Metropolitan inequalities in health system resources and COVID-19 adjusted life expectancy among older adults in Mexico

The mortality and morbidity consequences of the COVID-19 outbreak were concentrated among older adults. The health system response was critical to mitigating its negative effects, particularly through the redistribution of healthcare resources across territories. The objective of this study was to analyze inequities in the distribution of health resources in Mexico in relation to life expectancy (LE) and COVID-19 adjusted life expectancy (CALE) in the 60-64 age group at metropolitan level.

We conducted an ecological study covering the period from 2020 to 2023. LE was estimated using abridged life tables, and CALE was calculated using the Sullivan method. Correlation analyses were performed to assess the relationships between these indicators and healthcare resource variables. Inequities were quantified using the concentration index, while the dissimilarity index was used to estimate the proportion of resources that would need to be redistributed across metropolitan areas to achieve an equal distribution.

Our findings reveal an unequal distribution of healthcare resources during the pandemic. Metropolitan areas with greater resource availability achieved more favorable health outcomes. This pattern was particularly evident for resources related with specialized services, technological equipment, and health personnel in training. These are precisely the types of resources that should be distributed across metropolitan areas to advance toward a more equitable healthcare system.

Resource reallocation becomes a central component of health systems adaptation to public health emergencies. Our results highlight the need for more adequate territorial redistribution of healthcare resources to improve preparedness for future epidemiological emergencies.