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Design, develop, and implement the strategic information system on health, dependence, and healthy aging: an analysis of the Mexican experience

Population Health Metrics volume 22, Article number: 23 (2024) Cite this article

Abstract

Background

The Decade of Healthy Aging (2021–2030) emerges as a 10 years strategy to improve the lives of older adults, their families, and the communities in which they live. One of the actions defined in this framework is related to improving the measurement, monitoring, and understanding of characteristics, factors, and needs related to aging and health. The aim was to analyze and assess the process of construction and development of the Strategic Information System on Health, Funcional Dependence and Aging (SIESDE, for its acronym in Spanish). SIESDE will provide strategic information in Mexico at the municipal, state, and national levels that support the public policies on healthy aging.

Methods

The system processes and analyzes the data sources of the Health Information Systems and the National System of Statistical and Geographical Information. SIESDE comprises three components: (1) Design, construction, and evaluation of the indicators; (2) storage, management, and visualization, and (3) diffusion and translation of information.

Results

A total of 135 indicators were built on seven themes: (1) demographic, socioeconomic, and aging conditions, (2) health, (3) functional dependence, (4) healthy aging, (5) health services, (6) social and physical environments, and (7) complex indicators.

Conclusions

SIESDE is an effective system for providing an overall view of health, aging, and functional dependence.

Peer Review reports

Introduction

The Decade of Healthy Aging (2021–2030) emerges as a ten-year strategy that frames the commitment of different actors working together in the implementation of concerted, catalytic, and collaborative actions to improve the lives of older adults, their families, and the communities in which they live [1]. One of the actions defined in this framework is related to improving the measurement, monitoring, and understanding of characteristics, factors, and needs related to aging and health.

To conduct research and evidence synthesis, the World Health Organization’s (WHO) Consortium on Metrics and Evidence for Healthy Aging was integrated in 2017 as a group of policy-makers, members of civil society, and researchers from all WHO regions [2]. The key objectives are to improve the monitoring and translation of knowledge that impacts older adults’ quality of life. To track progress in healthy aging, data must be generated to compare and assess global progress [3].

In Mexico, as in many other countries in Latin America, because of decreased fertility and an increased life expectancy, a rapid increase in the number of older is being experienced. According to its country’s Population and Housing Census, individuals aged 60 years and older represented 12.0% in 2020 and it is estimated to reach 22.5% in 2050. However, the health conditions in which is being attained and older persons are far from favourable due to the increase in cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes [4]. Depending on each locality's socioeconomic and health resources, different sectors of the population experience an unequal impact of non-communicable diseases (NCD). However, these are still concentrated within groups with more significant social disadvantages [5] and continue to produce a severe deterioration in health, resulting in premature mortality and disability [6, 7]. Subsequently, a healthy life expectancy has not increased in parallel to life expectancy alone, traducing in considerable multimorbidity, frailty, and functional dependency. NCD increased prevalence, and its consequent impact on people’s functional dependency constitute one of the leading health challenges for Mexican society in the twenty-first century [8, 9].

Currently, data sets in their different forms, statistical and geographical, are necessary resources to locate, point out, and make the main public challenges visible. It is the basis for the design, monitoring, and evaluation of public policies that seek to serve the population. Although the production of information in Mexico is increasingly abundant in thematic and temporal coverage, its mere availability does not guarantee immediate articulation with the national priorities, such as guaranteeing the well-being and health needs of the population.

Despite the robustness of Mexico’s Health Information Systems (SIS, for its acronycm in Spanish) and the National Statistical and Geographic Information System (SNIEG, for its acronym in Spanish), data are fragmented, partial, and unrelated to addressing health, functional dependency, and aging. In this context, data science is an indispensable tool in the public sphere since it would contribute in the improvement of data performance through the construction of a system that generates strategic information oriented towards decision-making and the implementation of assertive actions that can have an impact in the reduction of NCD and functional dependency prevalence.

In this sense, the present work aims to analyze and assess the process of construction and development of the Strategic Information System on Health, Funcional Dependence and Aging (SIESDE, for its acronym in Spanish), to identify its strengths and weaknesses and to recognize its scope in the design of public policies that can have an impact on the aging population.

