Abstract
<title>Abstract</title> <p> <bold>Background</bold> Mexico lacks a national assessment integrating reported prison healthcare pathways and processes with prison resources, oversight and repeated administrative indicators. We assessed these domains across complementary national sources. <bold>Methods</bold> We performed a multi-source secondary analysis of public observational data. ENPOL 2021 measured chronic-care pathways, care processes and equity. Independent ENSANUT samples provided age-sex-standardised treatment benchmarks. State-clustered models assessed prison occupancy, staffing and general-system capacity. CNSIPEE 2021–2025 and monthly PRS reports through May 2026 supplied retrospective indicators. DNSP and CNDHE supplied external supervision and accountability signals. Analyses remained source-specific. <bold>Results</bold> Among 10,280 chronic person-condition episodes, 53.9% (95% CI 52.9–55.0) were centre-provided, 20.8% (19.9–21.7) self/family-financed and 23.1% (22.1–24.0) unattended. Medical examination on arrival, periodic medical review and vaccination were reported by 73.4%, 41.8% and 77.9%, respectively. Untreated prevalence exceeded standardised ENSANUT 2021 estimates for diabetes by 11.55 percentage points (95% CI 7.46–15.65) and hypertension by 13.60 points (9.30–17.90). In the overall primary analysis (6,601 people; 32 states), occupancy was associated with higher odds of unattended care (aOR per state SD 1.29, 95% CI 1.10–1.52; LRT p=0.004); in a joint model, staffing was inversely associated (OR 0.797, 95% CI 0.703–0.904), while general-system capacity was inconclusive. DNSP explicitly reported health-service deficiencies in 155/233 supervised state centres; the state deficiency proportion correlated with lower centre provision (Spearman rho=-0.47; bootstrap 95% CI -0.71 to -0.14). None of six CNSIPEE service-availability contrasts retained evidence after Holm adjustment. Across 3,872 state-months and 5,877 administrative deaths, lagged occupancy was associated with a higher death rate (IRR per 10 points 1.087, 1.009–1.171), but a future-occupancy diagnostic was similar. <bold>Conclusions</bold> Reported chronic-care and periodic-review gaps coincided with state-level associations of higher occupancy and lower staffing with unattended care; DNSP deficiencies correlated with lower centre provision. Service-availability results were inconclusive, and the mortality association lacked temporal specificity, supporting monitoring rather than causal interpretation. </p>