Journal of the Royal Society of Medicine最新文献

Objectives: To examine all-cause mortality differences among migrants from different countries/regions compared with native-born populations in England and Wales from 2007 to 2021 and assess whether migrant mortality patterns converge with or diverge from native-born trends over the study period.

Design: Descriptive, observational study analysing mortality trends over a 15-year period.

Setting: England and Wales, using national mortality records and Census data.

Participants: The study included all recorded deaths in England and Wales from 2007 to 2021, stratified by sex and country/region of birth.

Main outcome measures: European age-standardised rates (EASRs) and standardised mortality ratios (SMRs) for all-cause mortality, with and without COVID-19-related deaths. Linear regressions were used to assess mortality trends over time.

Results: Mortality patterns varied significantly by country/region of birth. While most migrant groups had lower mortality rates than the native-born population at the beginning of the study period, this advantage declined for many in recent years. Migrants from Ireland, Scotland and Northern Ireland exhibited consistently worse mortality outcomes. Excluding COVID-19 deaths, 14 out of 19 migrant groups retained a mortality advantage, though trends indicate substantial heterogeneity. Some migrant groups, particularly from North and Central America and parts of Europe, showed improving mortality rates, whereas others, such as those from Bangladesh, converged towards native-born mortality levels.

Conclusions: Despite lacking data on individual-level factors (e.g. duration of residence, socio-economic status and co-morbidities), this national-level study demonstrates important trends in migrant mortality. The findings highlight the urgent need for improved data to capture migration-related variables and enable a deeper understanding of the drivers behind observed trends. The decline in migrant mortality advantage over time for some groups highlights the importance of monitoring structural health inequalities and can inform targeted public health policies and more granular future research.

Objectives: Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors may exert neuroprotective effects. However, the comparative efficacy of individual agents remains unclear. This network meta-analysis (NMA) aimed to evaluate the differential impacts of these therapies on the incidence of mental status changes, specifically delirium, depression, dementia and coma.

Design: A frequentist NMA was conducted using data from randomised controlled trials (RCTs) investigating GLP-1 receptor agonists or SGLT2 inhibitors. The robustness of the findings was verified through a Bayesian NMA framework.

Setting: This study adopted a confirmatory framework focusing on pre-defined neuropsychiatric adverse outcomes in alignment with Cochrane recommendations.

Participants: Included trials enrolled individuals without baseline cognitive or psychiatric disorders.

Main outcome measures: The primary endpoint was the incidence of delirium, depression, dementia or coma during treatment. Secondary endpoints included changes in cognitive performance and drop-out rates.

Results: A total of 62 RCTs comprising 200,068 participants were included. Among all treatments, only high-dose dapagliflozin (10 mg/day) significantly reduced the occurrence of delirium and depression, particularly in patients with type 2 diabetes. Dulaglutide and liraglutide were the only agents associated with cognitive improvement. No significant benefits were observed for dementia or coma across all agents.

Conclusions: This analysis highlights agent-specific neuroprotective profiles: SGLT2 inhibitors, especially high-dose dapagliflozin, may mitigate the onset of delirium and depression, while GLP-1 receptor agonists, notably dulaglutide and liraglutide, may enhance cognitive function. These findings warrant consideration in selecting antihyperglycemic therapies for individuals at elevated neuropsychiatric risk.

Trial registration: PROSPERO CRD42024601021.The study protocol was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB E202516007).