Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Data Collection and Population
2.2. Variables of Interest
2.2.1. Use of Health Services
2.2.2. Covariates
2.3. Statistical Analysis
2.4. Ethical Aspects
3. Results
3.1. Characterístics of the Indigenous and Non-Indigenous Populations Analyzed
3.2. Factors Associated with the Use of Public Outpatient Services
3.3. Health Needs Motivating the Use of Public Outpatient Services
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Total Indigenous n = 249 | Total Non-Indigenous n = 3570 | |
---|---|---|
1. Respiratory and gastrointestinal infections | ||
Respiratory infection | 34 | 327 |
Gastrointestinal infection | 20 | |
Pneumonia or broncopneumonia | 18 | |
Ear infection | 1 | 17 |
Intestinal parasitosis | 2 | 11 |
Typhoid fever and brucellosis | 6 | |
Tuberculosis and hepatitis | 6 | |
2. Other infectious diseases | ||
Urinary tract infection | 9 | 63 |
Conjunctivitis | 1 | 15 |
Sexually transmitted infection | 8 | |
Dengue | 8 | |
Other infectious diseases | 19 | |
3. Diabetes and hypertension | ||
Diabetes | 42 | 570 |
Arterial hypertension | 33 | 467 |
4. Cardiovascular and circulatory system disease | ||
Cardiovascular diseases | 4 | 68 |
Embolism or stroke | 1 | 14 |
Other circulatory system diseases | 1 | 39 |
5. Non-infectious gastrointestinal disease and symptoms | ||
Gastritis, gastric ulcer, colitis | 10 | 126 |
Diarrhea | 6 | 41 |
Pancreas, liver and bile-duct problems | 1 | 38 |
Hernia | 2 | 22 |
Appendicitis | 5 | |
Other non-infectious gastrointestinal symptoms | 4 | 18 |
6. Other noncommunicable diseases | ||
Cancer or tumors | 4 | 104 |
Kidney disease | 5 | 93 |
Gynecological problems | 74 | |
Oral disease | 5 | 55 |
Allergies and rhinitis | 1 | 43 |
Skin and subcutaneous-tissue diseases | 2 | 43 |
Cataracts, glaucoma | 35 | |
Chronic obstructive pulmonary disease | 2 | 27 |
Thyroid and other hormonal problems | 1 | 26 |
Asthma | 2 | 21 |
Epilepsy and cerebral palsy | 20 | |
Hypertriglyceridemia/hypercholesterolemia/hyperuricemia | 1 | 20 |
Neuralgia/paralysis/multiple sclerosis | 14 | |
Food or drug poisoning | 1 | 13 |
Anemia | 1 | 12 |
Overweight and obesity | 1 | 8 |
Cysts | 2 | 4 |
Lupus | 1 | 4 |
Bites/stings | 4 | |
Malnutrition | 3 | |
Other non-communicable diseases | 2 | 61 |
7. Musculoskeletal system diseases | ||
Pain (hip, spine, back, knee, arm, foot) | 6 | 102 |
Arthritis | 3 | 49 |
Wear and tear of cartilage, bones or joints | 19 | |
Spinal problems | 9 | |
Knee problems | 5 | |
Herniated discs | 1 | 5 |
Osteoporosis | 5 | |
Fibromyalgia | 5 | |
Other diseases of the musculoskeletal system | 3 | 27 |
8. Mental and behavioral disorders | ||
