ABSTRACT Objective: To determine the association between type 2 diabetes mellitus and cataracts in Peruvian adults over 50 years of age. Methods: Cross-sectional analytical observational study corresponding to the secondary analysis of the 2019 Encuesta Demográfica y de Salud Familiar database. Type 2 diabetes mellitus was considered an independent variable and cataract as a dependent variable. A descriptive analysis was performed using absolute frequencies and weighted proportions, as well as a multivariate analysis using generalized linear models of the Poisson family with logarithmic link function to estimate prevalence ratios on the association between diabetes and cataracts. Results: Data from a total of 8,775 Peruvian adults over 50 years of age were analyzed, of whom 1,322 self-reported a diagnosis of cataract. Of the total respondents, 9.2% reported having been diagnosed with diabetes mellitus and 16.7% with cataracts. The crude model (p<0.001) and the adjusted models 1 (p=0.007) and 2 (p=0.029) found an association between having diabetes mellitus and having cataracts. Conclusion: Two out of ten adults aged 50 years old and older in Peru had cataracts. There was an association between having diabetes and the presence of cataracts in the Peruvian population.

RESUMO Objetivo: Determinar a associação entre o diabetes mellitus tipo 2 e catarata em adultos peruanos com mais de 50 anos de idade. Métodos: Estudo analítico observacional transversal correspondente à análise secundária da base de dados do Encuesta Demográfica y de Salud Familiar de 2019. O diabetes mellitus tipo 2 foi considerado variável independente e a catarata, variável dependente. Foi realizada uma análise descritiva utilizando frequências absolutas e proporções ponderadas, bem como uma análise multivariada, usando modelos lineares generalizados da família Poisson com função de ligação logarítmica para estimar razões de prevalência sobre a associação entre o diabetes e a catarata. Resultados: Foram analisados dados de 8.775 adultos peruanos com mais de 50 anos de idade, dos quais 1.322 autorrelataram diagnóstico de catarata. Do total de inquiridos, 9,2% relataram ter sido diagnosticados com diabetes mellitus e 16,7%, com cataratas. O modelo bruto (p<0,001), o modelo ajustado 1 (p=0,007) e o modelo ajustado 2 (p=0,029) encontraram associação entre ter diabetes mellitus e ter catarata. Conclusão: Dois em cada dez adultos com 50 anos de idade ou mais no Peru tinham catarata. Houve associação entre ter diabetes e a presença de catarata na população peruana.

Abstract Objective To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. Data Sources Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. Selection of Studies Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. Data Collection Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. Data Synthesis Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79–2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40–6.48; I2: 91.89%), showing high heterogeneity. Conclusion There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.

Resumo Objetivo Determinar a associação entre macrossomia fetal (FM) e hemorragia pós-parto (HPP) em mulheres da América Latina e Caribe (ALC). Fontes de dados Estudos avaliando a associação entre FM e HPP (≥ 500 ml) e HPP grave (≥ 1.000 ml) até 4 de novembro de 2021, indexados no CINHAL, Scopus, Embase, Biblioteca Cochrane, MEDLINE, LILACS e SciELO. Seleção de estudos Os critérios de inclusão foram estudos de corte e caso-controle que forneceram o número de casos de HPP e FM. Os critérios de exclusão foram estudos sem informação sobre o número de casos, com uma população de mulheres que não eram da ALC; publicado em um idioma diferente do inglês, espanhol ou português e com um design diferente. Coleta de dados A extração de dados foi realizada independentemente por dois autores, as discrepâncias foram resolvidas com um terceiro autor. Os dados relativos aos casos de FM e HPP foram recuperados. Síntese dos dados Dos 1.044 artigos avaliados, foram incluídos 5 estudos, de 6 países diferentes: Argentina e Uruguai (multipaíses), Índias Ocidentais, Antígua e Barbuda, Guiana Francesa e Suriname. O odds ratio agrupado (OR) para FM e HPP na meta-análise (cinco estudos) foi de 2,10 (intervalo de confiança de 95% [IC]: 1,79–2,47; I2: 0%), com estimativas dentro deste IC de 95% no análise sensitiva. O OR combinado para HPP grave (3 estudos) foi de 1,61 (95% CI: 0.40–6.48; I2: 91.89%), mostrando alta heterogeneidade. Conclusão Houve associação positiva entre FM e HPP na ALC, aumentando em 2 vezes o risco da presença desse evento. A alta heterogeneidade dos estudos que mediram a HPP grave não permite tirar conclusões sobre as estimativas obtidas.

