Municipal deprivation and cardiometabolic outcomes in Mexican adults: findings from ENSANUT 2021–2023

TL;DR

This study shows that poor Mexican municipalities have worse diabetes control despite similar disease detection rates, while wealthier areas face higher obesity and metabolic risks.

Contribution

The study reveals distinct health gradients in diabetes control and metabolic risk linked to municipal deprivation in Mexico.

Findings

Diabetes glycemic control drops from 31.8% in least deprived to 13.7% in most deprived Mexican municipalities.

Wealthier municipalities show higher obesity and metabolic syndrome rates compared to poorer areas.

Hypertension control remains poor (33% of treated cases) across all deprivation levels.

Abstract

Cardiometabolic diseases are rising rapidly in low- and middle-income countries. Managing them requires a full cascade of care: early detection, treatment, and long-term control. Yet in Mexico, many adults are not reached by effective care, especially in poorer municipalities where health services are scarce. These local inequities mean that the municipality of residence can strongly determine whether their condition is detected, treated, or controlled.

We used the Mexican National Health and Nutrition Survey 2021–2023 (ENSANUT), a sequence of independent national probabilistic, nationally and regional representative surveys with a total sample size of 32,087 adults (20 + years old). Municipal deprivation was assessed using the Density-Independent Social Lag Index (DISLI). Primary outcomes were diabetes identification, treatment, and glycemic control (the diabetes care cascade), along with indicators for hypertension, adiposity, metabolic syndrome, dyslipidemia, and kidney function. We used survey-weighted descriptive statistics and regression analysis to quantify disparities in outcomes across levels of municipal deprivation.

We found that screening participation and disease prevalence for diabetes, hypertension and dyslipidemia varied little among Mexican municipalities. However, two separate gradients were apparent: a steep gradient in diabetes control and an inverse gradient in metabolic risk. Adjusted estimates for diabetes control (HbA1c < 7%) dropped from 31.8% in the least to 13.7% in the most deprived areas. By contrast, the wealthier municipalities had higher levels of obesity and metabolic syndrome. Meanwhile, control of hypertension was equally poor (33% of treated cases) across all strata.

Deprivation had no impact on case finding at the local level, but it was related to significantly worse glycemic control. Those from poor areas were much less likely to achieve glycemic targets, reflecting structural care deficits. Higher obesity and metabolic risk in wealthier settings, however, point to the need for prevention efforts to focus on urban obesogenic environments. To narrow the inequity gap, proportionate universalism is needed: greater support for managing diabetes in disadvantaged towns and broader prevention strategies in advantaged ones.

The online version contains supplementary material available at 10.1186/s12939-025-02754-2.