Abstract
BackgroundThe U.S.-Mexico Border is an area of opportunity for improved health care access; however, gaps remain as to how and where U.S. border residents, particularly those who are underinsured, obtain care. Antibiotics are one of the most common reported drivers of cross-border healthcare access and a medication of particular concern since indiscriminate or inappropriate use is associated with antimicrobial resistance. In addition, many studies assessing preferences for Mexican pharmaceuticals and healthcare in U.S. border residents were done prior to 2010 when many prescription medications, including antibiotics, were available over the counter in Mexico.MethodsData used in this study were collected during the baseline examination of an ongoing longitudinal cohort study in Starr Country, Texas, one of 14 counties on the Texas-Mexico border. Participants self-reported the name, date of use, and the source country of each antibiotic used in the past 12 months. Logistic regression was used to determine social, cultural, and clinical features associated with cross-border procurement of antibiotics.ResultsOver 10% of the study cohort reported using antibiotics in the past 30 days with over 60% of all rounds used in the past 12 months sourced from Mexico. A lack of health insurance and generation score, a measure of acculturation, were the strongest predictors of cross-border procurement of antibiotics.ConclusionsFactors previously associated with cross-border acquisition of antibiotics are still present despite changes in 2010 to prescription drug regulations in Mexico. These results may be used to inform future public health initiatives to provide culturally sensitive education about responsible antibiotic stewardship and to address barriers to U.S. healthcare and pharmaceutical access in medically underserved, impoverished U.S.-Mexico border communities.
Highlights
2,000 miles long and spanning 62 miles north-tosouth, the border between the United States (U.S.) and Mexico encompasses 80 Mexican municipalities and 44 U.S counties with approximately 15 million people in residence [1, 2]
The socioeconomic status of U.S border residents is disproportionately lower than their respective state populations and the U.S average [4] such that if the 23 counties contiguous with the border formed a “51st state” it would have the lowest proportion of residents with a high school education and rank last in per capita income and primary health care accessibility [2, 5]
Healthcare providers and policymakers alike have long established that the U.S.-Mexico Border is an area of opportunity for improved health care access; gaps remain as to where and how U.S border residents, those who are uninsured or underinsured, obtain care [3]
Summary
2,000 miles long and spanning 62 miles north-tosouth, the border between the United States (U.S.) and Mexico encompasses 80 Mexican municipalities and 44 U.S counties with approximately 15 million people in residence [1, 2]. Healthcare providers and policymakers alike have long established that the U.S.-Mexico Border is an area of opportunity for improved health care access; gaps remain as to where and how U.S border residents, those who are uninsured or underinsured, obtain care [3]. The U.S Bureau of Transportation Statistics reported over 275 million crossings in 2019 alone [2] with prior studies indicating a high proportion of northbound crossings are U.S residents returning from medical treatment or the purchase of medications in Mexican pharmacies [6–9]. Many studies assessing preferences for Mexican pharmaceuticals and healthcare in U.S border residents were done prior to 2010 when many prescription medications, including antibiotics, were available over the counter in Mexico
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