Resumo Objetivo Determinar a adequação do cumprimento dos cuidados pré-natais (CPN) por mulheres grávidas no Peru e identificar os fatores associados. Métodos Foi realizado um estudo analítico transversal dos dados da Pesquisa Demográfica e de Saúde da Família Peruana de 2019 (Encuesta Demográfica y de Salud Familiar, ENDES, em espanhol). A variável dependente foi conformidade adequada coma CPN (fornecida por profissionais de saúde qualificados; primeira visita CPN durante o primeiro trimestre de gravidez; seis ou mais visitas CPN durante a gravidez; visitas CPN com conteúdo apropriado) por mulheres de 15 a 49 anos em seu último parto nos cinco anos anteriores à pesquisa. Os índices de prevalência bruta e ajustada e seus intervalos de confiança de 95% foram calculados usando um modelo de regressão log-binomial. Resultados Foi analisado um total de 18.386 mulheres, das quais 35,0% cumpriram adequadamente o CPN. A menor proporção de conformidade foi encontrada com o conteúdo de ANC (42,6%). Fatores sociodemográficos e aqueles relacionados à gravidez, como estar na faixa etária de 20 a 34 anos e 35 a 49 anos, ter educação secundária ou superior, pertencer a um quintil de riqueza da população que não a mais pobre, ser da região da selva, não ser de etnia nativa, ter um segundo ou terceiro gravidez, e tendo uma gravidez desejada, aumentou a probabilidade de apresentar conformidade adequada com CPN. Conclusão Apenas 3 em cada 10 mulheres no Peru mostraram conformidade adequada com o CPN. O cumprimento do conteúdo do CPN deve ser melhorado, e estratégias devem ser desenvolvidas para aumentar a proporção de cumprimento adequado com o CPN.

Abstract Objective To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. Methods An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. Results A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. Conclusion Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

ABSTRACT Objective: The aim of this study was to perform a spatial analysis of the prevalence of adolescent maternity in different districts of Peru and determine the spatial correlation with socioeconomic and sociodemographic characteristics. Material and Method: An ecological study was carried out through a spatial analysis based on the prevalence of adolescent maternity, registered in the 2017 National Census, of different districts of Peru. The global and local Moran's Indexes were used to establish clustering patterns. A spatial lag model was performed to correlate district sociodemographic and socioeconomic characteristics with adolescent maternity. Results: Data from 1874 districts were analyzed. Of all the adolescents, 122.144 (10.1%) had been mothers. Some districts showed a prevalence of adolescent maternity above 40%. Ucayali, Loreto, and San Martin were the administrative regions with the highest proportion of districts with adolescent pregnancies, surrounded by districts with also a high prevalence of adolescent pregnancies. The spatial lag model analysis showed a significant and positive association for illiteracy, single marital status, rurality, and location in the Jungle natural region of the district with adolescent maternity; access to drinking water showed a negative association. Conclusion: One in ten adolescents between 15 and 19 in Peru has been a mother. The districts with the highest prevalence of adolescent maternity are located in the Peruvian jungle region. Sociodemographic and socioeconomic factors at the district level such as illiteracy, rurality, single marital status, and location in the Jungle natural region were positively associated with adolescent maternity. A higher prevalence of access to drinking water at the district level is associated with a lower prevalence of adolescent maternity at the district level.

