Geography of diabetes complications and quality of diabetes care in Mexico, a cross-sectional analysis of the Health and Nutrition Survey ENSANUT 2012

The increasing number of people with microvascular diabetes complications is an emerging problem in Mexico. People with less financial resources and those living in deprived areas in terms of infrastructure are at an elevated risk of developing diabetes complications earlier in their lifetime. Early detection and care of diabetes is necessary in order to effectively control and reduce the rate of complications. However, providing comprehensive diabetes care in low-income settings and remote areas of Mexico has not yet been achieved (Tapia-Conyer, Gallardo-Rincón, & Saucedo-Martinez, 2013). The aim of this study is to determine how social and geopolitical determinants influence the utilisation of preventive measures and with that the development of diabetes complications. In order to do this, we explore the following points: i) Socioeconomic differences between people with and without diabetes complications. ii) The impact of the area of residency in Mexico’s socio-economical diverse regions on the prevalence of microvascular diabetes complications iii) How rural residency affects utilisation of preventive measures and the presence of diabetes complications We used cross-sectional data from the Mexican Health and Nutrition Survey (ENSANUT) 2012. A systematic literature review was conducted to assess the availability of epidemiological studies on microvascular diabetes complications and compare self-reported data from the ENSANUT 2012 with evidence from prior research conducted in Mexico. For further data analysis, 4,261 respondents aged 20 years and older with diabetes were included in the study. Univariate analysis, data visualization and multiple logistic regression models were performed to test associations between social determinants, the utilisation of preventive measures and the presence of diabetes complications in rural and urban areas as well as between Mexico’s 32 federal states. The results demonstrate that self-reported presence of microvascular diabetes complications varies from 44.7% to 77.1%. The highest prevalence is clustered in the centre of the West and the East coast and along the Gulf of Mexico. Socioeconomic factors (lower socioeconomic and educational status, marginalisation and absence of health insurance) are positively associated with the presence of diabetes complications. However, upon visual inspection, the geographical clustering of diabetes complications was not associated with the socioeconomic development of the area. Further analysis revealed that rural residency is significantly associated with the presence of diabetes complications (OR = 1.31; 95%CI = 1.02 – 1.69), and 71% of rural residents had not performed any preventive measure in the past 12 months compared to 60% in urban areas (p < 0.001). Based on these results, health political efforts to improve the feasibility and compliance of preventive diabetes care in rural areas should be undertaken to decrease the burden of disease. If a causal relationship between socioeconomic status and the geographical clustering of diabetes complications across Mexico’s states exists, needs to be further evaluated.