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Background: Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity. Methods: Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities. Results: We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory. Conclusions: These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years. [ABSTRACT FROM AUTHOR]

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Objective: Depression is the second most common mental disorder in older adults (OA) worldwide. The ways in which depression is influenced by the social determinants of health – specifically, by socioeconomic deprivation, income inequality and social capital - have been analyzed with only partially conclusive results thus far. The objective of our study was to estimate the association of income inequality and socioeconomic deprivation at the locality, municipal and state levels with the prevalence of depressive symptoms among OA in Mexico. Methods: Cross-sectional study based on a nationally representative sample of 8,874 OA aged 60 and over. We applied the brief seven-item version of the Center for Epidemiologic Studies Depression Scale (CES-D) to determine the presence of depressive symptoms. Additionally, to select the principal context variables, we used the Deprivation Index of the National Population Council of Mexico at the locality, municipal and state levels, and the Gini Index at the municipal and state levels. Finally, we estimated the association of income inequality and socioeconomic deprivation with the presence of depressive symptoms using a multilevel logistic regression model. Results: Socioeconomic deprivation at the locality (OR = 1.28; p<0.10) and municipal levels (OR = 1.16; p<0.01) correlated significantly with the presence of depressive symptoms, while income inequality did not. Conclusions: The results of our study confirm that the social determinants of health are relevant to the mental health of OA. Further research is required, however, to identify which are the specific socioeconomic deprivation components at the locality and municipal levels that correlate with depression in this population group. [ABSTRACT FROM AUTHOR]

Introduction: Functional limitations associated with the aging process can lead to the development of depressive symptoms and increase the vulnerability of older adults. Objective: To estimate the association between physical disability and the incidence of clinically significant depressive symptoms in older Mexican adults. Materials and methods: We conducted a retrospective cohort study with data from the Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM). The analytical sample (n=6,780) included adults over 50 years old with measurements for the main variables and no clinically significant depressive symptoms reported in the first round. These symptoms were evaluated with the CESD-9 scale and disability by means of the report of activities of daily living (ADL) or instrumental activities of daily living (IADL). Descriptive, bivariate, and multivariate analyses were performed using logistic regression models adjusted by sociodemographic variables, health conditions, childhood adversities, social participation, and stressful life events. Results: The incidence of clinically significant depressive symptoms was 25.75% (95% CI: 24,70 - 26,80). Compared to those without IADL limitations, an increased risk of 68% for the development of clinically significant depressive symptoms was found (95% CI: 1.10-2.57; p= 0,015). With the ADL model, the OR for the development of clinically significant depressive symptoms was 1.36 (1.01 -1.81; p= 0.039). Both models were adjusted by confounding variables. Conclusion: Presenting limitations in daily life is an important risk factor for the development of clinically significant depressive symptoms at two years of follow-up.

Considering that the world population is rapidly aging and disability is a very frequent event in older adults, there is an increasing interest in studying their determinants, such as the neighborhood characteristics. Thus, this study aimed to explore the association between the social environment of the neighborhood and disability in older adults. A cohort study was assembled using waves 1 and 2 from the Study of Global Ageing and Adults Health (SAGE) in Mexico, which included adults with 55+ years old. Neighborhood characteristics - such as social participation, trust and safety - and individual covariates were measured only in wave 1 (baseline), while disability was measured in both waves to adjust for the score of wave 1. Multilevel negative binomial models with random intercepts at the municipality level were constructed for the disability score in wave 2, using each of the social environment variables as the main exposure and adjusting for the sociodemographic and health-related variables. Finally, interaction terms with sex, age, and socioeconomic quintiles were tested. Results showed that neighborhoods with a medium (IRR: 0.68; 95%CI: 0.53-0.87) or high (IRR: 0.67; 95%CI: 0.52-0.86) safety level were associated with a significant reduction in the disability score of adults older than 75 years, although there was no association between other characteristics of the social environment and disability in the general sample. Consequently, actions to improve safety in the neighborhoods should be carried out to help reduce the disability score in vulnerable older adults, especially in a context where safety is a critical issue, as in Mexico.

The association between air pollution and suicide has recently been under examination, and the findings continue to be contradictory. In order to contribute evidence to this still unresolved question, the objective of the present study was to evaluate the association between air quality and daily suicides registered in Mexico City (MC) between 2000 and 2016. Air quality was measured based on exposure to particulate matter under 2.5 and 10 micrometers (µm) (PM 2.5 and PM 10 , respectively), ozone (O 3 ), nitrogen dioxide (NO 2 ), and sulfur dioxide (SO 2 ), adjusting for weather variables (air temperature and relative humidity), and holidays. To this end, an ecologic time series analysis was performed using a Poisson regression model conditioned by time and stratified by gender and age groups. Models were also generated to explore the lagged and accumulative effects of air pollutants, adjusted by weather variables. The effects of the pollutants were very close to the null value in the majority of the models, and no accumulative effects were identified. We believe these results, in this case, no evidence of a statistical association, contribute to the current debate about whether the association between air pollution and suicide reported in the scientific literature reflects an actual effect or an uncontrolled confounding effect.

