Abstract Background There is limited population-based evidence on the prevalence of cognitive impairment in Mexico, a country with a rapidly aging population and where key risk factors, such as diabetes and obesity, are common. This study describes the distribution of cognitive impairment in adults from Mexico City. Methods This cross-sectional population-based study included participants from the Mexico City Prospective Study which recruited 150,000 adults aged ≥ 35 years in 1998–2004. In 2015–2019 about 10,000 survivors were resurveyed with identical information from the original survey and additional assessments including a cognitive assessment. The main analyses included those aged 50–89 years with complete cognitive assessment and covariate data at resurvey. Cognitive impairment was defined by a score ≤ 24 on the Mini Mental State Examination (MMSE). The distribution of MMSE scores and cognitive impairment by age, sex, and major disease risk factors (diabetes, hypertension, and adiposity) was analyzed among those with complete MMSE data and some degree of self-reported formal education. Results Of the 9,288 participants aged 50–89 years at the 2015–2019 resurvey with complete data, 8,197 reported having at least some years of formal education. Among these (mean age 66 years; 31% men), their mean MMSE score was 26.2 (SD 3.6) points, 1,941 (24%) had cognitive impairment, their mean body-mass index (BMI) was 28.6 (SD 5.5) kg/m2, 3,008 (37%) had hypertension and 2,467 (30%) had diabetes. The sex- and district-standardised prevalence of cognitive impairment increased strongly with age, from 10% in those 50–59 years to 55% in those aged 80–89. At any given age, the prevalence of cognitive impairment was higher in women than in men. After accounting for the effects of age, sex, and district there was little difference in the prevalence of cognitive impairment between participants with or without diabetes, hypertension, overweight or obesity (BMI ≥ 25 km/m2), or high levels of fat mass. Conclusions In this population of adults aged 50–89 years from Mexico City, the prevalence of cognitive impairment was high, particularly among women. The extent to which cognitive impairment relates to health outcomes in this population needs to be investigated.

Background Social inequalities in adult mortality have been reported across diverse populations, but there is no large-scale prospective evidence from Mexico. We aimed to quantify social, including educational, inequalities in mortality among adults in Mexico City.Methods The Mexico City Prospective Study recruited 150 000 adults aged 35 years and older from two districts of Mexico City between 1998 and 2004. Participants were followed up until Jan 1, 2021 for cause-specific mortality. Cox regression analysis yielded rate ratios (RRs) for death at ages 35-74 years associated with education and examined, in exploratory analyses, the mediating effects of lifestyle and related risk factors.Findings Among 143 478 participants aged 35-74 years, there was a strong inverse association of education with premature death. Compared with participants with tertiary education, after adjustment for age and sex, those with no education had about twice the mortality rate (RR 184; 95% CI 171-198), equivalent to approximately 6 years lower life expectancy, with an RR of 178 (167-190) among participants with incomplete primary, 162 (153-172) with complete primary, and 134 (125-142) with secondary education. Education was most strongly associated with death from renal disease and acute diabetic crises (RR 365; 95% CI 305-438 for no education vs tertiary education) and from infectious diseases (267; 200-356), but there was an apparent higher rate of death from all specific causes studied with lower education, with the exception of cancer for which there was little association. Lifestyle factors (ie, smoking, alcohol drinking, and leisure time physical activity) and related physiological correlates (ie, adiposity, diabetes, and blood pressure) accounted for about four-fifths of the association of education with premature mortality.Interpretation In this Mexican population there were marked educational inequalities in premature adult mortality, which appeared to largely be accounted for by lifestyle and related risk factors. Effective interventions to reduce these risk factors could reduce inequalities and have a major impact on premature mortality.

The Mexico City Prospective Study is a prospective cohort of more than 150,000 adults recruited two decades ago from the urban districts of Coyoacán and Iztapalapa in Mexico City 1 . Here we generated genotype and exome-sequencing data for all individuals and whole-genome sequencing data for 9,950 selected individuals. We describe high levels of relatedness and substantial heterogeneity in ancestry composition across individuals. Most sequenced individuals had admixed Indigenous American, European and African ancestry, with extensive admixture from Indigenous populations in central, southern and southeastern Mexico. Indigenous Mexican segments of the genome had lower levels of coding variation but an excess of homozygous loss-of-function variants compared with segments of African and European origin. We estimated ancestry-specific allele frequencies at 142 million genomic variants, with an effective sample size of 91,856 for Indigenous Mexican ancestry at exome variants, all available through a public browser. Using whole-genome sequencing, we developed an imputation reference panel that outperforms existing panels at common variants in individuals with high proportions of central, southern and southeastern Indigenous Mexican ancestry. Our work illustrates the value of genetic studies in diverse populations and provides foundational imputation and allele frequency resources for future genetic studies in Mexico and in the United States, where the Hispanic/Latino population is predominantly of Mexican descent.