RESUMEN Objetivo: Realizar un análisis espacial de la prevalencia de maternidad adolescente en diferentes distritos del Perú y determinar la correlación espacial con características socioeconómicas y sociodemográficas. Material y Método: Estudio ecológico mediante un análisis espacial con base en la prevalencia de maternidad adolescente registrada en el Censo Nacional del 2017 de diferentes distritos de la población peruana. El índice local y global de Moran se utilizó para establecer patrones de agrupamiento. Se realizó un modelo de rezago espacial para correlacionar las características sociodemográficas y socioeconómicas del distrito con la maternidad adolescente. Resultados: Se analizaron datos de 1.874 distritos. Del total de adolescentes, 122.144 (10,1%) habían sido madres. Algunos distritos mostraron una prevalencia de maternidad adolescente superior al 40%. Ucayali, Loreto y San Martín fueron las regiones administrativas con la mayor proporción de distritos con embarazos adolescentes rodeados de distritos también con alta prevalencia de embarazos adolescentes. El modelo de rezago espacial mostró una asociación significativa y positiva para el analfabetismo, el estado civil soltero, la ruralidad y la ubicación en región natural Selva del distrito con la maternidad adolescente; el acceso al agua potable mostró una asociación negativa. Conclusión: Una de cada diez adolescentes de 15 a 19 años en Perú ha sido madre. Los distritos con mayor prevalencia de maternidad adolescente pertenecen a la región selva peruana. Los factores sociodemográficos y socioeconómicos a nivel distrital como el analfabetismo, la ruralidad, el estado civil soltero y la ubicación del distrito en la región natural Selva se asociaron positivamente con la maternidad adolescente. Una mayor prevalencia de acceso a agua potable a nivel distrital se asocia a una menor prevalencia de maternidad adolescente a nivel distrital.

RESUMO Objetivo: O objetivo deste estudo foi realizar uma análise espacial da prevalência da maternidade adolescente em diferentes distritos do Peru e determinar a correlação espacial com as características socioeconómicas e sociodemográficas. Material e Método: Um estudo ecológico foi realizado através de uma análise espacial com base na prevalência da maternidade adolescente, registrada no censo nacional de 2017, de diferentes distritos do Peru. Os índices de Moran globais e locais foram usados para estabelecer padrões de agrupamento. Um modelo espacial lag foi realizado para correlacionar as características sociodemográficas e socioeconómicas do distrito com a maternidade na adolescência. Resultados: Foram analisados os dados de 1874 distritos. Do total de adolescentes, 122.144 (10,1%) foram mães. Alguns distritos apresentaram prevalência de maternidade na adolescência acima de 40%. Ucayali, Loreto e San Martin foram as regiões administrativas com a maior proporção de distritos com gravidez na adolescência, rodeados por distritos com também alta prevalência de gravidez na adolescência. A análise de modelo espacial lag mostrou uma associação significativa e positiva para analfabetismo, estado civil solteiro, ruralidade e localização na região natural Selva do distrito com maternidade na adolescencia; acesso à água potável mostrou associação negativa. Conclusão: Um em cada dez adolescentes de 15 a 19 anos no Peru já foi mãe. Os distritos com maior prevalência de maternidade adolescente estão localizados na região natural Selva. Fatores sociodemográficos e socioeconómicos em nível distrital, como analfabetismo, ruralidade, estado civil solteiro e localização na região natural Selva, foram associados positivamente com a maternidade na adolescência. Uma prevalência mais alta de acesso a água potável no nível distrital está associada a uma prevalência mais baixa de maternidade adolescente no nível distrital.

ABSTRACT Introduction. High blood pressure (HBP) is a leading cause of death worldwide, where the male sex is the most affected group. Objetives. Determine the gender differences of the factors associated with HBP in the Peruvian population over 18 years of age. Methods. A secondary analysis of the 2017 National and Demographic Health Survey was performed. Crude (RP) and adjusted (RPa) prevalence ratios and 95% confidence intervals (95% CI) were calculated using generalized linear models of the Poisson family between the dependent variable (HBP) and independent. Results. The prevalence of HBP was found to be 17,8% in men and 11,4% in women. Age, being overweight and obese increased the likelihood of HBP. While being from the coast, mountain range and jungle decreased the likelihood of HBP in both sexes. Conclusions. There is a higher prevalence of HBP in the male sex and factors such as age, overweight and obesity increased the likelihood of HBP.