Stress | 1 | 16 |
Depression and anxiety | 2 | 21 |
Alzheimer’s | 4 | |
Illnesses generated by drug and alcohol consumption | 1 | 3 |
Other mental and behavioral disorders | 9 | |
9. Pregnancy, childbirth and puerperium | ||
Pregnancy | 11 | 158 |
Postpartum follow-up | 9 | |
Abortions | 4 | |
10. Injuries from accidents and assaults | ||
Physical injury from accident | 9 | 232 |
Physical injury from assault | 1 | 11 |
Physical injury from road accident | 5 | |
Injuries from falls | 1 | 4 |
11. Symptoms, signs and abnormal findings | ||
Headache | 7 | 40 |
Pain in some area of the body (other than head or musculoskeletal) | 3 | 19 |
Fever | 6 | 13 |
Fluid retention | 9 | |
Dizziness | 9 | |
Dehydration | 5 | |
Weakness, fatigue, hypoglycemia | 4 | |
Other symptoms, signs and abnormal findings | 7 | 26 |
12. Consultation of control or follow-up of results | ||
Routine medical checkup | 2 | 64 |
Control or review of surgery | 3 | 39 |
Follow-up of clinical results | 14 | |
Family planning | 6 | |
Appointment for the Prospera Program, Opportunidades or Healthy Child programs | 10 |
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Total Population | Indigenous Population | Non-Indigenous Population | ||||||
---|---|---|---|---|---|---|---|---|
n | 116,730 | 9371 | 107,359 | |||||
Weighted N | 94,146,910 | 6,724,738 | 87,422,172 | |||||
% | 100.0% | 7.1% | 92.9% | |||||
Freq. | Freq. | % | [95% CI] | Freq. | % | [95% CI] | p-Value | |
Individual sociodemographic characteristics | ||||||||
Sex | 0.08 | |||||||
Male | 55,577 | 4435 | 46.6 | [45.9, 47.4] | 51,142 | 47.3 | [47.1, 47.6] | |
Female | 61,153 | 4936 | 53.4 | [52.6, 54.1] | 56,217 | 52.7 | [52.4, 52.9] | |
Age (years, continuous) © | 116,730 | 9371 | 40.5 | [39.8, 41.2] | 107,359 | 40.8 | [40.6, 41.0] | 0.37 |
Years of schooling | 0.00 | |||||||
0 | 6571 | 1342 | 15.0 | [13.8, 16.3] | 5229 | 4.4 | [4.20, 4.60] | |
1–6 (elementary school or less) | 28,133 | 3444 | 37.4 | [35.7, 39.1] | 24,689 | 22.3 | [21.8, 22.7] | |
7–9 (completed or incomplete middle school) | 34,326 | 2522 | 26.1 | [24.8, 27.5] | 31,804 | 28.8 | [28.4, 29.3] | |
≥10 (high school and beyond | 47,700 | 2063 | 21.5 | [20.1, 23.1] | 45,637 | 44.5 | [43.8, 45.1] | |
Civil status | 0.00 | |||||||
Without partner | 49,133 | 3512 | 37.4 | [36.1, 38.7] | 45,621 | 43.4 | [42.9, 43.9] | |
With partner | 67,597 | 5859 | 62.6 | [61.3, 63.9] | 61,738 | 56.6 | [56.1, 57.1] | |
Health insurance schemes | 0.00 | |||||||
None | 19,507 | 1398 | 16.4 | [14.8, 18.1] | 18,109 | 19.2 | [18.7, 19.8] | |
Social Security a | 51,747 | 1689 | 15.7 | [14.1, 17.4] | 50,058 | 47.4 | [46.7, 48.2] | |
