Background:

Academic delay affects both the quality and equity of education. Identifying its associated factors, stratified by sex, is key to designing effective interventions.

Objective:

To assess the association between sociodemographic, mental health and lifestyle factors and academic underachievement during the first two years of medical school, stratified by sex and pandemic period.

Materials and methods:

A prospective cohort study was conducted with 10,866 first-year medical students (2017-2023) from the Faculty of Medicine at Universidad Nacional Autónoma de México (UNAM), followed for two years. Multivariate logistic regression models were applied, stratified by sex and pandemic period.

Results:

Differences were observed across the three periods in academic, sociodemographic, lifestyle, and health-related variables. Among men, older age, attending Colegio de Ciencias y Humanidades (CCH), overweight/obesity, and experiences of violence increased the risk of academic delay, whereas high previous academic performance, parental education, effective study strategies, and family support were protective factors. Among women, older age, attending CCH, violence, and the combination of depression and obesity were associated with higher risk, while private high school education and higher maternal education level were protective.

Conclusions:

Academic underachievement is influenced by sociodemographic and health factors, with sex-based differences. These findings highlight the need for tailored interventions to improve academic performance and reduce inequalities.