RESUMEN Introducción. La hipertensión arterial (HTA) es una de principales causas de muerte a nivel mundial, donde el sexo masculino es el grupo mayormente afectado. Objetivo. Determinar las diferencias según sexo de los factores asociados a HTA en la población peruana mayor de 18 años. Métodos. Se realizó un análisis secundario de la Encuesta Nacional y Demográfica de Salud 2017. Se calcularon razones de prevalencia crudas (RP) y ajustadas (RPa) y sus intervalos de confianza al 95% (IC 95%) mediante modelos lineales generalizados de la familia Poisson entre la variable dependiente (HTA) e independientes. Resultados. Se encontró que la prevalencia de HTA fue de 17,8% en hombres y 11,4% en mujeres. La edad, tener sobrepeso y obesidad aumentaron la probabilidad de padecer HTA. Mientras que ser de la costa, sierra y selva disminuyeron la probabilidad de HTA en ambos sexos. Conclusiones. Existe mayor prevalencia de HTA en el sexo masculino y factores como la edad, sobrepeso y obesidad aumentaron la probabilidad de padecer HTA.

ABSTRACT Objectives : To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. Materials and Methods . Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). Results . From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). Conclusions . The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

RESUMEN Objetivos: Identificar la prevalencia y factores asociados al uso de servicios de salud oral en adultos mayores (AM) peruanos durante el 2018. Materiales y métodos: Análisis secundario de los datos de 4874 AM peruanos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se consideró el uso de servicio de salud oral (sí/no) en razón de los seis meses previos a la aplicación de la encuesta como variable dependiente, las variables independientes fueron: sexo, edad, área de residencia, nivel educativo, estado civil, dominio geográfico, limitación física, afiliación a un seguro de salud, lengua hablada y quintil de bienestar. Se realizó un análisis descriptivo usando frecuencias absolutas y proporciones ponderadas, y un análisis multivariado empleando modelos lineales generalizados (familia Poisson). Resultados: Del total de AM, 52,6% fueron mujeres, 52,9% pertenecían al grupo de 60 a 69 años de edad, 77% pertenecían al área urbana y 81,1% estuvieron afiliados a un seguro de salud. La prevalencia del uso de servicios odontológicos durante los últimos seis meses fue 24,9%. El análisis multivariado encontró asociación con el área de residencia (p<0,001), el nivel educativo superior (p=0,001), la afiliación a un seguro de salud (p<0,001), el dominio geográfico (p=0,019) y todos los quintiles de bienestar (p<0,001). Conclusiones : La prevalencia de uso de servicios de salud oral en AM fue baja, y sus factores asociados fueron el área de residencia, el nivel educativo, la afiliación a un seguro de salud, el dominio geográfico y los quintiles de bienestar.

ABSTRACT Objective. To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

RESUMEN Objetivo. Estimar la prevalencia y determinar los factores asociados a la no utilización de instituciones prestadoras de servicios de salud (NUIPSS) en inmigrantes adultos venezolanos en Perú. Materiales y métodos. Estudio transversal analítico de la «Encuesta Dirigida a la Población Venezolana que Reside en el País» 2018. Se calculó la proporción de inmigrantes con NUIPSS (inmigrantes con algún síntoma o malestar, enfermedad, recaída de enfermedad crónica, accidente y molestia o problema como depresión, miedo, enojo, ansiedad, estrés y que consideraron que no era tan grave o necesario acudir a una institución prestadora de servicios de salud). Se estimaron razones de prevalencia (RP) crudas y ajustadas (RPa) de presentar NUIPSS usando modelos lineales generalizados. Resultados . Se incluyeron 2144 venezolanos inmigrantes. El 57,2% presentó NUIPSS, reportando motivos como: no contar con dinero (64,5%), carecer de seguro de salud (24,3%), automedicación (12,8%) y no disponer de tiempo (8,4%). Residir en Arequipa (Rpa:0,69; IC95%: 0,57-0,83) o Trujillo (Rpa: 0,87; IC95%: 0,76-0,99), padecer una enfermedad crónica (Rpa: 0,83; IC95%: 0,71-0,97) y estar afiliado al Seguro Integral de Salud (SIS) (Rpa: 0,28; IC95%: 0,13-0,61) se asoció con una menor probabilidad de NUIPSS. Ser de un grupo etario más joven al de 60 a más años se asoció con una mayor probabilidad de NUIPSS. Conclusiones. Uno de cada dos venezolanos inmigrantes en Perú presenta NUIPSS. Contar con SIS incrementa la probabilidad de acudir a atención médica en inmigrantes venezolanos en territorio peruano. Incrementar el aseguramiento público en salud de esta población, que actualmente es bajo, podría incrementar el uso de servicios de salud.