Schemes for those without Social Security coverage b | 43,812 | 6223 | 67.8 | [65.4, 70.1] | 37,589 | 32.1 | [31.3, 32.8] | |
Private or other c | 1116 | 17 | 0.1 | [0.10, 0.30] | 1099 | 1.3 | [1.10, 1.40] | |
Employed | 0.00 | |||||||
No | 49,987 | 4195 | 45.2 | [43.8, 46.6] | 45,792 | 42.6 | [42.1, 43.0] | |
Yes | 66,743 | 5176 | 54.8 | [53.4, 56.2] | 61,567 | 57.4 | [57.0, 57.9] | |
Household characteristics | ||||||||
Head of household with educational gap | 0.00 | |||||||
No | 65,130 | 2621 | 26.2 | [24.3, 28.2] | 62,509 | 59.2 | [58.4, 60.0] | |
Yes | 51,600 | 6750 | 73.8 | [71.8, 75.7] | 44,850 | 40.8 | [40.0, 41.6] | |
Number of household members © | 116,730 | 9371 | 4.8 | [4.70, 4.90] | 107,359 | 4.2 | [4.20, 4.20] | 0.00 |
Socioeconomic status (tertiles) | 0.00 | |||||||
Low | 36,411 | 6342 | 70.7 | [68.3, 73.0] | 30,069 | 26.1 | [25.3, 26.9] | |
Intermediate | 38,875 | 2219 | 21.2 | [19.3, 23.2] | 36,656 | 33.1 | [32.3, 33.8] | |
High | 41,444 | 810 | 8.1 | [6.70, 9.70] | 40,634 | 40.8 | [40.0, 41.7] | |
Benefited from a social program | 0.00 | |||||||
No | 96,276 | 6070 | 65.1 | [63.1, 67.1] | 90,206 | 86.1 | [85.7, 86.5] | |
Yes | 20,454 | 3301 | 34.9 | [32.9, 36.9] | 17,153 | 13.9 | [13.5, 14.3] | |
Area of residence | 0.00 | |||||||
Rural (<2500 inhab.) | 31,288 | 4748 | 49.4 | [45.6, 53.2] | 26,540 | 19.4 | [18.9, 20.0] | |
Urban | 85,442 | 4623 | 50.6 | [46.8, 54.4] | 80,819 | 80.6 | [80.0, 81.1] | |
Municipal marginalization index © | 116,730 | 9371 | 53.1 | [52.7, 53.6] | 107,359 | 58.1 | [58.0, 58.1] | 0.00 |
Indigenous Population | Non-Indigenous Population | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Used Public Outpatient Health Services | Used Public Outpatient Health Services | |||||||||||
Yes | No | Yes | No | |||||||||
n | 566 | 215 | 7628 | 1994 | ||||||||
Weighted N | 355,059 | 157,491 | 5,675,898 | 1,499,437 | ||||||||
% | 56.0% a,*** | 19.6% b,*** | 55.4% c,*** | 12.6% d,*** | ||||||||
Variables | n | % | [95% CI] | % | [95% CI] | p-Value | n | % | [95% CI] | % | [95% CI] | p-Value |
Individual sociodemographic characteristics | ||||||||||||
Sex | 0.00 | 0.00 | ||||||||||
Male | 336 | 38.6 | [34.5, 42.9] | 56.9 | [51.2, 62.5] | 3877 | 36.9 | [35.5, 38.2] | 53.7 | [50.9, 56.4] | ||
Female | 445 | 61.4 | [57.1, 65.5] | 43.1 | [37.5, 48.8] | 5745 | 63.1 | [61.8, 64.5] | 46.4 | [43.6, 49.1] | ||
Age (years, continuous) © | 781 | 48.9 | [46.9, 50.8] | 46.7 | [44.2, 49.1] | 0.20 | 9622 | 50.4 | [49.8, 51.0] | 42.9 | [42.0, 43.9] | 0.00 |
Years of schooling | 0.82 | 0.02 | ||||||||||
0 | 151 | 19.8 | [16.3, 23.7] | 18.4 | [14.0, 23.8] | 697 | 7.1 | [6.4, 7.9] | 5.9 | [4.90, 7.20] | ||