Material and methods

This project presents the process of the design, development, and implementation of the SIESDE, based on the Health Metrics Network (HMN) proposed by the World Health Organization (WHO). SIESDE is a proposal generated by the National Institute of Geriatrics (INGER for its acronym in spanish) in collaboration with the Institute of Geography (IGG-UNAM for its acronym in spanish), the University of Colima (UCOL for its acronym in spanish), and the Center of Excellence and Innovation/Christus Health International (CEI). Funded by the National Council of Humanities, Science and Technologies (CONAHCYT  for its acronym in spanish), upon being selected in the 2019 call for Data Science and Health Projects, derived from the National Strategy-Health Program (Pronaces-Salud, for its acronym in Spanish). The project development period was 29 months (2020–2023) and since March 2023, SIESDE has been available on the website https://saludyenvejecimiento.inger.gob.mx/, with free access. An interdisciplinary working group was formed, made up of 26 researchers from different areas of knowledge (medicine, gerontology, social sciences, demography, programming, technological development and innovation, data science and social communication). To achieve the goals of the project, the organization of the working group was carried out based on a general coordination and four groups: (1) Design and construction of the system (development of the methodological and conceptual framework to guide the project process); (2) Methodologies (Responsible for the design, construction and evaluation of statistics and indicators); (3) Visualization and accessibility of information (development group of the computer platform, website and geovisor) and (4) Transfer and dissemination of knowledge (design products corresponding to the virtual center).

A documentary review of indicators at the international and national level was carried out, as well as an exploration of available sources of information in a comprehensive manner from the perspective of healthy aging. In the working groups in charge of construction of the system and methodologies, the definition of priority indicators for their estimation and data management was discussed [10, 11]. All researchers involved are experts in the topic and consensus was reach during the several meetings. Every indicator was evaluated according to the type of information as presented in Results section. Regarding the dashboard, a review of the characteristics of each indicator (level of disaggregation and crossing with other variables) was carried out to then define the basic components of the dashboard and particularities, as well as the scope and limitations of the visualization proposal[12].

Setting

Although the production of statistical, geographic and health information in Mexico is abundant in terms of thematic and temporal coverage and level of disaggregation, the data are fragmented and disconnected when it comes to addressing health, functional dependence and aging in Mexico. Derived from this scenario, the proposal Strategic Information System on Health, Functional Dependence and Aging (SIESDE) arises as an information system that feeds on the available information and transforms it into indicators that account for the conditions in which the Mexican population ages.

SIESDE aims to provide strategic information in Mexico at the municipal, state, and national levels that supports the design, monitoring, and evaluation of public policies on health, functional dependence, and healthy aging. The system processes and analyzes the data sources of the Health Information Systems and the National System of Statistical and Geographical Information and generates statistics and indicators from a demographic, epidemiological, socioeconomic, and spatial perspective. This system is installed on an informatics platform. It includes a center for disseminating and transferring knowledge to contribute to preserving and improving the quality of life and well-being of all.

The SIESDE is a set of coordinated components and procedures for the processing, analysis, administration, storage, and transfer of information required to improve the health of the Mexican population (Fig. 1).

Fig. 1
figure 1

Source Own elaboration

Components and procedures of the Strategic Information System on Health, Functional Dependence and Aging (SIESDE).

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Results

The construction of the SIESDE comprises three components: (1) design, construction, and evaluation of the indicators; (2) storage, management, and visualization, and (3) diffusion and translation of information.

Design, construction, and evaluation of the indicators

The process to generate indicators for the SIESDE comprised three stages: (i) design, (ii) construction, and (iii) evaluation. In the design stage, efforts were concentrated on the documentary review to define the thematic structure, the search for indicators proposed in the international and national framework, as well as the exploration of available information sources to measure health conditions, function dependence, and aging in Mexico. In particular, the framework of healthy aging and the Decade of Healthy Aging promoted by the WHO [1, 13], are the basic guidelines for the design and structure of the indicators, as well as the review of other open access indicator platforms available from different national, international and regional institutions. Also, workshops were also with experts in aging, health, demography, and spatial perspective to prioritize indicators.

The SIESDE's thematic structure is based on seven themes:

  1. (i)

    Demographic, socioeconomic, aging conditions: demographic situation of Mexico, the characteristics of its population, and socioeconomic condition.

