Increased risk of heart attacks – An unmeasured cost of the war on drugs in Mexico

Eileen Lee and Tim Bruckner

Since the start of the Mexican Drug War in December 2006, over 100,000 people have been murdered and over 20,000 are still missing. The escalation of violence has led to questions regarding the legitimacy and ability of political institutions, including law enforcement, to protect the public. A yet unmeasured cost of the drug war, related to living in an insecure environment, is the increased risk of dying from a heart attack.

We recently found that heart attack deaths among the elderly rose in months when Mexico’s homicide rate also rose. Our study adds to the growing literature on the collateral consequences of violence among persons who do not directly know the perpetrators or the victims. We believe that a threat, or perceived threat, to security from Mexico’s rising homicides, and the attendant media coverage, may have induced a stress response that triggered an excess of heart attacks. Given the high homicide rate in Mexico, the country provided a reasonable setting for us to test how population health responds to threats to security.

We used time-series methods to examine, from 2000 to 2012, the relation between Mexico’s monthly heart attack deaths and monthly homicides. After controlling for trend and seasonal patterns in heart attacks, we found that heart attacks among older adults rise in months when homicides also rise. This finding remained specific to heart attacks and not for other causes of death thought to be unrelated to threats to security (e.g., diabetes), which gives us confidence in our results.

A Very Brief History of the Drug War
In December 2006, then-President Felipe Calderon set out to fulfill his promise of being ‘tough on crime’. Starting with the state of Michoacán, he sent federal troops to combat the drug trafficking organizations. This long-term and sustained campaign became known as the Mexican Drug War. The goal was to weaken the illicit organizations by systematically targeting and removing the mid and top leadership.

However, the targeted removal of the top leadership created a power vacuum. New groups emerged while existing ones splintered; violence erupted as they fought for control of the billion-dollar drug trade. Within 4 years, Mexico’s population homicide rate tripled from a low of 8.1 per 100,000 in 2007 to a high of 23.7 per 100,000 in 2011. In 2011, Mexico had an annual homicide rate that was 5 times that of the United States. Homicides increased both in magnitude and level of brutality. The intense media coverage of these events arguably contributed to a general sense of unease and insecurity even in areas unaffected by high homicides. This looming threat to the security of Mexican citizens may have elevated heart attack morbidity and mortality.

Assessing the Context: Measuring the Deaths
During this time, drug trafficking organizations (DTOs) murdered, kidnapped, and extorted to intimidate and control. Drug trafficking rivalries evolved into a gruesome public affair. Victims were tortured and displayed in public areas with or without all of their body parts. Murders served as a warning to not cross the drug traffickers.

The relative impunity with which the DTOs operated and the message that they sent was clear. In the end, outspoken journalists, activists, and politicians were silenced by execution. Multiple newspapers and blogs ceased reporting on drug trafficking and drug related murders.

One thing was clear: The police and the government were unable to protect the public. However, the number of heart attack fatalities alone do not contextualize the extent to which environmental insecurity and general destabilization affected the life of Mexican citizens.

Where do we go from here?
Since 2012, homicides have fallen on average by about 10% a year but remain higher than in 2007. During this time, reports of extortion and kidnapping have increased. The progression of the drug war is often quantified in terms of dollars spent, kilos of drugs seized, and in the number of dead bodies. Deaths from heart attacks related to an increase in homicides are yet another statistic. Other questions are less clear: What is the real human cost of the drug war? Who pays for it? And most importantly, how can societies address the problem?

Read more:

Lee EH and Bruckner TA. Threats to security and ischaemic heart disease deaths: the case of homicides in Mexico. Int J Epidemiol 2016, doi: 10.1093/ije/dyw110. [Free to access until 13 September 2016]

INEGI. Mortalidad conjunto de datos: defunciones por homicidios [Table].

Heinle K, Molzahn C, and Shirk DA. Drug violence in Mexico: data and analysis through 2014. Trans-Border Institute, University of San Diego; 2015.

Sharkey P. The acute effect of local homicides on children’s cognitive performance. Proc Natl Acad Sci U S A. 2010; 107(26): 11733–11738.

This study was started when corresponding author, Eileen Lee, was a Master’s candidate at the University of California, Irvine Demographic and Social Analysis Program. She now works in Berlin, Germany as a Research Consultant for Actionable Research Inc. Dr. Tim Bruckner is an Associate Professor of Public Health at University of California, Irvine.