1–6 (elementary school or less) | 309 | 38.2 | [33.5, 43.2] | 42.2 | [34.9, 49.8] | 2818 | 30.3 | [28.9, 31.8] | 26.5 | [24.2, 28.9] | ||
7–9 (completed or incomplete middle school) | 182 | 23.2 | [19.0, 27.9] | 20.9 | [15.4, 27.7] | 2822 | 27.8 | [26.5, 29.2] | 30.0 | [27.5, 32.7] | ||
≥10 (high school and beyond | 139 | 18.9 | [15.4, 22.9] | 18.5 | [13.7, 24.5] | 3285 | 34.8 | [33.2,36.3] | 37.6 | [34.9, 40.3] | ||
Civil status | 0.34 | 0.14 | ||||||||||
Without partner | 250 | 31.2 | [27.1, 35.7] | 35.1 | [27.6, 43.5] | 3695 | 38.8 | [37.3, 40.4] | 41.2 | [38.5, 44.0] | ||
With partner | 531 | 68.8 | [64.3, 72.9] | 64.9 | [56.5, 72.4] | 5927 | 61.2 | [59.6, 62.7] | 58.8 | [56.0, 61.5] | ||
Health insurance schemes | 0.00 | 0.00 | ||||||||||
None | 51 | 2.7 | [1.50, 4.90] | 17.7 | [13.1, 23.6] | 590 | 3.3 | [2.70, 4.10] | 22.4 | [20.0, 25.0] | ||
Social Security | 206 | 28.1 | [23.6, 33.0] | 11.5 | [7.6, 17.1] | 5511 | 65.9 | [64.3, 67.5] | 34.5 | [31.8, 37.2] | ||
Schemes for population without SS coverage | 521 | 69.2 | [64.2, 73.8] | 70.7 | [63.4, 77.1] | 3483 | 30.7 | [29.2, 32.2] | 42.3 | [39.4, 45.3] | ||
Private or other | 17 | 0.1 | [0.0, 0.2] | 0.8 | [0.30, 1.90] | |||||||
Employed | 0.00 | 0.00 | ||||||||||
No | 393 | 55.7 | [50.6, 60.6] | 35.1 | [28.8, 41.9] | 5006 | 56.7 | [55.1, 58.2] | 38.0 | [35.4, 40.7] | ||
Yes | 388 | 44.3 | [39.4, 49.4] | 64.9 | [58.1, 71.2] | 4616 | 43.4 | [41.8, 44.9] | 62.0 | [59.3, 64.6] | ||
Household characteristics | ||||||||||||
Head of household with educational lag | 0.26 | 0.68 | ||||||||||
No | 234 | 32.1 | [27.1, 37.6] | 27.2 | [20.9, 34.5] | 5295 | 55.9 | [54.1, 57.6] | 55.1 | [52.2, 58.0] | ||
Yes | 547 | 67.9 | [62.4, 72.9] | 72.8 | [65.5, 79.1] | 4327 | 44.1 | [42.4, 45.9] | 44.9 | [42.0, 47.8] | ||
Number of members © | 781 | 4.2 | [3.9, 4.5] | 4.3 | [3.90, 4.70] | 0.69 | 9622 | 3.9 | [3.8, 4.0] | 4.0 | [3.9, 4.2] | 0.03 |
Socioeconomic status (tertiles) | 0.17 | 0.00 | ||||||||||
Low | 548 | 71.9 | [67.4, 76.0] | 78.1 | [73.3, 82.1] | 2998 | 25.8 | [24.4, 27.3] | 35.4 | [32.6, 38.3] | ||
Intermediate | 171 | 19.9 | [16.3, 24.0] | 17.4 | [13.6, 22.0] | 3569 | 38.1 | [36.3, 39.9] | 35.1 | [31.9, 38.4] | ||
High | 62 | 8.3 | [6.4, 10.6] | 4.5 | [3.00, 6.70] | 3055 | 36.1 | [34.4, 37.8] | 29.5 | [26.7, 32.5] | ||
Benefited from a social program | 0.89 | 0.00 | ||||||||||
No | 441 | 57.1 | [51.8, 62.2] | 57.8 | [50.2, 65.1] | 7458 | 78.4 | [77.1, 79.7] | 84.6 | [82.6, 86.4] | ||
Yes | 340 | 42.9 | [37.8, 48.2] | 42.2 | [34.9, 49.8] | 2164 | 21.6 | [20.3, 22.9] | 15.4 | [13.6, 17.4] | ||
Area of residence | 0.03 | 0.00 | ||||||||||
