Changes and heterogeneity in quality-amenable excess mortality in Mexico: a systematic analysis for the years 2012, 2018, and 2021

Abstract

Background: Low quality of care has emerged as key policy concern in low and middle-income countries. This study explores the changes and heterogeneity in preventable and healthcare-amenable excess mortality across regions and demographic groups in Mexico for 2012, 2018, and 2021.

Methods: We estimate excess mortality for the top ten healthcare amenable causes of death in Mexico. Excess mortality is categorized into preventable mortality, which could be avoided by preventing disease onset, and amenable mortality, which could be avoided through timely and effective healthcare. In broad terms, amenable mortality is derived by comparing case fatality rates in Mexico from those in a group of benchmark countries. This amenable mortality is further split into low quality and non-utilization amenable. The analysis used data from the Global Burden of Disease (GBD) study and the Encuesta Nacional de Salud y Nutrición (ENSANUT) surveys.

Findings: The findings indicate that healthcare-amenable mortality attributed to low quality was 52·5% in 2012 and 57·2% in 2021. Diabetes mellitus and chronic kidney disease were the predominant causes of amenable deaths, with an estimated 28,953 and 23,772 deaths in 2021, respectively. In 2021, an estimated 25·41 per 100,000 males died due to poor quality compared to 17·31 per 100,000 females. The of share of quality-amenable mortality for some conditions was also different between males and females in 2021. For diabetes mellitus, 38·7% of amenable mortality in males was due to poor quality, compared to 52·4% for females and for chronic kidney disease the percentage for males was 35·1% as opposed to 49·4% for females.

Interpretation: The large share of healthcare-amenable deaths attributable to poor quality underscores the persistent deficiencies in healthcare delivery processes. Despite efforts to improve healthcare quality, substantive disparities remain, particularly across factors such as sex and age. The findings highlight the need for targeted healthcare policies aimed at improving quality for all groups. Future policies should prioritize addressing the specific needs of high-risk groups to improve the overall performance of the healthcare system.

Funding: This study received no external funding.

Keywords: Health economics; Health policy; Health systems; Latin America and the Caribbean; Mexico; Quality of healthcare.

Fig. 1

Decomposition of excess mortality in Mexico 2021. Notes: Author's elaboration using results for excess mortality for the top 10 causes by burden.

Fig. 2

Age and sex heterogeneities for years of life lost (2012–2018–2021). Notes: Author's calculations using GBD and ENSANUT data.^,, , , , In Panel a, CKD stands for Chronic Kidney Disease, IHD stands for Ischemic Heart Disease, LRI stands for Lower Respiratory Infections and COPD stands for Chronic Obstructive Pulmonary Disease. In Panel b, years of life lost due to poor quality are for the top 10 causes by burden in Mexico (2021). Results are age-sex standardized in panel a.