  2. (ii)

    Health: status and trends of the health situation and risk factor in the Mexican population.

  3. (iii)

    Functional dependence: corresponds to experiencing difficulty, due to a physical or mental limitation, and the need for help to perform activities of daily living (ADL). In terms of the availability of information, there are few data sources in Mexico that allow an approach to the analysis of functional dependence in Mexican Health and Aging Study (MHAS) and the National Survey of Health and Nutrition are important instruments, but they are limited to account for the conditions and degrees of dependence and level of disaggregation. For the SIESDE, it was necessary to have a higher level of disaggregation and characterization of functional dependence, for which information from the 2020 Population and Housing Census was used, which added, for the first time, a battery of disability questions based on in the methodology of the Group of Washington (WG) and the Conceptual Framework of Reference of International Functioning, Disability and Health (CIF)[14, 15].

  4. (iv)

    Healthy aging: show opportunities to maintain and improve health, delay dependence.

  5. (v)

    Health services: generate evidence on the conditions of the health system in Mexico.

  6. (vi)

    Social and physical environments: give the advances in the elimination of physical and social barriers in the cities and localities.

  7. (vii)

    Complex indicators: three indicators of healthy aging were built based on different indicators and sources (Global Age Watch Index [16], Active Ageing Index [17], Measuring the age-friendliness of cities [18]), aggregated at the national and state level (Table 1).

Table 1 SIESDE. Thematic structure
Full size table

SIESDE produces indicators with three main sources: Census, Population Surveys, and Administrative Records. Likewise, the indicators generated by Global Burden Disease were downloaded and ordered [19] (Table 1). We generate information from a wide set of topics within each source of information, so we only evaluated the capacity and practices to collect, process, and analyze data; dissemination data (public access); and integration and use of data. The census was considered the main source of information for SIESDE because it has the advantage of generating information for Mexico’s three levels of government: national, state, and municipal. However, this source has limitations in generating information on the health status of the Mexican population, the quality of health services, and the degree of adaptation of the environments to the needs of older adults. For this reason, the SIESDE also used a set of Household Surveys and Administrative Records as sources of information. Estimates of healthy life expectancy indicators and disease burden from the GBD Study were also used.

In the construction stage, the objective of each indicator and its importance were defined, the variables necessary for the calculation were identified, the calculation method, formula, periodicity and geographic disaggregation were determined. Then, we estimated the indicator and prepared a metadata sheet, which summarizes the main characteristics of each indicator, as well as an information source file, which specifies the variables extracted for each indicator. When analyzing the availability of previous years and the regularity with which new rounds of information sources are generated, it was necessary to consider the automation of indicator ordering and generation processes, which allow new indicators to be added quickly and thus keep the data updated. SIESDE. The indicator automation process consists of building a generic code that allows calculating, filtering, ordering, and exporting the data of a certain indicator so that the result obtained can be uploaded to the database no adjustment required. Python was chosen as the language to automate some indicators because it has multiple libraries and frameworks that facilitate and reduce the time to perform multiple tasks required in the data science area. In total, 32 indicators were automated based on the Censuses and Population Counts (2000, 2005, 2010), MHAS (2001, 2003, 2012, 2015, 2018, 2021), National Survey of Household Income and Expenses (2016, 2018, 2020), Open data from the Ministry of Health: Registry of Deaths (2000 to 2020) and Global Burden of Disease (2001 to 2019).

In the evaluation stage, the indicators were evaluated according to the type of information used. For indicators generated from census samples (extended questionnaire) or probabilistic surveys, the evaluation included two stages: the evaluation of the design and the characteristics of the source, from the review of criteria that account for the coverage, content, relevance, consistency, and indicator reliability; and the evaluation of the accuracy of the data, obtained based on the estimates of the standard error, coefficient of variation, and confidence interval. While the evaluation of indicators generated from censuses or administrative records only required the evaluation of the design and characteristics of the source of information.

For the SIESDE was built 135 indicators, which presents a favorable evaluation because of a rigorous process followed by the election of each indicator, of which 32.6% (n = 44) corresponds to the topic Demographic, socioeconomic, and aging conditions, 17.0% (n = 23) Health, 16.3% (n = 22) Functional dependence, 8.1% (n = 11) Healthy aging, 8.9% (n = 12) Health services, 14.8% (n = 20) Social and physical environments, and 2.2%(n = 3) Complex indicators.