Background Body‐mass index is the sum of fat mass index (FMI) and lean mass index (LMI), which vary by age, sex, and impact on disease outcomes. We investigated the separate and joint relevance of FMI and LMI with vascular‐metabolic causes of death in Mexican adults. Methods and Results A total of 113 025 adults aged 35 to 74 years and free from diabetes or other chronic diseases when recruited into the Mexico City Prospective Study were followed for 19 years. Cox models estimated sex‐specific death rate ratios from vascular‐metabolic causes after adjustment for confounders and exclusion of the first 5 years of follow‐up. To account for the strong correlation between FMI and LMI, additional models estimated rate ratios associated with “residual FMI” and “residual LMI” (ie, the residuals from linear regression analyses of FMI on LMI, or vice versa). In both sexes, higher FMI and LMI were associated with higher risks of vascular‐metabolic mortality. For a given (ie, fixed) level of LMI, the rate ratio (95% CI) for vascular‐metabolic mortality per 1 kg/m 2 higher residual FMI strengthened and was higher in women (1.52 [1.38–1.68]) than in men (1.19 [1.13–1.25]). By contrast, for a given level of FMI, higher residual LMI was inversely associated with vascular‐metabolic mortality (rate ratio per 1 kg/m 2 0.67 [0.56–0.80] in women and 0.94 [0.90–0.98] in men). Conclusions In this study, higher residual FMI was more strongly associated with vascular‐metabolic mortality in women than in men. Conversely, higher residual LMI was inversely associated with vascular‐metabolic mortality, particularly in women.

Introduction Although higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought to assess the risk of death from infection associated with diabetes in Mexico. Research design and methods Between 1998 and 2004, a total of 159 755 adults ≥35 years were recruited from Mexico City and followed up until January 2021 for cause-specific mortality. Cox regression yielded adjusted rate ratios (RR) for death due to infection associated with previously diagnosed and undiagnosed (HbA1c ≥6.5%) diabetes and, among participants with previously diagnosed diabetes, with duration of diabetes and with HbA1c. Results Among 130 997 participants aged 35–74 and without other prior chronic diseases at recruitment, 12.3% had previously diagnosed diabetes, with a mean (SD) HbA1c of 9.1% (2.5%), and 4.9% had undiagnosed diabetes. During 2.1 million person-years of follow-up, 2030 deaths due to infectious causes were recorded at ages 35–74. Previously diagnosed diabetes was associated with an RR for death from infection of 4.48 (95% CI 4.05–4.95), compared with participants without diabetes, with notably strong associations with death from urinary tract (9.68 (7.07–13.3)) and skin, bone and connective tissue (9.19 (5.92–14.3)) infections and septicemia (8.37 (5.97–11.7)). In those with previously diagnosed diabetes, longer diabetes duration (1.03 (1.02–1.05) per 1 year) and higher HbA1c (1.12 (1.08–1.15) per 1.0%) were independently associated with higher risk of death due to infection. Even among participants with undiagnosed diabetes, the risk of death due to infection was nearly treble the risk of those without diabetes (2.69 (2.31–3.13)). Conclusions In this study of Mexican adults, diabetes was common, frequently poorly controlled, and associated with much higher risks of death due to infection than observed previously, accounting for approximately one-third of all premature mortality due to infection.

The Mexico City Prospective Study (MCPS) is a prospective cohort of over 150,000 adults recruited two decades ago from the urban districts of Coyoacán and Iztapalapa in Mexico City. We generated genotype and exome sequencing data for all individuals, and whole genome sequencing for 10,000 selected individuals. We uncovered high levels of relatedness and substantial heterogeneity in ancestry composition across individuals. Most sequenced individuals had admixed Native American, European and African ancestry, with extensive admixture from indigenous groups in Central, Southern and South Eastern Mexico. Native Mexican segments of the genome had lower levels of coding variation, but an excess of homozygous loss of function variants compared with segments of African and European origin. We estimated population specific allele frequencies at 142 million genomic variants, with an effective sample size of 91,856 for Native Mexico at exome variants, all available via a public browser. Using whole genome sequencing, we developed an imputation reference panel which outperforms existing panels at common variants in individuals with high proportions of Central, South and South Eastern Native Mexican ancestry. Our work illustrates the value of genetic studies in populations with diverse ancestry and provides foundational imputation and allele frequency resources for future genetic studies in Mexico and in the United States where the Hispanic/Latino population is predominantly of Mexican descent.### Competing Interest StatementAndrey Ziyatdinov, Joshua Backman, Joelle Mbatchou, Sheila M. Gaynor, Tyler Joseph, Yuxin Zou, Daren Liu, Jeffrey Staples, Razvan Panea, Xiaodong Bai, Suganthi Balasubramanian, Lukas Habegger, Rouel Lanche, Alex Lopez, Evan Maxwell, Marcus Jones, Eric Jorgenson, William Salerno, John Overton, Jeffrey Reid, Timothy Thornton, Goncalo Abecasis, Aris Baras, Jonathan Marchini are current employees and/or stockholders of Regeneron Genetics Center or Regeneron Pharmaceuticals. Abhishek Nag, Katherine Smith and Slave Petrovski are current employees and/or stockholders of AstraZeneca Mark Reppell is current employee and/or stockholder of AbbVie.

