Assessing Mexico’s prison health system: access, care processes, resources, accountability and administrative mortality indicators

Background Mexico lacks a national assessment integrating chronic-care pathways in prisons with prison resources, supervision and administrative indicators. We assessed these domains across complementary national public sources. Methods We performed a secondary analysis of public observational data. Cross-sectional ENPOL 2021 microdata classified chronic-care episodes by provider and financing. Independent ENSANUT 2021 samples provided age-sex-standardized treatment benchmarks, including socioeconomically restricted comparators. A mixed model specified with a directed acyclic graph related state prison occupancy to unattended care with a documented barrier, adjusting for marginalization, system size, pretrial share, legal status and incarceration duration. Repeated aggregate administrative series (CNSIPEE 2021–2025; monthly PRS reports 2015–2026) were analyzed ecologically, not as individual follow-up. Results Among 10,280 chronic-care episodes, 53.9% (95% CI 52.9–55.0) were center-provided, 20.8% (19.9–21.7) self/family-financed and 23.1% (22.1–24.0) untreated. Among untreated non-communicable episodes in state prisons, center non-provision was the most frequent reason for absent treatment. In 6,301 people across 32 states, higher occupancy was associated with unattended care (aOR per state SD 1.37, 95% CI 1.12–1.66; survey-weighted 1.37, 1.12–1.67), and greater prison medical staffing with less unattended care (aOR 0.75, 0.63–0.89); there was no clear evidence of an association with general-system medical capacity. Untreated diabetes exceeded ENSANUT 2021 estimates by 11.55 percentage points (7.46–15.65), and this gap persisted when the comparator was restricted to lower-socioeconomic strata, whereas the initial hypertension difference (13.60 points) was not clearly demonstrated in the lowest-wellbeing tercile. Indigenous identification was associated with 3.6 points (1.2–6.0) more unattended care within states. Periodic medical review was reported by 41.8%. Service-availability contrasts were inconclusive, and administrative mortality series did not support time-ordered inference. Conclusion Ongoing chronic care in Mexican prisons relied substantially on family financing or remained untreated, and higher occupancy and lower medical staffing were consistently associated with unattended care. Administrative indicators should be read as monitoring signals; prospective center-level data with stable identifiers are needed.