Dissonant health transition in the states of Mexico, 1990–2013

a systematic analysis for the Global Burden of Disease Study 2013

Héctor Gómez-Dantés, Nancy Fullman, Héctor Lamadrid-Figueroa, Lucero Cahuana-Hurtado, Blair Darney, Leticia Avila-Burgos, Ricardo Correa-Rotter, Juan A. Rivera, Simon Barquera, Eduardo González-Pier, Tania Aburto-Soto, Elga Filipa Amorin de Castro, Tonatiuh Barrientos-Gutiérrez, Ana C. Basto-Abreu, Carolina Batis, Guilherme Borges, Ismael Campos-Nonato, Julio C. Campuzano-Rincón, Alejandra de Jesús Cantoral-Preciado, Alejandra G. Contreras-Manzano & 42 others Lucia Cuevas-Nasu, Vanessa V. de la Cruz-Gongora, Jose L. Diaz-Ortega, María de Lourdes García-García, Armando Garcia-Guerra, Teresita González de Cossío, Luz D. González-Castell, Ileana Heredia-Pi, Marta C. Hijar-Medina, Alejandra Jauregui, Aida Jimenez-Corona, Nancy Lopez-Olmedo, Carlos Magis-Rodríguez, Catalina Medina-Garcia, Maria E. Medina-Mora, Fabiola Mejia-Rodriguez, Julio C. Montañez, Pablo Montero, Alejandra Montoya, Grea L. Moreno-Banda, Andrea Pedroza-Tobías, Rogelio Pérez-Padilla, Amado D. Quezada, Vesta L. Richardson-López-Collada, Horacio Riojas-Rodríguez, Maria J. Ríos Blancas, Christian Razo-Garcia, Martha P Romero Mendoza, Tania G. Sánchez-Pimienta, Luz M. Sánchez-Romero, Astrid Schilmann, Edson Servan-Mori, Teresa Shamah-Levy, Martha M. Téllez-Rojo, José L. Texcalac-Sangrador, Haidong Wang, Theo Vos, Mohammad H. Forouzanfar, Mohsen Naghavi, Alan D. Lopez, Christopher J L Murray, Rafael Lozano

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. Methods We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. Findings From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1–3·8), from 72·1 years (71·8–72·3) to 75·5 years (75·3–75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9–14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6–23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. Interpretation Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. Funding Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Original languageEnglish (US)
Pages (from-to)2386-2402
Number of pages17
JournalThe Lancet
Volume388
Issue number10058
DOIs
StatePublished - Nov 12 2016
Externally publishedYes

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Health Transition
Mexico
Quality-Adjusted Life Years
Life Expectancy
Chronic Renal Insufficiency
Mortality
Health
Violence
Malnutrition
Communicable Diseases
Global Burden of Disease
Protein-Energy Malnutrition
Somatoform Disorders
Sanitation
Neck Pain
Wounds and Injuries
Depressive Disorder
Health Policy
Low Back Pain
Uncertainty

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gómez-Dantés, H., Fullman, N., Lamadrid-Figueroa, H., Cahuana-Hurtado, L., Darney, B., Avila-Burgos, L., ... Lozano, R. (2016). Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 388(10058), 2386-2402. https://doi.org/10.1016/S0140-6736(16)31773-1

