title: The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.
abstract: BACKGROUND
  Substantial proportions of US residents in the USA-Mexico border region cross into Mexico for health care; increases in violence in northern Mexico may have affected this access. We quantified associations between violence in Mexico and decreases in access to care for border county residents. We also examined associations between border county residence and access.
  
  
  METHODS
  We used hospital inpatient data for Arizona, California and Texas (2005-10) to estimate associations between homicide rates and the probability of hospitalization for ambulatory care sensitive (ACS) conditions. Hospitalizations for ACS conditions were compared with homicide rates in Mexican municipalities matched by patient residence.
  
  
  RESULTS
  A 1 SD increase in the homicide rate of the nearest Mexican municipality was associated with a 2.2 percentage point increase in the probability of being hospitalized for an ACS condition for border county patients. Residence in a border county was associated with a 1.3 percentage point decrease in the probability of being hospitalized for an ACS condition.
  
  
  CONCLUSIONS
  Increased homicide rates in Mexico were associated with increased hospitalizations for ACS conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition. Expanding access in the border region may mitigate these effects by providing alternative sources of care.
authors.affiliation: Department of Markets, Public Policy, and Law, Boston University School of Management, Boston, MA, USA Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Geissler
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.affiliation: Department of Economics, Duke University, Durham, NC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Becker
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D001130:Arizona / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011336:Probability; D013781:Texas / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: USA–Mexico border region; ambulatory care sensitive condition; healthcare access; violence