisible epidemic / Quantificação da carga da doença renal crônica na América Latina: uma epidemia invisível

RESUMEN Objetivo. 1) Describir la carga de la enfermedad renal crónica en países de América Latina entre 1990 y 2019 y, 2) estimar la correlación entre los años de vida saludables perdidos (AVISA) con el índice sociodemográfico y el índice de acceso y calidad de salud. Métodos. Análisis secundario y ecológico, basado en el Estudio de la Carga Global de Enfermedades, Lesiones y Factores de Riesgo 2019. Se reportaron las tasas estandarizadas de mortalidad, años perdidos por muertes prematuras (APMP), años de vida ajustados por discapacidad (AVAD) y AVISA por enfermedad renal crónica para 1990, 2005 y 2019. La información se desagregó por países, sexo, grupos etarios y subcausas. Resultados. Entre 1990 y 2019, la carga de la enfermedad renal crónica aumentó considerablemente en los países de América Latina, convirtiéndose en una de las principales causas de mortalidad y de AVISA. La tasa estandarizada de AVISA por enfermedad renal crónica se debió, en gran medida, al peso de las muertes prematuras más que a la discapacidad. En 2019, Nicaragua, El Salvador, México y Guatemala se destacaron por tener las tasas estandarizadas de mortalidad por enfermedad renal crónica y de AVISA más elevadas, mientras que Uruguay presentó las más bajas. Conclusiones. La enfermedad renal crónica es una epidemia invisibilizada que representa una carga excesiva, en mortalidad y AVISA, para los países de América Latina. Es indispensable aunar esfuerzos regionales para enfrentar la enfermedad, además de impulsar acciones locales que atiendan las particularidades de cada país.

ABSTRACT Objective. 1) Describe the burden of chronic kidney disease in Latin American countries between 1990 and 2019; and 2) Estimate the correlation between disability-adjusted life years (DALYs) and the Sociodemographic Index and the Healthcare Access and Quality Index. Methods. Secondary and ecological analysis, based on the 2019 Global Burden of Diseases, Injuries and Risk Factors Study. Standardized mortality rates, years of life lost to due to premature death (YLLs),years of healthy life lost due to disability (YLDs) and DALYs due to chronic kidney disease were reported for 1990, 2005, and 2019. Information was disaggregated by country, sex, age group, and sub-cause. Results. Between 1990 and 2019, the burden of chronic kidney disease increased considerably in Latin American countries, becoming one of the main causes of mortality and DALYs. The standardized rate of DALYs for chronic kidney disease was largely due to the weight of premature deaths rather than disability. In 2019, Nicaragua, El Salvador, Mexico, and Guatemala had the highest standardized mortality rates for chronic kidney disease and DALYs, while Uruguay had the lowest. Conclusions. Chronic kidney disease is an invisible epidemic that places an excessive burden in terms of mortality and DALYs on Latin American countries. It is essential to join forces to tackle the disease in the region, and promote local actions that address the particularities of each country.

RESUMO Objetivo. 1) Descrever a carga da doença renal crônica nos países da América Latina entre 1990 e 2019 e 2) estimar a correlação entre os anos de vida saudável perdidos (AVISA), o índice sociodemográfico e o índice de acesso e qualidade da saúde. Métodos. Análise secundária e ecológica, baseada no estudo Carga Global de Doenças, Lesões e Fatores de Risco 2019 (GBD). Foram informadas taxas de mortalidade padronizadas, anos de vida perdidos por morte prematura (AVP) por morte prematura, anos de vida ajustados por incapacidade (AVAI) e AVISA devido a doença renal crônica de 1990, 2005 e 2019. Os dados foram desagregados por país, sexo, faixas etárias e causas subjacentes. Resultados. Entre 1990 e 2019, a carga de doença renal crônica aumentou consideravelmente nos países da América Latina, tornando-se uma das principais causas de mortalidade e de AVISA. A taxa padronizada de AVISA devido à doença renal crônica foi influenciada em grande parte pelo peso das mortes prematuras, e não da incapacidade. Em 2019, Nicarágua, El Salvador, México e Guatemala se destacaram por terem as maiores taxas padronizadas de mortalidade por doença renal crônica e AVISA, ao passo que Uruguai teve as menores taxas. Conclusões. A doença renal crônica é uma epidemia invisível, que representa uma carga excessiva em termos de mortalidade e de AVISA para os países da América Latina. É essencial unir esforços na região para combater a doença, além de promover ações locais que atendam às particularidades de cada país.

Factores intrínsecos y extrínsecos asociados con caídas en adultos mayores: estudio de casos y controles en México / Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico

Resumen Antecedentes: Las caídas tienen un origen multifactorial. Objetivo: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. Métodos: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. Resultados: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. Conclusiones: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Abstract Background: Falls have a multifactorial origin. Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in elderly. Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

Factors associated with environmental barriers of people with disabilities in Mexico

ABSTRACT OBJECTIVE: To examine the associations between sociodemographic, health and disability-related factors and the perception of environmental barriers outside the home environment by individuals with permanent disabilities in Mexico. METHODS: In this cross-sectional, population-based study, we used data from the 2010 National Survey of Perceptions of Disability in the Mexican Population of 2,041 participants older than 18 with permanent disability. The perceptions of barriers take into consideration the challenges of getting around and using transportation outside the home environment. The covariates consisted of sociodemographic, health-related and disability-related factors. Multivariate logistic regression was used. RESULTS: The perception of environmental barriers outside the home environment was associated with being a woman, living in an urban area, speaking an indigenous language, experiencing emotional symptoms, having walking/movement, visual or self-care disabilities, having severe/extreme disability, having disability caused by illness, using physical devices, and receiving assistance and care in the home environment. CONCLUSIONS: This information is valuable for the design of public policies and programs that promote the participation of individuals with permanent disabilities, a high-priority issue in low- and middle-income countries.

Determinantes sociodemográficos del acceso a la detección del cáncer de mama en México: una revisión de las encuestas nacionales / Sociodemographic determinants of access to breast cancer screening in Mexico: a review of national surveys

El objetivo de este artículo es identificar los factores que explican el acceso a la detección del cáncer de mama en México en función de las características sociodemográficas de las mujeres, de acuerdo con tres encuestas representativas en el ámbito nacional. Se realizaron estadísticas descriptivas y se emplearon técnicas de análisis de clasificación múltiple. Las variables dependientes fueron que las mujeres se hubieran realizado: 1) la autoexploración, 2) el examen clínico de mamas, o 3) la mamografía; las covariables fueron: grupos de edad, escolaridad, tipo de localidad (urbana/rural), estado conyugal, número de hijos, derechohabiencia y estrato socioeconómico. Se encontró una cobertura de detección baja y se observaron brechas entre distintos grupos femeninos según las características sociodemográficas. Por lo general, las mujeres de estratos económicos más bajos, sin derechohabiencia y con menores niveles educativos, registraron prácticas de detección inferiores a la media nacional.

The aim of this article is to identify factors affecting access to breast cancer screening in Mexico according to the sociodemographic characteristics of the women, using three nationally-representative surveys. Descriptive statistics were performed and multiple classification analysis techniques were used. The dependent variables were that the women had realized: 1) breast self-examination, 2) clinical breast examination, or 3) mammography; the covariates were: age group, education level, type of locality (urban/rural), marital status, number of children, enrollment in social security and socioeconomic status. A low level of screening use was detected and gaps were observed between different groups of women according to sociodemographic characteristics. In general women of lower economic strata, without enrollment in social security and with lower educational levels, showed fewer detection practices than the national average.