The selected indicators proposed for the system by the working group are adequate since they are framed from the healthy aging approach. Although the Sustainable Development Goals (SDGs) indicators were reviewed, more essential frameworks of reference needed to be provided for the indicator proposal. However, the proposal of the group of experts regarding the information needs in different fields of decision-making was incorporated. Regarding the methodological elements, some indicators cannot be obtained in a regular base, due to the unavailability of the questions in all the rounds or from the sources themselves in previous years. (Fig. 2 and Table 2).

Fig. 2
figure 2

Source Own elaboration

Assessing indicators.

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Table 2 Components for the evaluation
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Storage, management, and display of indicators

The website http://saludyenvejecimiento.inger.gob.mx/ was created as a space for presentation, dissemination, and exchange, where general information on the project and working group is displayed, and the documents are available for viewing and downloading scientific-graphic resources generated by SIESDE (newsletters, sociodemographic and health profiles, thematic analyses, infographics, and video capsules) through the Virtual Knowledge Center. There is also a repository that allows the linking and consultation of the documentary material corresponding to the construction and development of the SIESDE, a glossary of the system, as well as reports and reports of interest.

The dashboard is the web application where the indicators of the SIESDE are located and from where they can be viewed in graph, table, and map (http://saludyenvejecimiento.inger.gob.mx:3000/). The dashboard architecture is divided into three delimited entities: (a) Front End: is what users can see and manipulate and was built using React, TypeScript, and HighCharts technologies; (b) Back End (what the user does not see but allows the information to be manipulated; it is made up of an API (Application Programming Interfaces). The API-Rest allows the frontend to communicate with the database and was built with Python and Flask technologies, and (c) Database, which allows information to be stored, in this case from the indicator tables, and was developed using MySQL (Fig. 2). The structure of the MySQL database is based on an entity relationship structure, where each indicator corresponds to a table.

Geographic Information Systems (GIS) are systems that allow the integration and analysis of geographic information, allowing the data obtained to be displayed on a map, which is a flat, reduced, and simplified representation of the Earth's surface or a part of it. GIS integrate information through layers or data covers that are superimposed on each other, depending on the information required. From the integration by the superimposition of these layers, a thematic map is obtained, a graphic representation of a specific theme. In recent years, Web-based GIS has contributed to many applications for displaying and editing cartography in virtual environments. In this context, one of the objectives of SIESDE is to develop a map viewer for displaying indicators through thematic maps. The technologies used for the development of the map viewer are HTML, CSS, Javascript (J Query), and for the Geoserver Back End.

In an integral way, the user interacts with the system through the Front End in its three components that are linked in turn with the Back End components and the database (Fig. 3).

Fig. 3
figure 3

Source Own elaboration

System architecture diagram.

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In the process of designing and developing the interface of the platform, constant communication was necessary between the developers and the indicator generation group to define the elements that needed to be incorporated to visualize the indicators and their breakdown according to the availability, our interest in making visible contexts and specific population, improving the specificity of indicators that were available on other platforms and possible consultation requirements. The elements of the dashboard interface are described below (Fig. 4): (1) Menu: display all subtopics to user; (2) Dropdown Menu: allow users to see the indicators corresponding to each subtopic; (3) Dropdown filters: allow users to select the chart type (compare by ages group, states, totals), level of disaggregation (state and/or municipality) and the variables available to cross the indicators (sex and other characteristics) and available years (period); (4) Information and Precision Botton: allow users to view and download the selected indicator´s, metadata and source file. The precision button can be used to consult and download the table with the elements of statistical precision and commands for its calculation in Stata (txt format) for those indicators that were estimated based on samples; (5) Map Botton: to allow users to consult the thematic map of the indicator; (6) Chart: the graphical representation of the selected indicators is displayed with the possibility of exporting in pdf and image format (JPG and PNG) and (7) Table: users consult and download the table of the selected indicator. Throughout the development of the dashboard, it was necessary to review and validate the display of each indicator in all its elements and define the clearest way that would allow the user to consult intuitively.