A growing body of literature shows that neighborhood characteristics influence older adults' mental health. Therefore, the aim of this study was to examine the association between structural and social characteristics of the neighborhood, and depression in Mexican older adults. A longitudinal study was conducted based on waves 1 (2009-2010) and 2 (2014) of the Mexican sample from the Study on global AGEing and adult health (SAGE). A street-network buffer around each participant's household was used to define neighborhood, so that built environment and social characteristics were assessed within it. Depression was ascertained by using an algorithm based on the Composite International Diagnostic Interview. In the analysis, multilevel logistic regression models were constructed separately for each built and social environments measurement, adjusted for socioeconomic, demographic and health-related covariates, and stratified by area of residence (urban versus rural). The results showed that a length of space between 15-45 meters restricted to vehicles was significantly associated with a lower risk of depression in older adults from the urban area (OR: 0.44; IC 95% 0.23-0.83) and the protective association appeared to be larger with increasing space with this restriction, although it lacked significance. Contrarily, the built environment measures were not predictive of depression in the rural setting. On the other hand, none of the variables from the social environment had a significant association, although safety appeared to behave as a risk factor in the overall (OR: 1.48; CI 95% 0.96-2.30; p = 0.08) and rural (OR: 3.44; CI 95% 0.95-12.45; p = 0.06) samples, as it reached marginal significance. Research about neighborhood effects on older adults' mental health is an emergent field that has shown that depression might be treated not only from the individual-level, but also from the neighborhood-level. Additionally, further research is needed, especially in low- and middle-income countries, to help guide neighborhood policies., Competing Interests: The authors have declared that no competing interests exist.

Introduction: We still lack information about how changes in modifiable health risk behaviors influence the utilization of healthcare services. This study assesses the relationships between prospective patterns of modifiable health risk behaviors and the utilization of healthcare services., Material and Methods: This was a prospective study among men and women participants in the Health Workers Cohort Study, aged 18 years and older. The following data about modifiable health risk behaviors was collected in two waves of the study (2004-2006 and 2010-2012): 1) physical activity, b) consumption of fruit and vegetables, 3) alcohol, and 4) tobacco consumption, to determine the association between the utilization of healthcare services after 6 years of follow-up (period 2010-2012). Information was collected through self-administered questionnaires; clinical and anthropometric variables were measured following standard procedures. Analyses were conducted using zero-inflated negative binomial regression models., Results: Participants with a pattern of consumption of < 3 portions of fruits and vegetables per day (p = 0.035) and did not meet recommended levels of PA (p = 0.013) during the two waves of the study had fewer preventative consultations; those who quit smoking reported a higher frequency of preventative consultations (p = 0.021) and more visits with a medical specialist (p = 0.048). Participants who reduced alcohol consumption to low or completely stopped its consumption reported fewer visits to the general physician (p = 0.031), p < 0.05., Conclusions: Changes in prospective patterns of modifiable health risk behaviors influenced the use of healthcare services after 6 years of follow-up. Findings in this study could be useful to determine possible demands of healthcare services among populations with specific modifiable health risk behaviors., Competing Interests: The authors have declared that no competing interest exist.

This study aims to estimate the relationship between employment status and depressive symptoms among Mexican adults, as well as to explore its differential effect by gender. Cross-sectional study of 36,516 adults between 20 and 59 years of age taken from the 2012 Mexican National Health and Nutrition Survey. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale (CES-D), and the employment status was determined a week before the survey. Logistic regression models were stratified by gender and education level and adjusted by sociodemographic and health-related conditions to estimate the association between depressive symptoms and employment status. The prevalence of clinically depressive symptoms was 7.59% for men and 18.62% for women. In the case of men, those who were unemployed were more likely to present depressive symptoms (OR = 1.66; 95%CI: 1.08-2.55) than those who were working. For women, employment status is not associated with the presence of depressive symptoms, except in students (OR = 1.57; 95%CI: 1.02-2.43) compared with those who were working. In both genders, disability preventing one from working was associated with depressive symptoms. Although being employed has been reported to be associated with lower levels of psychiatric morbidity, the estimated effect is different for men and women. Occupational health policies should consider these conditions.

