Health coverage for people without social security in Mexico: a retrospective cohort to assess childhood acute lymphoblastic leukaemia survival

We aimed to measure survival of children with acute lymphoblastic leukaemia (ALL) under Mexico’s public health insurance for the population without social security, and explore patient groups that may be at risk for increased mortality. We conducted a retrospective cohort study using claims data from Mexico’s Seguro Popular program, covering cancer treatment in people without social security, 2005-15. We estimated 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this public healthcare insurance scheme. 8,977 children with ALL were treated under Seguro Popular in 2005-15. Under this financing scheme, treated children doubled from 535 in 2005 to 1,070 in 2015, and their 5-year survival was 61.8% (95%CI 60.8, 62.9). Estimates for 5-year survival remained constant over time. We observed wide gaps in risk-standardized 5-year survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-paediatric specialty hospital (Hazards Ratio, HR=1.18; 95%CI 1.09, 1.26), facilities without a paediatric oncology/haematology specialist (HR=2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR=1.22; 95%CI 1.13, 1.32). In a decade Mexico’s Seguro Popular doubled access to ALL treatment for children without social security and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year survival was unsatisfactory and did not improve over time. Our results provide lessons for Mexico’s evolving health system and for countries moving towards universal health coverage. Novelty and impact There has been no comprehensive assessment of the health outcomes of Mexico’s policy for financing high-cost cancer treatments that was part of Seguro Popular , health reform aimed at providing care to the population without social security. The study identified several factors amenable to intervention that could improve survival for childhood ALL in Mexico and reduce the observed disparities. Decision could consider administrative databases as a source of clinical outcomes to ensure the quality their systems. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was funded by Fundacion Rio Arronte and the National Council for Science and Technology (Mexico). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The project was approved by the Institutional Review Board at the National Institute of Public Health (P121-18/CI:1586). All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data is currently not available.