La investigación en diabetes en México: un mapa de 13 años de financiamiento público

Rojas-Rajs, Soledad; Natera, José Miguel; Gómez, Oswaldo Sinoé Medina

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ARTICLE • Cad. Saúde Pública 34 (9) • 2018 • https://doi.org/10.1590/0102-311X00090717 copiar

La investigación en diabetes en México: un mapa de 13 años de financiamiento público

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen:

En México la diabetes es un grave problema de salud pública y es una enfermedad de alto costo para el sistema de salud. La investigación en salud es esencial para generar nuevo conocimiento para combatir este problema, pero existe escasa información sobre su generación y uso. Este trabajo examina el financiamiento público de 303 proyectos de investigación sobre diabetes, otorgados por el Consejo Nacional de Ciencia y Tecnología en México, entre 2002 y 2014. Los proyectos fueron sistematizados y clasificados de acuerdo con el tipo de investigación, disciplina o temática, y objetivo de generación de conocimiento. Con estos datos, se elaboró un modelo econométrico que relacional el financiamiento con las características de los proyectos. Los resultados muestran que el financiamiento está centrado en áreas básica y biomédica, particularmente en investigación genética, y que los recursos destinados a la investigación en diabetes se han incrementado en el tiempo pero no de manera constante, sino coyuntural. En los proyectos de investigación sobre diabetes hay un alto nivel de concentración en varias dimensiones: áreas de investigación, temáticas, objeto de estudio, instituciones que realizan la investigación, y regiones. El análisis de la asignación de recursos sugiere que México necesita una agenda de investigación en diabetes más fuerte y orientada, con fundamento en discusiones sobre el equilibrio entre investigación básica y aplicada, y sobre investigación orientada hacia implementaciones de tipo práctico. SE discute también la importancia de promover investigación sobre el sistema de salud para mejorar el cuidado a los pacientes con diabetes, así como la de implementar mecanismos para evaluar el impacto de la investigación en diabetes a corto, mediano y largo plazo, como parte de la política de ciencia y tecnología en México.

Palabras-clave:
Diabetes Mellitus; Investigación; Financiación de la Investigación; Financiación Gubernamental

Fund	Diabetes research		Amount of funding
Fund	Number	%	Amount (USD millions PPP 2011 year)	%
FOSIB	126	41.6	21.8	36.4
FOSISS	150	49.5	33.4	55.6
FPDCAPN	27	8.9	4.8	8.0
Total	303	100.0	60.0	100.0

Type of research	Description
Basic	Studies not conducted in living humans, but in animal models, tissues, or ex vivo organs.
Biomedical	Studies in living humans, not involving interventions, but the development of basic knowledge on pathological (genesis, evolution) or biological (i.e. genetic expression studies) processes.
Clinical	Patient-centered research on pathology diagnosis, treatment, and evolution, including preclinical and clinical research.
Public health	Studies on the distribution and determinants of conditions or events (particularly diseases) related to health and the implementation of such studies for diseases and other health problems control. Includes epidemiological surveillance and descriptive studies, as well as analytical studies on health determinants and risk factors. Researched at population level.
Health systems	Studies about the care of health problems by service providers, assessing technical, operational, financial, and administrative aspects related to the provision of health services.

Knowledge application objects	Description
Studies	Research focused on knowing the nature of health-disease processes, whose main purpose is to generate new knowledge.
Technique	Research focused on the development or improvement of medical practice application criteria or forms. Includes the definition or modification of critical values on pathological processes, and research on genetic biomarkers.
Phytopharmaceuticals	Development and characterization of the healing properties of plants for the treatment of pathologies.
Medical device	Objects, medical equipment or materials useful in the treatment of diseases.
Evaluations	Research aimed at verifying the technical or economic efficiency of the system or the health care strategies.
Interventions	Alternative proposals or modifications to treatments or care models to be implemented into a population.

Variables	Description
Funding amount	Number of actual millions of MXN - the year 2002 as reference - with which each research project was funded by the various mechanisms of CONACYT.
Type of research	Classifies the projects according to their research: Basic, Biomedical, Clinical, Public health, or Health systems. By collinearity, Basic research is considered a reference; therefore, the results of this dimension may be interpreted as deviations against this type of research.
Research topic	Discriminates the projects according to Biology and biochemistry, Genetics, Risks and determinants, Pharmacology, Pathophysiology, Nutrition, or Health care models. The reference research topic to be used for avoiding collinearity is Genetics.
Knowledge application objects	Dimension that categorizes the projects according to their final result. The categories considered are: Studies, Techniques, Phytopharmaceuticals, Medical device, Evaluations, or Interventions. In this case, collinearity will be avoided using the variable “Interventions” as the basis of deviation.
Research institution	Indicates the research institution that received the funding. Five institutions have been considered: The Mexican Social Security Institute (IMSS), the National Institute of Public Health (INSP), the Center for Research and Advanced Studies (CINVESTAV), the National Autonomous University of Mexico (UNAM), and the Metropolitan Autonomous University (UAM).
Research region	Considering the high concentration on Mexico City and the State of Morelos, projects are classified by sorting out the institutions that are not located in the states gathering most of the projects. Therefore, the variable created is called “NoCDMX-NoMorelos”.
Starting year of research	Figure 1 indicates a 2004-2010 positive promotion of research; therefore, it will be measured if the projects funded during these years are distinct from the others.
Call	Points out if the projects belong to FOSIB or FOSISS. The FPDCAPN was not used as a variable since there are very few projects thus funded.

