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Methods: From to , four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79, respondents in to , respondents in Adolescents, measles - rubella vaccine

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Type 2 diabetes is the leading cause of morbidity and mortality in the world. In Mexico it is the first cause of mortality, disability, and potential years of life lost due to premature death. At the beginning of the target period, the diabetes mortality rate was higher in IMSS beneficiaries than in the control population.

Differences in the trends between the two groups suggest that they are not the exclusive result of institutional interventions. Living and work conditions could explain these differences. Non-communicable diseases are one of the most serious health challenges in the 21st century, and national development requires measures to avoid their expansion 1. To deal with this challenge, the World Action Plan for the Prevention and Control of Non-Communicable Diseases was launched for , emphasizing the need for progress in the health system, reoriented and strengthened to improve early detection of persons with non-communicable diseases in order to avoid complications, reduce the need for hospitalizations and complex interventions, and prevent premature death 2.

Type 2 diabetes is the leading global cause of mortality and morbidity, affecting to million people in the world. In Mexico, type 2 diabetes is the leading cause of mortality, years of life lost due to premature death, years with disability, and years of healthy life lost 4.

According to estimates, the incidence of diagnosed diabetes increased exponentially from to The projected rates in various incidence-by-age scenario suggest that prevalence of diabetes in adults may reach Meanwhile, the private sector consists of service providers working in private offices, clinics, and hospitals, besides purchase of services from insurance companies 7.

Screening for altered glucose tolerance was done each year at the beginning of the program and currently every three years in the population over 45 years of age, and starting at 20 years in individuals with overweight or obesity and a direct family history of diabetes. A descriptive study was conducted, based on interrupted time series analysis, both pre-post type for the IMSS beneficiary population as well as pre-post, considering the threat to the internal validity or inferential validity derived from distinct external events in relation to target intervention known as a historical factor in such studies.

The factor was controlled by studying and comparing with a control group, consisting of deaths in non-IMSS beneficiaries over 20 of age during the same period analyzed. Definition of type 2 diabetes was based on codes EE14 of the International Classification of Diseases, 10th revision.

Importantly, SINAIS is administered by the General Division of Health Information, whose responsibilities defining parameters for death certificates, coordinating the elaboration of guides for exchange of health information, and serving as the official source of health information in Mexico. The R statistical package, version 3. During the period studied, there were 1,, deaths from diabetes, of which , were individuals covered by the IMSS.

However, in the diabetes mortality rate was higher in the population not covered Table 1. In the mortality analysis of the IMSS beneficiary population, the Durbin Watson test showed a statistically significant negative correlation in time period 3, so it was necessary to shape the adjustment model based on this time period Table 3.

In the mortality analysis of the beneficiary population compared to the control group not covered by the IMSS , the results of the Durbin-Watson test did not show correlation Table 3. The model built with the control group shows that at the start of the study period, diabetes mortality was higher in IMSS beneficiaries than in controls.

Time series analysis is widely used to assess policies or interventions in various scenarios 11 , 12 , 13 , including successful applications to evaluate public health programs 12 , 14 , 15 , The strength of the analysis used with the control group is that the results allow showing the evidence of the effects of health interventions while controlling confounders that could compromise validity However, one should acknowledge that estimation of mortality rates according to age groups in IMSS beneficiaries in does not necessarily reflect the real mortality rate.

The second scenario shows a significant contrast with the control group, with a significant increase in mortality. The main differences between the two groups feature employment status: while workers covered by the IMSS have formal employment with social and economic benefits, workers without social security generally lack job security and work in informal jobs, underemployment, and part-time or seasonal jobs with no benefits.

In light of the above, studies are needed that address living and work conditions that determine lifestyles in order to explain differences in mortality from type 2 diabetes in the population covered by the IMSS when compared to individuals with access to other health services, with the aim of implementing programs that affect the structural and proximal social determinants of health Current efforts focusing on lifestyle changes take a prevention-centered approach with individual responsibility 26 , 27 , 28 , despite evidence that obesity and diabetes require multisector action involving different sectors that contribute to the production, distribution, and marketing of foods while creating an environment that facilitates physical activity 1.

World Health Organization. Global status report on noncommunicable diseases Geneva: World Health Organization; National, regional, and global trends in fasting plasma glucose and diabetes prevalence since systematic analysis of health examination surveys and epidemiological studies with country-years and 2. Lancet ; Burden of type 2 diabetes in Mexico: past, current and future prevalence and incidence rates. Prev Med ; Laurell A. La reforma contra la salud y seguridad social.

Durbin-Watson test. In: Lovric M, editor. International encyclopedia of statistical science. Berlin: Springer; Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol ; Soumerai SB. How do you know which health care effectiveness research you can trust?

A guide to study design for the perplexed. Prev Chronic Dis ; E Impact of pneumococcal conjugate vaccines on childhood otitis media in the United Kingdom. Vaccine ; Socioeconomic inequalities in adolescent health a time-series analysis of 34 countries participating in the Health Behaviour in School-aged Children study.

Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis ; Helmet legislation and admissions to hospital for cycling related head injuries in Canadian provinces and territories: interrupted time series analysis.

BMJ ; f Effect of 20 mph traffic speed zones on road injuries in London, controlled interrupted time series analysis. BMJ ; b Evaluation of the impact on non-communicable chronic diseases of a major integrated primary health care program in Mexico. Fam Pract ; Rev Cuba Med Gen Integr ; Estrategia 5 Pasos para la salud escolar. Programa Escuela y Salud. In: Chapela C, editora. American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan.

Endocr Pract ; 17 Suppl Impact of a comprehensive intervention to families with teenage sons with overweight and obesity in a primary care setting: a case report. Diabetes Metab Syndr ; 11 Suppl 1:S Medina-Reyes contributed to the data collection and analysis. Services on Demand Journal. Abstract: Type 2 diabetes is the leading cause of morbidity and mortality in the world. Introduction Non-communicable diseases are one of the most serious health challenges in the 21st century, and national development requires measures to avoid their expansion 1.

Material and methods A descriptive study was conducted, based on interrupted time series analysis, both pre-post type for the IMSS beneficiary population as well as pre-post, considering the threat to the internal validity or inferential validity derived from distinct external events in relation to target intervention known as a historical factor in such studies. Results During the period studied, there were 1,, deaths from diabetes, of which , were individuals covered by the IMSS.

Discussion and conclusions Time series analysis is widely used to assess policies or interventions in various scenarios 11 , 12 , 13 , including successful applications to evaluate public health programs 12 , 14 , 15 , Referencias 1. How to cite this article.

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Stop B, Washington DC. Francisco P. From to , four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey.

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