Objectives. To identify the prevalence and factors associated with the use of oral health services in Peruvian older adults (OA) during 2018. Materials and Methods. Secondary analysis of data on 4,874 Peruvian OAs from the Demographic and Family Health Survey (ENDES) carried out in 2018. The use of oral health services was considered (yes/no) based on the six months prior to the application of the survey as a dependent variable. The independent variables were sex, age, area of residence, educational level, marital status, geographical domain, physical limitation, health insurance, spoken language, and welfare index quintile. A descriptive analysis was performed using absolute frequencies and weighted proportions, and a multivariate analysis using generalized linear models (Poisson regression). Results. From the total of OAs, 52.6% were women, 52.9% belonged to the 60-69 age group, 77% belonged to the urban area, and 81.1% had a health insurance. The prevalence of the use of dental care services in the last six months was 24.9%. Multivariate analysis found association with area of residence (p<0.001), higher educational level (p=0.001), health insurance affiliation (p<0.001), geographic domain (p=0.019), and all welfare index quintiles (p<0.001). Conclusions. The prevalence of the use of dental care services in OAs was low, and its associated factors were the area of residence, educational level, health insurance, geographic domain, and welfare index quintiles.

Objetivos. Identificar la prevalencia y factores asociados al uso de servicios de salud oral en adultos mayores (AM) peruanos durante el 2018. Materiales y métodos. Análisis secundario de los datos de 4874 AM peruanos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se consideró el uso de servicio de salud oral (sí/no) en razón de los seis meses previos a la aplicación de la encuesta como variable dependiente, las variables independientes fueron: sexo, edad, área de residencia, nivel educativo, estado civil, dominio geográfico, limitación física, afiliación a un seguro de salud, lengua hablada y quintil de bienestar. Se realizó un análisis descriptivo usando frecuencias absolutas y proporciones ponderadas, y un análisis multivariado empleando modelos lineales generalizados (familia Poisson). Resultados. Del total de AM, 52,6% fueron mujeres, 52,9% pertenecían al grupo de 60 a 69 años de edad, 77% pertenecían al área urbana y 81,1% estuvieron afiliados a un seguro de salud. La prevalencia del uso de servicios odontológicos durante los últimos seis meses fue 24,9%. El análisis multivariado encontró asociación con el área de residencia (p<0,001), el nivel educativo superior (p=0,001), la afiliación a un seguro de salud (p<0,001), el dominio geográfico (p=0,019) y todos los quintiles de bienestar (p<0,001). Conclusiones. La prevalencia de uso de servicios de salud oral en AM fue baja, y sus factores asociados fueron el área de residencia, el nivel educativo, la afiliación a un seguro de salud, el dominio geográfico y los quintiles de bienestar.

Objective.To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

Objetivo. Estimar la prevalencia y determinar los factores asociados a la no utilización de instituciones prestadoras de servicios de salud (NUIPSS) en inmigrantes adultos venezolanos en Perú. Materiales y métodos. Estudio transversal analítico de la «Encuesta Dirigida a la Población Venezolana que Reside en el País» 2018. Se calculó la proporción de inmigrantes con NUIPSS (inmigrantes con algún síntoma o malestar, enfermedad, recaída de enfermedad crónica, accidente y molestia o problema como depresión, miedo, enojo, ansiedad, estrés y que consideraron que no era tan grave o necesario acudir a una institución prestadora de servicios de salud). Se estimaron razones de prevalencia (RP) crudas y ajustadas (RPa) de presentar NUIPSS usando modelos lineales generalizados. Resultados. Se incluyeron 2144 venezolanos inmigrantes. El 57,2% presentó NUIPSS, reportando motivos como: no contar con dinero (64,5%), carecer de seguro de salud (24,3%), automedicación (12,8%) y no disponer de tiempo (8,4%). Residir en Arequipa (Rpa:0,69; IC95%: 0,57-0,83) o Trujillo (Rpa: 0,87; IC95%: 0,76-0,99), padecer una enfermedad crónica (Rpa: 0,83; IC95%: 0,71-0,97) y estar afiliado al Seguro Integral de Salud (SIS) (Rpa: 0,28; IC95%: 0,13-0,61) se asoció con una menor probabilidad de NUIPSS. Ser de un grupo etario más joven al de 60 a más años se asoció con una mayor probabilidad de NUIPSS. Conclusiones. Uno de cada dos venezolanos inmigrantes en Perú presenta NUIPSS. Contar con SIS incrementa la probabilidad de acudir a atención médica en inmigrantes venezolanos en territorio peruano. Incrementar el aseguramiento público en salud de esta población, que actualmente es bajo, podría incrementar el uso de servicios de salud.

