Social Determinants and Chronic Disease Burden in Latin America: Epidemiological and Clinical Perspectives
DOI:
https://doi.org/10.64784/207Palabras clave:
Health inequalities, Chronic diseases, Epidemiology, Public health, Internal medicine, Social determinants of health, Diabetes mellitus, Cardiovascular diseases, Obesity, Multimorbidity, Healthcare disparities, Latin America, Preventive medicine, Healthcare accessibility, Epidemiological surveillanceResumen
Health inequalities and chronic noncommunicable diseases (NCDs) represent major public health challenges worldwide, particularly in low- and middle-income countries. The present review aimed to analyze the relationship between health inequalities and chronic disease burden from epidemiological and clinical perspectives, with emphasis on Mexico, Colombia, and Ecuador. A narrative review methodology was utilized through the analysis of scientific literature indexed in international databases including PubMed, Scopus, Google Scholar, WHO, and PAHO reports. The study integrated epidemiological evidence, clinical findings, and public health perspectives related to cardiovascular diseases, diabetes mellitus, obesity, chronic respiratory diseases, chronic kidney disease, and associated social determinants of health. The findings demonstrated that poverty, limited healthcare access, low educational attainment, food insecurity, and healthcare fragmentation substantially influence chronic disease prevalence, progression, and clinical outcomes. Mexico demonstrated the highest relative burden of obesity, diabetes mellitus, hypertension, and cardiovascular diseases among the countries analyzed. Multimorbidity patterns involving obesity, diabetes, and hypertension were frequently identified, increasing healthcare complexity and long-term morbidity. Preventive medicine, primary healthcare strengthening, epidemiological surveillance, multidisciplinary management, and health education emerged as essential strategies for reducing chronic disease inequalities. The review concludes that chronic disease burden cannot be understood exclusively from a biological perspective, as structural social determinants significantly influence epidemiological patterns and healthcare outcomes. Addressing healthcare inequalities requires integrated public health interventions, equitable healthcare systems, and multidisciplinary preventive strategies capable of improving long-term population health outcomes.
Referencias
• Antonio-Villa, N. E., et al. (2024). Diabetes subgroups and sociodemographic inequalities in Mexico. The Lancet Regional Health – Americas.
• Brant, L. C. C., et al. (2024). Epidemiology of cardiometabolic health in Latin America and the Caribbean. The Lancet Regional Health – Americas.
• Camacho, P. A., et al. (2020). Self-reported prevalence of chronic non-communicable diseases in relation to socioeconomic and educational factors in Colombia. BMC Public Health, 20, 896.
• De Maio, F. G. (2011). Understanding chronic non-communicable diseases in Latin America: Towards an equity-based research agenda. Globalization and Health, 7, 36. https://doi.org/10.1186/1744-8603-7-36
• GBD 2021 Stroke Risk Factor Collaborators. (2024). Global, regional, and national burden of stroke and its risk factors, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology.
• Hacker, K. (2024). The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 8(1), 112–119. https://doi.org/10.1016/j.mayocpiqo.2023.08.005
• Hernández-Ruiz, Á., et al. (2022). Challenges and perspectives of the double burden of malnutrition in Latin America. Clinical Nutrition ESPEN, 49.
• Luciani, S., Agurto, I., Caixeta, R., Hennis, A., & Hennis, A. J. M. (2023). Noncommunicable diseases in the Americas: A review of the Pan American Health Organization’s 25-year program of work. Revista Panamericana de Salud Pública, 47, e81. https://doi.org/10.26633/RPSP.2023.81
• Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099–1104. https://doi.org/10.1016/S0140-6736(05)71146-6
• Mensah, G. A., et al. (2023). Global burden of cardiovascular diseases and risks, 1990–2022. Journal of the American College of Cardiology, 82(25), 2350–2473.
• Mullachery, P. H., et al. (2021). Mortality amenable to healthcare in Latin American cities: A cross-sectional study. The Lancet Global Health, 10(2), e223–e232.
• Ong, K. L., Stafford, L. K., McLaughlin, S. A., Boyko, E. J., Vollset, S. E., Smith, A. E., et al. (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 402(10397), 203–234.
• Pan American Health Organization. (2024). Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes. PAHO.
• Pan American Health Organization. (2024). Noncommunicable diseases in the Americas. PAHO. https://www.paho.org/en/topics/noncommunicable-diseases
• Roberti, J., et al. (2023). Inequalities in health system coverage and quality: A cross-sectional study of Latin American and Caribbean countries. The Lancet Regional Health – Americas.
• Sacoto, F., Torres, I., & López-Cevallos, D. F. (2021). Sustainability in chronic disease prevention: Lessons from the Salud al Paso program in Ecuador. Revista Panamericana de Salud Pública, 45, e30.
• Silva-Peñaherrera, M., et al. (2020). Health inequity in workers of Latin America and the Caribbean. International Journal for Equity in Health, 19, 109.
• World Health Organization. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. WHO.
• World Health Organization. (2025). Noncommunicable diseases. WHO. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
• Zhang, H., et al. (2024). Global burden of metabolic diseases, 1990–2021. Metabolism: Clinical and Experimental.
