Cartas al editor
Causes of total and permanent disability in middle-aged adult workers affiliated with the Mexican Social Security Institute in Baja California, Mexico
To the editor: With the present study, we show the causes of total and permanent disability (TPD) in health care personnel and a group of insured workers affiliated with the Mexican Social Security Institute (IMSS) in the state of Baja California, Mexico, during the period from 2005 to 2011.
Worldwide, pensions usually only refer to retirement pensions. However, another important reality that accompanies any pension system is that not all members reach retirement in an optimal state of health. Disease and non-occupational accidents causing disability are also important in the scheme of social security.1 According to Article 119 of the IMSS' Law, TPD exists when the insured person suffers a total disability that results in a 50% loss of regular monthly income and that inability results from a non-professional illness or accident.2
We included all (n= 208) cases of TPD reported in IMSS health care personnel issued from January 1, 2005 to December 31, 2011. The causes of disability among health care personnel were matched in a 2:1 ratio with the first 416 TPD reports of workers insured with the IMSS by gender and age (±5 years). The average age (±SD) at the time of the disability report was 47.0 (±7.0) years and 379 (60.7%) were women. The main causes of disability are shown in table I. Females had a significantly higher frequency of disability for rheumatic diseases (13.2 vs. 6.5%, p=0.008). Males had a significantly higher frequency of disability due to secondary to chronic diabetes mellitus (DM) (16.7 vs. 11.1%, p=0.04), cardiovascular diseases (20.0 vs. 9.5%, p=0.001) and psychiatric disorders (7.8 vs. 4.5%, p=0.08) (table II).
The Global Burden of Disease (GBD) studies done in 2010 found the main contributors to global years lived with disability (YLD) were mental and behavioral disorders, musculoskeletal disorders, and diabetes.3 The number of people with disabilities is increasing due to population growth, ageing, emergence of chronic diseases and medical advances that preserve and prolong life, creating overwhelming demands for health and rehabilitation services.
Diabetes, hypercholesterolemia, systemic arterial hypertension, smoking and obesity are considered to be traditional risk factors for cardiovascular disease (CVD). In Mexico, a high prevalence of CVD risk factors has been observed in the adult Mexican population, which could explain the higher frequency of total disability from CVD diseases and diabetes seen in our study.
In Mexico, 9% have type 2 DM4 and 13% of the population (<40 years of age) have early-onset of type 2 DM.5 In our study, DM was one of the major causes of disability. Diabetes increases the risk of disabling and life-threatening complications due to microvascular disease (affecting the kidneys, eyes and limbs) and macrovascular disease (involving the coronary, cerebrovascular and peripheral vascular systems).
It is essential to maintain integrated preventive health programs for the entire population with the aim of identifying health risk factors in a timely manner, thus avoiding complications that are ultimately responsible for some disabling conditions.
Abraham Zonana-Nacach, MC,(1) Alejandra Acosta-Angulo, MC,(2) Marco César Moreno-Cázarez, MC,(3) Rafael Gómez-Naranjo, MC.(4)
(1) Unidad de Investigación Clínica y Epidemiológica, Hospital General Regional No. 20, Instituto Mexicano del Seguro Social. Tijuana, Baja California, México. firstname.lastname@example.org
(2) Unidad de Medicina Familiar No. 27, Instituto Mexicano del Seguro Social. Tijuana, Baja California, México.
(3) Servicio de Prevención y Promoción de la Salud para los Trabajadores del IMSS, HGR No. 20, Instituto Mexicano del Seguro Social. Tijuana, Baja California, México.
(4) Programa Salud en el Trabajo, HGR No. 20, Instituto Mexicano del Seguro Social. Tijuana, Baja California, México.
1. The International Labour Organization (ILO). The Social Security (minimum standards) Convention, 1952 (No. 102) [internet document]. Aviable at: http://www.ilo.org/dyn/normlex/en/f?p=1000:1:0::NO:::
2. Ley del Seguro Social. Capítulo V del seguro de invalidez y vida, IMSS [internet document]. Aviable at: www.imss.gob.mx/estadisticas/Documents/20112012/C05.pdf.
3. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2163-2196.
4. Escobedo-de la Peña J, Buitrón-Granados LV, Ramírez-Martínez JC, Chavira-Mejía R, Schargrodsky H, Champagne BM. Diabetes in Mexico. CARMELA study. Cir Cir 2011;79:424-431.
5. Jiménez-Corona A, Rojas R, Gómez-Pérez FJ, Aguilar-Salinas CA. Early-onset type 2 diabetes in a Mexican survey: results from the National Health and Nutrition Survey 2006. Salud Publica Mex 2010;52 suppl 1:S27-S35.