Fig. 4
figure 4

Landing page of the dashboard

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One of the main objectives of SIESDE is to assertively disseminate information generated between the scientific community, public instances, and the population in general, promoting its use, appropriation, and application. It should be remembered that dissemination is a multidisciplinary task focused on communicating scientific knowledge and bringing information closer to the different sectors of society, implying a challenge because it is not necessarily there is a similar level of knowledge between users. Therefore, it requires non-technical and contextualized language to make it accessible, enjoyable and of interest to the public.

A Virtual Knowledge Transfer Center promoves the use of information´s SIESDE. This tool allows  to disseminate  and transfer the information and knowledge generated at SIESDE through various scientific-graphic resources (health profiles, comparative analyzes, bulletins, infographics) to decision-makers, academics, and social actors in health.

A set of 33 health profiles, ten comparative analyzes, eight bulletins, ten infographics, and 4 videos were done. The profiles provided an overview of the state of health and aging of the population at the national level and in each of the states. The comparative analysis allowed us to review the contrasts between the conditions in which older people within the country, and considering different levels of dependence. The bulletins exposed the main characteristics of the SIESDE, its usefulness for the generation of public policies, the prevalence of dependence in the Mexican population and the need for long-term care, the conditions of access and quality of health services in Mexico, the adaptation of environments to the aging process, and mortality levels. The infographics were designed for distribution to decision-makers and the public. They contained a set of basic indicators to summarize relevant information on aging, health, dependence, access to services, mortality, and favorable environments. One of the elements added to its portfolio is four videos, in which different researchers explain the process followed to build the SIESDE, comment on its characteristics, and the importance of its use for generating public health policies.

The SIESDE has adequate management of its components since the evaluation and calculation processes for the generation of indicators are clearly and precisely presented, as well as the analysis and presentation of information translated into bulletins, infographics, and health profiles. In addition, the dashboard components integrate, in a structured and user-friendly way, the indicators from various sources and topics in one place, but always considering the methodological recommendations for the presentation of metadata proposed by the SNIEG.

Discussion

With the objective of improving the lives of older people, SIESDE focuses on providing an overall view of health, aging, and functional dependency markers that can help build public policies that benefit the aging population, gain NCD prevention and control, and strengthen data systems in Mexico. The SIESDE will provide the greatest utility for detecting thematic gaps, harmonizing and standardizing concepts and methodologies in the development of statistics and indicators, concentrating and articulating key information related to aging, and producing relevant, quality and timely information to better meet the needs of the Mexican adult and older persons.

Through the review by the group of experts, the importance of aging and health indicators in Mexico today is shown, as well as the importance of facilitating the work with their availability on a freely accessible site. One of the main difficulties that SIESDE faces is its sustainability that depends, at least in part, of policy decisions but aging is a topic that has been gained relevance and we expect that the SIESDE  become a priority. Some countries and organizations have made efforts to improve the visualization of health statistics of the aging population around the world. [19,20,21,22,23], but they are limited to differentiating information by age groups and do not focus on the particularities of older people and the specific information needs in this field. Local efforts have been made to generate data on aging from this perspective [24, 25]. Compared to these dashboards, SIESDE constitutes a data system with national coverage and even with a level of disaggregation by state and municipality. In addition, the calculation and interpretation information for each indicator is available on dashboard, which constitutes a way of making the processes transparent and replicable.

Efforts must be directed at continuing to generate indicators that allow us to respond to the needs of the population. For example, SIESDE is limited in information on care due to the little information generated in our country and the lack of regulation of long term care institutions and caregivers [26].

Geographical data visualization tools have also been developed to aid in the analysis and exploration of large demographic datasets [27,28,29], which is often a difficult task. To our knowledge, SIESDE represents the first robust data visualization tool in Mexico that allows the further exploration and geographical localization of various datasets relating to demographics, health, aging, and functional dependence.

Another aspect detected in the review of available sources is related to the availability of health data that allow for a closer approach to care, considering the fragmentation of the health system. Electronic tools used to provide Mexico’s health authorities other ways to visualize, interpret, and analyze data at a subdistrict, district, or state level, have been established with success and proved helpful in improving quality standards and achieving indicator targets in a short period of time [30].

