{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T10:52:44Z","timestamp":1782989564192,"version":"3.54.5"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persons with disabilities (PWD) face disproportionate barriers to social protection and healthcare worldwide, yet comprehensive multi-source evidence linking social security coverage, morbidity, and mortality outcomes remains scarce in Latin America.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional, multi-source population-based study with a prospective cohort component, integrating nine nationally representative Mexican data sources (2017\u20132023) encompassing over 125 million persons. Disability was operationalized using source-specific measures, including Washington Group-based instruments where available. We examined social security coverage disparities, catastrophic health expenditure, chronic disease prevalence, intersectional exclusion, prospective three-year mortality, and geographic overlap with healthcare infrastructure deficits. Survey-weighted logistic regression with progressive adjustment, Benjamini\u2013Hochberg correction for multiple comparisons, and unweighted binomial models for prospective mortality were employed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 6.8 million PWD in the 2020 Census, apparent social security coverage advantages reflected a structural shift to non-contributory programs driven by older age structure; after demographic adjustment the advantage disappeared (OR = 0.99,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.30), with a modest residual protective effect after full adjustment (OR = 0.92,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Disability compounded exclusion for women (interaction OR = 1.07) and indigenous persons (interaction OR = 1.10; both\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Catastrophic health expenditure was higher among PWD households (adjusted OR = 2.02). Disease prevalence was significantly higher across all nine conditions assessed (adjusted ORs ranging from 1.46 for diabetes to 2.92 for depressive symptomatology), with less than 5% attenuation after adjustment. Prospective three-year mortality was elevated (adjusted OR = 3.77; 95% CI: 3.02\u20134.70; risk ratio 3.0), with a severity gradient reaching OR = 7.24. Non-contributory coverage was not associated with lower mortality (OR = 0.89,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.32). Geographic analysis ecologically estimated approximately 502,858 triple-vulnerable PWD concentrated in high-marginalization states.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The apparent social security advantage of PWD is an artifact of older age structure and a shift toward non-contributory programs that confer nominal affiliation without a detectable mortality benefit in this older-adult cohort, with disadvantage intensifying for indigenous women with disability. Expanding enrollment alone is likely insufficient: closing this gap requires disability-inclusive coverage that translates affiliation into effective protection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1847293","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T10:16:21Z","timestamp":1782987381000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The compounding burden of disability in Mexico: social protection gaps, chronic disease excess, and prospective mortality from national open data sources"],"prefix":"10.3389","volume":"14","author":[{"given":"Sof\u00eda","family":"Gutierrez-Perez","sequence":"first","affiliation":[{"name":"Comisi\u00f3n Estatal de Derechos Humanos Jalisco","place":["Guadalajara, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith Carolina","family":"De Arcos-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente","place":["T\u00f3nala, Mexico"]},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara","place":["Tlajomulco de Zu\u00f1iga, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauricio Alfredo","family":"Ambriz-Alarc\u00f3n","sequence":"additional","affiliation":[{"name":"Antiguo Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d","place":["Guadalajara, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian Rafael","family":"Rubio-Mora","sequence":"additional","affiliation":[{"name":"Antiguo Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d","place":["Guadalajara, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"L\u00f3pez-Y\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente","place":["T\u00f3nala, Mexico"]},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara","place":["Tlajomulco de Zu\u00f1iga, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia Noem\u00ed","family":"Vargas-Becerra","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara","place":["Tlajomulco de Zu\u00f1iga, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahian Alexandra","family":"Gonz\u00e1lez-Espinosa","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara","place":["Tlajomulco de Zu\u00f1iga, Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 \u00c1ngel","family":"Castillo-Avila","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara","place":["Tlajomulco de Zu\u00f1iga, 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