Dissonant health transition in the states of Mexico, 1990–2013 : a systematic analysis for the Global Burden of Disease Study 2013. / Gómez-Dantés, Héctor; Fullman, Nancy; Lamadrid-Figueroa, Héctor; Cahuana-Hurtado, Lucero; Darney, Blair; Avila-Burgos, Leticia; Correa-Rotter, Ricardo; Rivera, Juan A.; Barquera, Simon; González-Pier, Eduardo; Aburto-Soto, Tania; de Castro, Elga Filipa Amorin; Barrientos-Gutiérrez, Tonatiuh; Basto-Abreu, Ana C.; Batis, Carolina; Borges, Guilherme; Campos-Nonato, Ismael; Campuzano-Rincón, Julio C.; de Jesús Cantoral-Preciado, Alejandra; Contreras-Manzano, Alejandra G.; Cuevas-Nasu, Lucia; de la Cruz-Gongora, Vanessa V.; Diaz-Ortega, Jose L.; de Lourdes García-García, María; Garcia-Guerra, Armando; de Cossío, Teresita González; González-Castell, Luz D.; Heredia-Pi, Ileana; Hijar-Medina, Marta C.; Jauregui, Alejandra; Jimenez-Corona, Aida; Lopez-Olmedo, Nancy; Magis-Rodríguez, Carlos; Medina-Garcia, Catalina; Medina-Mora, Maria E.; Mejia-Rodriguez, Fabiola; Montañez, Julio C.; Montero, Pablo; Montoya, Alejandra; Moreno-Banda, Grea L.; Pedroza-Tobías, Andrea; Pérez-Padilla, Rogelio; Quezada, Amado D.; Richardson-López-Collada, Vesta L.; Riojas-Rodríguez, Horacio; Ríos Blancas, Maria J.; Razo-Garcia, Christian; Mendoza, Martha P Romero; Sánchez-Pimienta, Tania G.; Sánchez-Romero, Luz M.; Schilmann, Astrid; Servan-Mori, Edson; Shamah-Levy, Teresa; Téllez-Rojo, Martha M.; Texcalac-Sangrador, José L.; Wang, Haidong; Vos, Theo; Forouzanfar, Mohammad H.; Naghavi, Mohsen; Lopez, Alan D.; Murray, Christopher J L; Lozano, Rafael.

In: The Lancet, Vol. 388, No. 10058, 12.11.2016, p. 2386-2402.