Objective: To assess and identify changes in the temporal trend in mortality from alcohol-attributable gastrointestinal diseases and their disease burden based on years of life lost (YLL) in Peru. Materials and methods: An ecological study of the death records of the Ministry of Health of Peru was conducted from 2003-2016. A gastrointestinal death attributable to alcohol was considered if the basic, intermediate, or final cause of death included ICD-10 codes: K70, K700-4, K709, K292, K852, and K860. Crude and age-adjusted mortality rates were calculated for the general population aged 15 or older and by sex, and YLL. Joinpoint regression analysis was performed to evaluate trends in mortality. Results: There were 11 148 deaths by alcohol-attributable gastrointestinal diseases, being more frequent in males (74.89%), in adults aged 45 years and above (83.67%), living in urban area (69.87%) and the Andes region (60.0%), and in subjects with liver disease (85.98%). Adjusted mortality rates varied from 6.21 (95% CI: 5.78- 6.63) in 2003 to 3.95 (95% CI: 3.67-4.22) in 2016. The trend of mortality decreased in the general population (APC: -6.17, 95% CI: -9.9 to -2.2, p=0.007) during the period 2008-2016. Deaths from the causes studied generated 224 545 YLL. Conclusions: A declining trend was found in gastrointestinal deaths attributable to alcohol in the period 2008-2016. The highest mortality occurred in males, individuals aged 45 years and above, living in urban areas and the Andes region.

Objetivo: Evaluar e identificar los cambios en la tendencia temporal en mortalidad debida a las enfermedades gastrointestinal causadas por el alcohol y su carga de enfermedad basada en años de vida potencialmente perdidos (AVPP) en Perú. Material y métodos: Un estudio ecológico de los reportes de muerte del Ministerio de Salud del Perú entre 2013 a 2016. Se consideró una enfermedad gastrointestinal asociada al alcohol si la causa final o básica o intermedia de la muerta incluía los códigos CIE 10: K70, K700-4 K709 K292 K852 y K860. Los índices de mortalidad bruta y ajustada a la edad se calcularon para población general mayor de 15 años y por sexo y AVPP. Se realizaron análisis de regresión joinpoint para evaluar las tendencias en mortalidad. Resultados: Hubieron 11 148 muertes por enfermedades gastrointestinal atribuidas al uso de alcohol, siendo más frecuente en hombres (74,89%), en personas de 45 a más años de edad (83,67%), pobladores de área urbana (69,87%), en la región de los Andes (60,0%) y en sujetos con enfermedad hepática (85,98%). La tasa de mortalidad ajustada varió de 6,21 (95% IC 5,78 - 6,63) en 2003 a 3,95 (95% IC 3,67 - 4,22) en el 2016. La tendencia de la mortalidad disminuyó en la población general (APC: -6,17, 95% IC: -9,9 a -2,2, p=0,007) durante el periodo 2008-2016. Las muertes debidas a las causas estudiadas generaron 224 545 años perdidos. Conclusiones: Se encontró una tendencia decreciente en las muertes por enfermedades gastrointestinal atribuidas al alcohol en el periodo 2008-2016. La mortalidad más alta ocurrió en hombres, personas de 45 a más años, procedentes de áreas urbanas y de la región de los Andes.