Characterizing the epidemiological transition in Mexico: national and subnational burden of diseases, injuries, and risk factors
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BACKGROUND: Rates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities. METHODS AND FINDINGS: We estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries). CONCLUSIONS: Mexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.
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Similar national comparative risk assessments were done in Australia, Iran, Japan, Mexico, South Africa, Thailand, the USA, and Vietnam.
“National comparative risk assessments (including in Australia, Iran, Japan, Mexico, South Africa, Thailand, USA, and Vietnam) have also been undertaken with similar approaches.11–16”
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- Authors
- Stevens, G., Dias, R. H., Thomas, K. J. A., Rivera, J. A., Carvalho, N., Barquera, S., Hill, K., & Ezzati, M.
- Affiliations
- Harvard University (US)
- Pennsylvania State University (US)
- Corresponding author
- Stevens, Gretchen
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2008-06-17
- Volume
- 5
- Issue
- 6
- Pages
- e125
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC2429945
- OpenAlex
- W2164683920
- Cited by
- 249
- References
- 54
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 9 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 14 · 2018: 13 · 2017: 17 · 2016: 17 · 2015: 12 · 2014: 31 · 2013: 26 · 2012: 20
- FWCI
- 34.52
- Type
- journal article
- Language
- en
- Update notices
- correction (2008-07-29)
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Greater South Information System
- Topics
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- epidemiological transition, disease burden, injuries, risk factors, disability-adjusted life years, non-communicable diseases, subnational heterogeneity, Mexico, body mass index, alcohol consumption, hyperglycemia, malnutrition, road traffic injuries, ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, under-five mortality
- MeSH terms
- Algorithms, Cause of Death, Decision Trees, Developing Countries, Disease, Geography, Humans, Mexico, Mortality, Risk Factors, Socioeconomic Factors, Global Health, Wounds and Injuries, Cost of Illness
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