Research output: Contribution to journalArticle

Gómez-Dantés, H, Fullman, N, Lamadrid-Figueroa, H, Cahuana-Hurtado, L, Darney, B, Avila-Burgos, L, Correa-Rotter, R, Rivera, JA, Barquera, S, González-Pier, E, Aburto-Soto, T, de Castro, EFA, Barrientos-Gutiérrez, T, Basto-Abreu, AC, Batis, C, Borges, G, Campos-Nonato, I, Campuzano-Rincón, JC, de Jesús Cantoral-Preciado, A, Contreras-Manzano, AG, Cuevas-Nasu, L, de la Cruz-Gongora, VV, Diaz-Ortega, JL, de Lourdes García-García, M, Garcia-Guerra, A, de Cossío, TG, González-Castell, LD, Heredia-Pi, I, Hijar-Medina, MC, Jauregui, A, Jimenez-Corona, A, Lopez-Olmedo, N, Magis-Rodríguez, C, Medina-Garcia, C, Medina-Mora, ME, Mejia-Rodriguez, F, Montañez, JC, Montero, P, Montoya, A, Moreno-Banda, GL, Pedroza-Tobías, A, Pérez-Padilla, R, Quezada, AD, Richardson-López-Collada, VL, Riojas-Rodríguez, H, Ríos Blancas, MJ, Razo-Garcia, C, Mendoza, MPR, Sánchez-Pimienta, TG, Sánchez-Romero, LM, Schilmann, A, Servan-Mori, E, Shamah-Levy, T, Téllez-Rojo, MM, Texcalac-Sangrador, JL, Wang, H, Vos, T, Forouzanfar, MH, Naghavi, M, Lopez, AD, Murray, CJL & Lozano, R 2016, 'Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013', The Lancet, vol. 388, no. 10058, pp. 2386-2402. https://doi.org/10.1016/S0140-6736(16)31773-1
Gómez-Dantés, Héctor ; Fullman, Nancy ; Lamadrid-Figueroa, Héctor ; Cahuana-Hurtado, Lucero ; Darney, Blair ; Avila-Burgos, Leticia ; Correa-Rotter, Ricardo ; Rivera, Juan A. ; Barquera, Simon ; González-Pier, Eduardo ; Aburto-Soto, Tania ; de Castro, Elga Filipa Amorin ; Barrientos-Gutiérrez, Tonatiuh ; Basto-Abreu, Ana C. ; Batis, Carolina ; Borges, Guilherme ; Campos-Nonato, Ismael ; Campuzano-Rincón, Julio C. ; de Jesús Cantoral-Preciado, Alejandra ; Contreras-Manzano, Alejandra G. ; Cuevas-Nasu, Lucia ; de la Cruz-Gongora, Vanessa V. ; Diaz-Ortega, Jose L. ; de Lourdes García-García, María ; Garcia-Guerra, Armando ; de Cossío, Teresita González ; González-Castell, Luz D. ; Heredia-Pi, Ileana ; Hijar-Medina, Marta C. ; Jauregui, Alejandra ; Jimenez-Corona, Aida ; Lopez-Olmedo, Nancy ; Magis-Rodríguez, Carlos ; Medina-Garcia, Catalina ; Medina-Mora, Maria E. ; Mejia-Rodriguez, Fabiola ; Montañez, Julio C. ; Montero, Pablo ; Montoya, Alejandra ; Moreno-Banda, Grea L. ; Pedroza-Tobías, Andrea ; Pérez-Padilla, Rogelio ; Quezada, Amado D. ; Richardson-López-Collada, Vesta L. ; Riojas-Rodríguez, Horacio ; Ríos Blancas, Maria J. ; Razo-Garcia, Christian ; Mendoza, Martha P Romero ; Sánchez-Pimienta, Tania G. ; Sánchez-Romero, Luz M. ; Schilmann, Astrid ; Servan-Mori, Edson ; Shamah-Levy, Teresa ; Téllez-Rojo, Martha M. ; Texcalac-Sangrador, José L. ; Wang, Haidong ; Vos, Theo ; Forouzanfar, Mohammad H. ; Naghavi, Mohsen ; Lopez, Alan D. ; Murray, Christopher J L ; Lozano, Rafael. / Dissonant health transition in the states of Mexico, 1990–2013 : a systematic analysis for the Global Burden of Disease Study 2013. In: The Lancet. 2016 ; Vol. 388, No. 10058. pp. 2386-2402.
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title = "Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013",
abstract = "Background Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. Methods We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. Findings From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95{\%} uncertainty interval 3·1–3·8), from 72·1 years (71·8–72·3) to 75·5 years (75·3–75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3{\%} (11·9–14·6{\%}) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130{\%} by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1{\%} (4·6–23·1{\%}). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10{\%} of DALYs in 2013. Interpretation Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. Funding Bill & Melinda Gates Foundation, Instituto Nacional de Salud P{\'u}blica.",
author = "H{\'e}ctor G{\'o}mez-Dant{\'e}s and Nancy Fullman and H{\'e}ctor Lamadrid-Figueroa and Lucero Cahuana-Hurtado and Blair Darney and Leticia Avila-Burgos and Ricardo Correa-Rotter and Rivera, {Juan A.} and Simon Barquera and Eduardo Gonz{\'a}lez-Pier and Tania Aburto-Soto and {de Castro}, {Elga Filipa Amorin} and Tonatiuh Barrientos-Guti{\'e}rrez and Basto-Abreu, {Ana C.} and Carolina Batis and Guilherme Borges and Ismael Campos-Nonato and Campuzano-Rinc{\'o}n, {Julio C.} and {de Jes{\'u}s Cantoral-Preciado}, Alejandra and Contreras-Manzano, {Alejandra G.} and Lucia Cuevas-Nasu and {de la Cruz-Gongora}, {Vanessa V.} and Diaz-Ortega, {Jose L.} and {de Lourdes Garc{\'i}a-Garc{\'i}a}, Mar{\'i}a and Armando Garcia-Guerra and {de Coss{\'i}o}, {Teresita Gonz{\'a}lez} and Gonz{\'a}lez-Castell, {Luz D.} and Ileana Heredia-Pi and Hijar-Medina, {Marta C.} and Alejandra Jauregui and Aida Jimenez-Corona and Nancy Lopez-Olmedo and Carlos Magis-Rodr{\'i}guez and Catalina Medina-Garcia and Medina-Mora, {Maria E.} and Fabiola Mejia-Rodriguez and Monta{\~n}ez, {Julio C.} and Pablo Montero and Alejandra Montoya and Moreno-Banda, {Grea L.} and Andrea Pedroza-Tob{\'i}as and Rogelio P{\'e}rez-Padilla and Quezada, {Amado D.} and Richardson-L{\'o}pez-Collada, {Vesta L.} and Horacio Riojas-Rodr{\'i}guez and {R{\'i}os Blancas}, {Maria J.} and Christian Razo-Garcia and Mendoza, {Martha P Romero} and S{\'a}nchez-Pimienta, {Tania G.} and S{\'a}nchez-Romero, {Luz M.} and Astrid Schilmann and Edson Servan-Mori and Teresa Shamah-Levy and T{\'e}llez-Rojo, {Martha M.} and Texcalac-Sangrador, {Jos{\'e} L.} and Haidong Wang and Theo Vos and Forouzanfar, {Mohammad H.} and Mohsen Naghavi and Lopez, {Alan D.} and Murray, {Christopher J L} and Rafael Lozano",
year = "2016",
month = "11",
day = "12",
doi = "10.1016/S0140-6736(16)31773-1",
language = "English (US)",
volume = "388",
pages = "2386--2402",
journal = "The Lancet",
issn = "0140-6736",
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}

