[A socio-spatial analysis of social exclusion and inequity in health in Mexico].

OBJECTIVE Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. METHODS Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalization level and for municipalities grouped according to degree of marginalization. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity. RESULTS A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalization) in relationship to the 1st quartile (lowest marginalization); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalization; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. CONCLUSIONS Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.