Rural (<2500 inhab.) | 390 | 45.8 | [41.4, 50.2] | 57.6 | [52.9, 62.2] | 2460 | 18.3 | [17.2, 19.4] | 23.6 | [22.2, 25.0] | ||
Urban (≥2500 inhab.) | 391 | 54.2 | [49.8, 58.6] | 42.4 | [37.8, 47.1] | 7162 | 81.7 | [80.6, 82.8] | 76.4 | [75.0, 77.8] | ||
Municipal marginalization index © | 781 | 53.6 | [53.1, 54.0] | 52.2 | [51.6, 52.9] | 0.01 | 9622 | 58.1 | [58.0, 58.2] | 57.5 | [57.4, 57.7] | 0.00 |
Population | Indigenous a,Δ | Non-Indigenous b,Δ | ||||
---|---|---|---|---|---|---|
Non-Users of Outpatient Services (Reference) | n = 214 | n = 1984 | ||||
Users of Public Outpatient Services | n = 564 | n = 7617 | ||||
OR | [95% CI] | p-Value | OR | [95% CI] | p-Value | |
Sociodemographic characteristics of users | ||||||
Sex | ||||||
Male | Ref. | Ref. | ||||
Female | 1.68 | [1.14, 2.47] | 0.01 | 1.63 | [1.40, 1.90] | 0.00 |
Age (years, continuous) © | 1.00 | [0.98, 1.02] | 0.99 | 1.02 | [1.01, 1.02] | 0.00 |
Age squared (years) | 1.00 | [1.00, 1.00] | 0.86 | 1.00 | [1.00, 1.00] | 0.50 |
Categorical educational levels Years of schooling | ||||||
0 | Ref. | Ref. | ||||
1–6 (elementary school or less) | 0.87 | [0.50, 1.51] | 0.62 | 0.98 | [0.72, 1.35] | 0.91 |
7–9 (completed or incomplete middle school) | 1.00 | [0.46, 2.20] | 0.99 | 1.03 | [0.72, 1.46] | 0.89 |
≥10 (high school and beyond) | 0.75 | [0.32, 1.74] | 0.50 | 0.95 | [0.66, 1.38] | 0.79 |
Civil status | ||||||
Without partner | Ref. | Ref. | ||||
With partner | 1.31 | [0.80, 2.14] | 0.28 | 1.04 | [0.88, 1.22] | 0.64 |
Employed | ||||||
No | Ref. | Ref. | ||||
Yes | 0.48 | [0.31, 0.75] | 0.00 | 0.60 | [0.51, 0.70] | 0.00 |
Health insurance schemes | ||||||
None | Ref. | Ref. | ||||
Social Security | 14.57 | [6.32, 33.56] | 0.00 | 10.63 | [8.02, 14.09] | 0.00 |
Schemes for the population without Social Security coverage | 5.61 | [2.71, 11.61] | 0.00 | 4.08 | [3.06, 5.44] | 0.00 |
Private and other | n/a | 0.86 | [0.25, 3.01] | 0.82 | ||
Household characteristics | ||||||
Head of household with educational lag | ||||||
Yes | Ref. | Ref. | ||||
No | 1.00 | [0.58, 1.72] | 1.00 | 1.05 | [0.87, 1.28] | 0.59 |
Number of household members | 1.01 | [0.91, 1.12] | 0.85 | 1.03 | [0.99, 1.07] | 0.21 |
Socioeconomic status (by tertile) | ||||||
Low | Ref. | Ref. | ||||
Intermediate | 0.76 | [0.42, 1.35] | 0.35 | 1.11 | [0.90, 1.37] | 0.31 |
High | 1.04 | [0.53, 2.03] | 0.91 | 0.99 | [0.77, 1.29] | 0.96 |
Affiliated with a social program | ||||||
No | Ref. | Ref. | ||||
Yes | 0.89 | [0.54, 1.49] | 0.66 | 1.25 | [1.03, 1.53] | 0.03 |
Area of residence | ||||||
Rural (<2500 inhab.) | Ref. | Ref. | ||||
Urban (≥2500 inhab.) | 1.29 | [0.77, 2.16] | 0.33 | 0.99 | [0.83, 1.19] | 0.95 |