	Model: type of research & region	Model: research topic & region	Model: knowledge application objects & region	Model: research institution	Model: research topic & research institution	Model: research type & research institution
Type of research
Biomedical	-0.221 *	-	-	-	-	-0.198 *
	(0.099)	-	-	-	-	(0.100)
	[-2.22]	-	-	-	-	[-1.99]
Clinical	-0.308 *	-	-	-	-	-0.317 *
	(0.121)	-	-	-	-	(0.125)
	[-2.56]	-	-	-	-	[-2.54]
Public health	-0.22 **	-	-	-	-	-0.311 *
	(0.119)	-	-	-	-	(0.128)
	[-1.85]	-	-	-	-	[-2.42]
Health systems	-0.322 **	-	-	-	-	0.175 ***
	(0.168)	-	-	-	-	(-2.500)
	[-1.92]	-	-	-	-	[0.013]
Research topic
Biology & biochemistry	-	-0.247 *	-	-	-0.255 *	-
	-	(0.112)	-	-	(0.111)	-
	-	[-2.20]	-	-	[-2.30]	-
Risk & determinants	-	-0.400 *	-	-	-0.467 ***	-
	-	(0.169)	-	-	(0.172)	-
	-	[-2.37]	-	-	[-2.72]	-
Pharmacology	-	-0.266 **	-	-	-0.297 *	-
	-	(0.141)	-	-	(0.138)	-
	-	[-1.89]	-	-	[-2.15]	-
Pathophysiology	-	-0.243 **	-	-	-0.237 **	-
	-	(0.143)	-	-	(0.142)	-
	-	[-1.69]	-	-	[-1.67]	-
Nutrition	-	-0.343 *	-	-	-0.450 ***	-
	-	(0.154)	-	-	(0.155)	-
	-	[-2.23]	-	-	[-2.91]	-
Health care models	-	-0.343 *	-	-	-0.452 ***	-
	-	(0.172)	-	-	(0.173)	-
	-	[-2.00]	-	-	[-2.62]	-
Knowledge application objects
Studies	-	-	-0.053	-	-	-
	-	-	(0.130)	-	-	-
	-	-	[-0.40]	-	-	-
Technique	-	-	0.245 **	-	-	-
	-	-	(0.147)	-	-	-
	-	-	[1.66]	-	-	-
Phytopharmaceuticals	-	-	0.070	-	-	-
	-	-	(0.203)	-	-	-
	-	-	[0.34]	-	-	-
Medical device	-	-	-0.041	-	-	-
	-	-	(0.198)	-	-	-
	-	-	[-0.21]	-	-	-
Evaluations	-	-	-0.303	-	-	-
	-	-	(0.207)	-	-	-
	-	-	[-1.47]	-	-	-
Research institution
IMSS	-	-	-	0.200 **	0.192 **	0.240 *
	-	-	-	(0.116)	(0.113)	(0.113)
	-	-	-	[1.72]	[1.70]	[2.13]
INSP	-	-	-	0.303 *	0.418 ***	0.405 ***
	-	-	-	(0.131)	(0.132)	(0.135)
	-	-	-	[2.30]	[3.17]	[3.01]
CINVESTAV	-	-	-	0.422 *	0.377 *	0.344 **
	-	-	-	(0.183)	(0.180)	(0.180)
	-	-	-	[2.31]	[2.10]	[1.91]
UNAM	-	-	-	0.124	0.118	0.037
	-	-	-	(0.119)	(0.113)	(0.116)
	-	-	-	[1.04]	[1.05]	[0.32]
UAM	-	-	-	0.500	0.523	0.384
	-	-	-	(0.459)	(0.452)	(0.455)
	-	-	-	[1.09]	[1.16]	[0.84]
Research region
NoCDMX-NoMorelos	-0.150 **	-0.140 **	-0.183 *	-	-	-
	(0.083)	(0.084)	(0.082)	-	-	-
	[-1.81]	[-1.66]	[-2.23]	-	-	-
Morelos	-	-	-	-	-	-
	-	-	-	-	-	-
	-	-	-	-	-	-
Querétaro	-	-	-	-	-	-
	-	-	-	-	-	-
	-	-	-	-	-	-
Sonora	-	-	-	-	-	-
	-	-	-	-	-	-
	-	-	-	-	-	-
Jalisco	-	-	-	-	-	-
	-	-	-	-	-	-
	-	-	-	-	-	-
Starting year
2004	0.430 *	0.425 *	0.470 ***	0.405 *	0.451 *	0.457 *
	(0.178)	(0.179)	(0.178)	(0.181)	(0.180)	(0.180)
	[2.41]	[2.37]	[2.65]	[2.24]	[2.51]	[2.54]
2010	0.204 **	0.213 **	0.201 **	0.209 **	0.241 *	0.233 *
	(0.109)	(0.109)	(0.109)	(0.110)	(0.108)	(0.108)
	[1.87]	[1.94]	[1.84]	[1.91]	[2.23]	[2.16]
Fund
FOSIB	-	-	-0.163 **	-0.070	-0.203 *	-0.300 ***
	-	-	(0.086)	(0.140)	(0.085)	(0.089)
	-	-	[-1.90]	[-0.50]	[-2.39]	[-3.38]
FOSISS	0.316 ***	0.202 *	-	0.140	-	-
	(0.085)	(0.080)	-	(0.141)	-	-
	[3.74]	[2.51]	-	[0.99]	-	-
Model data
n	303	303	303	303	303	303
R²	0.0977	0.1002	0.1049	0.1013	0.14	0.1284
Prob > F	0.0002	0.0005	0.0001	0.0005	0.0001	0.0001

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[1] Correspondence S. Rojas-Rajs Universidad Autónoma Metropolitana Xochimilco. Calzada del Hueso 1100, Col. Villa Quietud, Delegación Coyoacán, Ciudad de México / Ciudad de México - 04960, México. srojasrajs@gmail.com