Among many other information and communication technologies, visualization tools in data science are used to transform raw information into easily understood and organized data [31]. One of the many advantages of implementing a strategic tool for health information analysis that by making, otherwise unused and fragmented data, noticeable, ways for revealing patterns and data-driven hypothesis can be attained. WHO has emphasized the importance of data visualization methods to explore and communicate quantitative and qualitative data and deliver concise insights about health topics [32].

Strategic digital information tools are essential for data analysis. By reviewing quality indicators, health system planners can have a broad scope on the current burden of NCD and the aging and functional dependence situation in Mexico. However, further prospective studies are required to determine if the implementation of SIESDE is efficient in fulfilling the goal of improving the lives of older people, in addition to seeking to achieve the sustainability of SIESDE [33, 34].

Conclusions

In the absence of a single accessible information system, the SIESDE represents an effort to cover this need and generate evidence at different levels for the design and evaluation of public policies aimed at addressing, controlling, and reducing the prevalence of disability, NCD and consequent dependence, as well as the design of specific programs for adults and old persons. Also, it offers in a single site data and statistics that allow dimensioning the complexity of aging.

The SIESDE generates public value by creating objective conditions (high quality service) and subjective conditions (institutional identity and support to collaborate with other actors) to promote healthy aging in the Mexican population through the production, dissemination and use of scientific knowledge, the development and training of human resources and the provision of health services aimed for older people.

Availability of data and materials

Not applicable.

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Acknowledgements

Not applicable.

Funding

This project was funded by Consejo Nacional de Humanidades, Ciencia y Tecnologías (CONAHCYT), project number FORDECYT-PRONACES/9155/20 and by Instituto Nacional de Geriatria.

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Authors and Affiliations

  1. Instituto Nacional de Geriatría, Ciudad de México, Mexico

    Luis Miguel Gutierrez-Robledo, Rosa Estela García-Chanes, Emely Estefanía Max-Monroy, Liliana Giraldo-Rodríguez, Teresa Álvarez-Cisneros, Ana Cristina Gómez-Ugarte, José Antonio de la Rosa-Parra, Fernando Rebollar-Castelán, Víctor Montaño-Serrano, Francisco Gerson Cuero-Muciño, Roberto Carlos Rivera-González & Carmen García-Peña

  2. Unidad Académica Profesional Tianguistenco, Universidad Autónoma del Estado de México, Estado de México, Mexico

    Ángel Gabriel Estévez-Pedraza

  3. Christus Excellence and Innovation Center, Monterrey, Mexico

    Sara Gabriela Yeverino-Castro & Santiago Yeomans-Almada

  4. El Colegio de la Frontera Norte, Departamento de Estudios de Población, Tijuana, Baja California, Mexico

    Abigail Vanessa Rojas-Huerta

  5. Instituto de Geografía, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico

    Luis Octavio Ramírez-Fernández

  6. Universidad de Colima, Colima, Mexico

    Cesar González-González

Authors
  1. Luis Miguel Gutierrez-Robledo
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  2. Rosa Estela García-Chanes
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  3. Emely Estefanía Max-Monroy
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  10. Víctor Montaño-Serrano
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  13. Sara Gabriela Yeverino-Castro
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  14. Abigail Vanessa Rojas-Huerta
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  15. Luis Octavio Ramírez-Fernández
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  16. Cesar González-González
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  17. Santiago Yeomans-Almada
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  18. Carmen García-Peña
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Contributions

All authors are the working group that developed the System. CGP had the original idea and REGC and EEMM wrote the first draft. CGP, SGYA and LMGR reviewed and added additional ideas. TAC, LGR, CGG added additional conceptual ideas. EEMM, ACGU, JADP, RCRG developed the methods and results section. AGEP, FRC, VMS, FGCM, SGYC, SYA developed the results section corresponding to the platform and website. AVRH and LORF developed the map viewer section.

Corresponding author

Correspondence to Carmen García-Peña.

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The authors declare no competing interests.

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Gutierrez-Robledo, L.M., García-Chanes, R.E., Max-Monroy, E.E. et al. Design, develop, and implement the strategic information system on health, dependence, and healthy aging: an analysis of the Mexican experience. Popul Health Metrics 22, 23 (2024). https://doi.org/10.1186/s12963-024-00345-x

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Keywords

Population Health Metrics

ISSN: 1478-7954