Municipal marginalization index (continuous) | 1.03 | [0.98, 1.08] | 0.23 | 1.03 | [1.00, 1.07] | 0.07 |
Population | Indigenous | Non-Indigenous | |||||||
---|---|---|---|---|---|---|---|---|---|
N | 249 | 3570 | |||||||
Weighted N | 146,881 | 2,571,065 | |||||||
% | 41.4% a | 45.3% b | |||||||
N | n | % | [95% CI] | N | n | % | [95% CI] | p-Value | |
Respiratory and gastrointestinal infections | 24,707 | 37 | 16.8 | [12.7, 22.0] | 257,214 | 405 | 10.0 | [8.9, 11.2] | 0.012 |
Other infectious diseases | 6090 | 10 | 4.2 | [2.5, 6.8] | 68,307 | 113 | 2.7 | [2.1, 3.4] | 0.246 |
Diabetes and hypertension | 40,414 | 75 | 27.5 | [22.8, 32.7] | 776,400 | 1037 | 30.2 | [28.1, 32.3] | 0.442 |
Cardiovascular and circulatory diseases | 3380 | 6 | 2.3 | [1.0, 5.2] | 88,470 | 121 | 3.4 | [2.7, 4.3] | 0.412 |
Non-infectious gastrointestinal disease and symptoms | 14,229 | 23 | 9.7 | [6.0, 15.4] | 181,425 | 250 | 7.1 | [6.0, 8.3] | 0.236 |
Other non-communicable diseases | 20,243 | 31 | 13.8 | [10.3, 18.2] | 505,719 | 684 | 19.7 | [17.9, 21.6] | 0.080 |
Musculoskeletal diseases | 7229 | 13 | 4.9 | [2.6, 9.0] | 158,932 | 226 | 6.2 | [5.2, 7.3] | 0.471 |
Mental and behavioral disorders | 1524 | 4 | 1.0 | [0.5, 2.1] | 36,392 | 53 | 1.4 | [1.0, 2.0] | 0.562 |
Pregnancy, childbirth and puerperium | 6437 | 11 | 4.4 | [2.3, 8.3] | 116,068 | 171 | 4.5 | [3.7, 5.4] | 0.930 |
Accidental injuries and assaults | 7804 | 11 | 5.3 | [3.7, 7.5] | 188,302 | 252 | 7.3 | [6.2, 8.6] | 0.503 |
Symptoms, signs and abnormal findings | 13,030 | 23 | 8.9 | [5.7, 13.6] | 90,245 | 125 | 3.5 | [2.8, 4.4] | 0.000 |
Consultation for control or follow-up of results | 1794 | 5 | 1.2 | [0.5, 3.2] | 103,591 | 133 | 4.0 | [3.1, 5.1] | 0.010 |
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Pelcastre-Villafuerte, B.E.; Avila-Burgos, L.; Meneses-Navarro, S.; Cerecer-Ortiz, N.; Montañez-Hernández, J.C. Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity. Int. J. Environ. Res. Public Health 2023, 20, 3048. https://doi.org/10.3390/ijerph20043048
Pelcastre-Villafuerte BE, Avila-Burgos L, Meneses-Navarro S, Cerecer-Ortiz N, Montañez-Hernández JC. Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity. International Journal of Environmental Research and Public Health. 2023; 20(4):3048. https://doi.org/10.3390/ijerph20043048
Chicago/Turabian StylePelcastre-Villafuerte, Blanca Estela, Leticia Avila-Burgos, Sergio Meneses-Navarro, Nadia Cerecer-Ortiz, and Julio César Montañez-Hernández. 2023. "Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity" International Journal of Environmental Research and Public Health 20, no. 4: 3048. https://doi.org/10.3390/ijerph20043048