Background: Recent epidemiological research has shown that exposure to fine particulate pollution (PM 2.5 ) is associated with a reduction in cognitive function in older adults. However, primary evidence comes from high-income countries, and no specific studies have been conducted in low and middle-income countries where higher air pollution levels exist., Objectives: To estimate the association between the exposure to PM 2.5 and cognitive function in a nationally representative sample of older Mexican adults and the associated effect modifiers., Methods: Data for this study were taken from the National Survey of Health and Nutrition in Mexico carried out in 2012. A total of 7986 older adults composed the analytical sample. Cognitive function was assessed using two tests: semantic verbal fluency and three-word memory. The annual concentration of PM 2.5 was calculated using satellite data. Association between exposure to PM 2.5 and cognitive function was estimated using two-level logistic and linear regression models., Results: In adjusted multilevel regression models, each 10 μg/m 3 increase in ambient PM 2.5 raised the odds of a poorer cognitive function using the three-word memory test (OR = 1.37, 95% CI: 1.08, 1.74), and reduced the number of valid animal named in the verbal fluency test (β = -0.72, 95% CI: -1.05, -0.40). Stratified analyses did not yield any significant modification effects of age, sex, indoor pollution, urban/rural dwelling, education, smoking and other factors., Conclusions: This study supports an association between exposure to PM 2.5 concentrations and cognitive function in older adults. This is particularly relevant to low- and middle-income countries, which are marked by a rapid growth of their aging population and high levels of air pollution., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: The short version of the Center for Epidemiologic Studies (CES-D) Depression Scale is a viable tool for screening depressive symptomatology in the general population, but its factorial invariance for indigenous populations in Latin America has not been reported. Objective: To describe the differences in the prevalence of depressive symptomatology and the factorial invariance of the short version of the CES-D scale for the Mexican indigenous population. Materials and methods: We conducted a cross-sectional study with a representative sample of 37,165 Mexican adults aged 20 to 59 years. Indigenous identity was determined by self-report of being a speaker of an indigenous language. Eight groups of analysis were created according to gender, literacy, and being indigenous. An exploratory factor analysis was used to describe the prevalence of depressive symptoms as measured by the short version of the CES-D, as well as the configuration factorial invariance of the profiles. The variance-covariance matrices of the pairs of profiles were compared using the modified Mantel test. Results: The prevalence of depressive symptoms was 16.8% (95% CI: 13.4-20.3) for indigenous women who could read, 21.3% (95% CI: 15.5% 27.1) for indigenous women who could not read, 8.5% (95% CI: 6.0-11.1) for indigenous men who could read, and 10.4% (95% CI: 5.2-15.6) for indigenous men who could not read. No significant differences in the factorial loads of the profiles were found. Conclusion: The prevalence of depressive symptoms in indigenous people is lower than in the nonindigenous population. The factorial invariance of the CES-D scale was high for the indigenous population.

Introduction: Suicide is a complex and multifactorial phenomenon with growing importance to public health. An increase in its occurrence has been observed in Mexico over the past 10 years. The present article analyzes the secular trend in suicide at the national level between the years 2000 and 2013., Materials and Methods: All suicides during the study period (n = 64,298, of which 82.11% were men) were characterized using a spectral decomposition of the time series and a wavelet analysis to evaluate the effect of seasonal changes, type of area (urban versus rural) and sex., Results: A seasonal pattern was observed with statistically significant cycles every 12 months, where peaks were identified in May but only for men in urban zones as of the year 2007. In addition, specific days of the year were found to have a higher frequency of suicides, which coincided with holidays (New Year, Mother's Day, Mexican Independence Day and Christmas)., Conclusion: A wavelet analysis can be used to decompose complex time series. To the best of our knowledge, this is the first application of this technique to the study of suicides in developing countries. This analysis enabled identifying a seasonal pattern among urban men in Mexico. The identification of seasonal patterns can help to create primary prevention strategies, increase the dissemination of crisis intervention strategies and promote mental health. These strategies could be emphasized during specific periods of the year and directed towards profiles with a higher risk.

Objective: To identify the factors associated with fatal occupational injuries in Mexico in 2012 among workers affiliated with the Mexican Social Security Institute., Methods: Analysis of secondary data using information from the National Occupational Risk Information System, with the consequence of the occupational injury (fatal versus non-fatal) as the response variable. The analysis included 406,222 non-fatal and 1,140 fatal injuries from 2012. The factors associated with the lethality of the injury were identified using a logistic regression model with the Firth approach., Results: Being male (OR=5.86; CI95%: 4.22-8.14), age (OR=1.04; CI95%: 1.03-1.06), employed in the position for 1 to 10 years (versus less than 1 year) (OR=1.37; CI95%: 1.15-1.63), working as a facilities or machine operator or assembler (OR: 3.28; CI95%: 2.12- 5.07) and being a worker without qualifications (OR=1.96; CI95%: 1.18-3.24) (versus an office worker) were associated with fatality in the event of an injury. Additionally, companies classified as maximum risk (OR=1.90; CI 95%: 1.38-2.62), workplace conditions (OR=7.15; CI95%: 3.63-14.10) and factors related to the work environment (OR=9.18; CI95%:4.36-19.33) were identified as risk factors for fatality in the event of an occupational injury., Conclusions: Fatality in the event of an occupational injury is associated with factors related to sociodemographics (age, sex and occupation), the work environment and workplace conditions. Worker protection policies should be created for groups with a higher risk of fatal occupational injuries in Mexico.

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico's Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.