The spatial assessments of water supply quality from wells, springs, and surface bodies were performed during the dry and rainy seasons in six municipalities in the eastern regions of Michoacán (Central Mexico). Different physicochemical parameters were used to determine the supplies’ Water Quality Index (WQI); all of the communities presented good quality. The analysis indicates that many water quality parameters were within limits set by the international standards, showing levels of “excellent and good quality” according to WQI, mainly during the dry season (except at San Pedro Jácuaro and Irimbo communities in the rainy season). However, some sites showed “poor quality” and “unsuitable drinking water” related to low pH levels (<5) and high levels of turbidity, color, Fe, Al, Mn, and arsenic. Multivariate statistical analysis techniques (Principal Component and Hierarchical Cluster) and geographic information system (GIS) identify potential sources of water pollution and estimate the geographic extension of parameters with negative effects on human health (mainly in communities without sampling). According to multivariate analysis, the Na+/K+ ratio and water temperature (22–42 °C) in various sites suggest that the WQI values were affected by geological and geothermal conditions and physical changes between seasons, but were not from anthropogenic activity. The GIS established predictions about the probable spatial distribution of arsenic levels, pH, temperature, acidity, and hardness in the study area, which provides valuable information on these parameters in the communities where the sampling was not carried out. The health risk assessment for dermal contact and ingestion showed that the noncancer risk level exceeded the recommended criteria (HQ > 1) in the rainy season for three target groups. At the same time, the carcinogenic risk (1 × 10−3) exceeded the acceptability criterion in the rainy season, which suggests that the As mainly represents a threat to the health of adults, children, and infants.

Background: More than half of deaths due to coronavirus disease 2019 (COVID-19) occur in men. The reasons behind this fact have been poorly studied. We aimed to test the hypothesis that risk factors aggregation is not the only explanation of the high case fatality rate (CFR) observed in men with COVID-19. Methods: We analyzed the May 25th 2020 Mexican Ministry of Health's official database on all people tested for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal swabs. An electronic database was arranged for the present analysis with collected risk factors and epidemiological information. Results: We studied 65,856 patients with confirmed COVID-19. Compared with men, women had a higher prevalence of hypertension, obesity, asthma, chronic obstructive pulmonary disease (COPD), and immunosuppression; whereas men had a higher frequency of smoking, indigeneity and chronic kidney disease (CKD). There were 7179 (CFR: 10.9%) deaths in total, 4870 (67.8%) occurring in men, and 2309 (32.2%) in women (CFR 13% vs. 8.2%, respectively; HR: 1.60, 95% CI: 1.52–1.68; P<0.001). To account for risk factors aggregation putatively explaining the high CFR in men, we performed a separate analysis by risk factor group, age categories and sex. In the groups with hypertension, diabetes, obesity, and smoking, CFR was higher at almost every age category in men. In the groups with COPD, cardiovascular disease, CKD, asthma, and immunosuppression, CFR was higher in men or there were no significant differences compared with women. Moreover, CFR was higher in men than in women, even in subgroups of individuals with different number of risk factors. Interpretation: We found that risk factors aggregation is not the only explanation for the high CFR in men with rtRT-PCR-confirmed COVID-19. Funding Statement: This study did not receive sponsorship. Declaration of Interests: The authors declare that there are no competing conflicts of interest.

Introduction:Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19. Material and methods:We analysed the Mexican Ministry of Health's official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase-polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model. Results:As of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07-10.59%). The median time (interquartile range, IQR) from symptoms onset to death was 9 days (5-13 days), and from hospital admission to death 4 days (2-8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IMV, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV). Conclusions:In Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.