TY - JOUR

T1 - Dissonant health transition in the states of Mexico, 1990–2013

T2 - a systematic analysis for the Global Burden of Disease Study 2013

AU - Gómez-Dantés, Héctor

AU - Fullman, Nancy

AU - Lamadrid-Figueroa, Héctor

AU - Cahuana-Hurtado, Lucero

AU - Darney, Blair

AU - Avila-Burgos, Leticia

AU - Correa-Rotter, Ricardo

AU - Rivera, Juan A.

AU - Barquera, Simon

AU - González-Pier, Eduardo

AU - Aburto-Soto, Tania

AU - de Castro, Elga Filipa Amorin

AU - Barrientos-Gutiérrez, Tonatiuh

AU - Basto-Abreu, Ana C.

AU - Batis, Carolina

AU - Borges, Guilherme

AU - Campos-Nonato, Ismael

AU - Campuzano-Rincón, Julio C.

AU - de Jesús Cantoral-Preciado, Alejandra

AU - Contreras-Manzano, Alejandra G.

AU - Cuevas-Nasu, Lucia

AU - de la Cruz-Gongora, Vanessa V.

AU - Diaz-Ortega, Jose L.

AU - de Lourdes García-García, María

AU - Garcia-Guerra, Armando

AU - de Cossío, Teresita González

AU - González-Castell, Luz D.

AU - Heredia-Pi, Ileana

AU - Hijar-Medina, Marta C.

AU - Jauregui, Alejandra

AU - Jimenez-Corona, Aida

AU - Lopez-Olmedo, Nancy

AU - Magis-Rodríguez, Carlos

AU - Medina-Garcia, Catalina

AU - Medina-Mora, Maria E.

AU - Mejia-Rodriguez, Fabiola

AU - Montañez, Julio C.

AU - Montero, Pablo

AU - Montoya, Alejandra

AU - Moreno-Banda, Grea L.

AU - Pedroza-Tobías, Andrea

AU - Pérez-Padilla, Rogelio

AU - Quezada, Amado D.

AU - Richardson-López-Collada, Vesta L.

AU - Riojas-Rodríguez, Horacio

AU - Ríos Blancas, Maria J.

AU - Razo-Garcia, Christian

AU - Mendoza, Martha P Romero

AU - Sánchez-Pimienta, Tania G.

AU - Sánchez-Romero, Luz M.

AU - Schilmann, Astrid

AU - Servan-Mori, Edson

AU - Shamah-Levy, Teresa

AU - Téllez-Rojo, Martha M.

AU - Texcalac-Sangrador, José L.

AU - Wang, Haidong

AU - Vos, Theo

AU - Forouzanfar, Mohammad H.

AU - Naghavi, Mohsen

AU - Lopez, Alan D.

AU - Murray, Christopher J L

AU - Lozano, Rafael

PY - 2016/11/12

Y1 - 2016/11/12

N2 - Background Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. Methods We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. Findings From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1–3·8), from 72·1 years (71·8–72·3) to 75·5 years (75·3–75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9–14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6–23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. Interpretation Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. Funding Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

AB - Background Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. Methods We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. Findings From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1–3·8), from 72·1 years (71·8–72·3) to 75·5 years (75·3–75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9–14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6–23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. Interpretation Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. Funding Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

UR - http://www.scopus.com/inward/record.url?scp=84992092059&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992092059&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(16)31773-1

DO - 10.1016/S0140-6736(16)31773-1

M3 - Article

VL - 388

SP - 2386

EP - 2402

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10058

ER -