Pub Date : 2025-11-21DOI: 10.1016/j.lanwpc.2025.101755
Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell
Background
Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).
Methods
Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.
Findings
Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.
Interpretation
Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.
{"title":"Economic evaluation of potential national childhood screening strategies for type 1 diabetes in Australia","authors":"Winnie Chen , Kirsten Howard , Sarah Norris , Natasha Nassar , Maria E. Craig , Kirstine J. Bell","doi":"10.1016/j.lanwpc.2025.101755","DOIUrl":"10.1016/j.lanwpc.2025.101755","url":null,"abstract":"<div><h3>Background</h3><div>Type 1 diabetes (T1D) is an autoimmune condition affecting children. We aimed to investigate the costs and cost-effectiveness of potential national childhood screening strategies for T1D compared to no screening (usual care).</div></div><div><h3>Methods</h3><div>Screening costs were obtained from trial-based estimates. A Markov microsimulation model was developed to identify the most cost-effective childhood T1D screening strategy. The three screening strategies modelled were: Strategy 1) newborn genetic risk-stratification with bloodspot sampling, followed by autoantibody screening in at-risk children; Strategy 2) infant genetic risk-stratification using saliva sampling, followed by autoantibody screening in at-risk children; Strategy 3) population-wide autoantibody screening at two childhood ages. The model tracked 100,000 individuals from birth to 30 years of age. One-way and probabilistic sensitivity analyses were conducted.</div></div><div><h3>Findings</h3><div>Newborn bloodspot genetic risk-stratified screening (strategy 1) was the most cost-effective strategy. Incremental cost-effectiveness ratios (ICERs) were $50,682 per quality-adjusted life year (QALY) gained for strategy 1, $85,440 per QALY gained for strategy 2, and $133,285 per QALY gained for strategy 3. In the optimal strategy (strategy 1), the cost was $480,798 per screen-detected T1D and $12,183 per episode of diabetic ketoacidosis avoided. Results were sensitive to changes in time horizon, discount rates, and cost of the screening tests.</div></div><div><h3>Interpretation</h3><div>Of the three modelled T1D screening strategies, newborn bloodspot genetic risk-stratified screening was the most cost-effective. Varying cost inputs may change this hierarchy. Our economic evaluation will be useful for informing future T1D childhood screening policy in Australia and other high-income countries.</div></div><div><h3>Funding</h3><div>JDRF Australia.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101755"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.lanwpc.2025.101752
Guiying Cao , Huang Jing , Cai Jie , Min Liu
Syphilis was nearly eliminated from China in the 1960s; however, it has resurgent and continued to spread in the country since the 1980s. Surveillance data from China revealed that the notification rate of syphilis increased 11.88% annually between 2004 and 2019, with an notification rate of 38.37 per 100,000 population in 2019. This paper aims to summarize the national policies and plans for syphilis since the 1980s; the full-cycle management strategy for the publicity and education, screening, diagnosis and treatment, management, and surveillance and monitoring of syphilis; the epidemiology of syphilis; and challenges in the prevention and control in China. Finally, we propose a series of new strategies to better manage syphilis to help eliminate the infection in China.
{"title":"The changing epidemiology of syphilis: new strategies for new challenges in China","authors":"Guiying Cao , Huang Jing , Cai Jie , Min Liu","doi":"10.1016/j.lanwpc.2025.101752","DOIUrl":"10.1016/j.lanwpc.2025.101752","url":null,"abstract":"<div><div>Syphilis was nearly eliminated from China in the 1960s; however, it has resurgent and continued to spread in the country since the 1980s. Surveillance data from China revealed that the notification rate of syphilis increased 11.88% annually between 2004 and 2019, with an notification rate of 38.37 per 100,000 population in 2019. This paper aims to summarize the national policies and plans for syphilis since the 1980s; the full-cycle management strategy for the publicity and education, screening, diagnosis and treatment, management, and surveillance and monitoring of syphilis; the epidemiology of syphilis; and challenges in the prevention and control in China. Finally, we propose a series of new strategies to better manage syphilis to help eliminate the infection in China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101752"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that poses a serious public health challenge in several Asian countries. In this study, we aimed to describe the recent epidemiological characteristics of SFTS in Japan using denominator-based test data.
Methods
We analysed reported SFTS case-patients in Japan using national surveillance data from March 2013 to April 2024. The case-fatality ratio (CFR) was calculated using the National Vital Statistics Surveillance System (NVSSS) for 2013–2022. Trends in test numbers and positivity rates were examined using data from annual reports and public health institute surveys.
Findings
During the study period, 931 case-patients were reported, including 11 veterinary healthcare workers. The annual notification rate rose from 3.12 per ten million in 2013 to 10.46 in 2023, with 30 (64%) estimated infection prefectures, primarily in western and central Japan. The NVSSS CFRs remained high at approximately 20%. Test numbers and positive results increased from 2013 (n = 350, n = 41) to 2022 (n = 923, n = 95); however, positivity decreased from 12% to 10%.
Interpretation
The annual SFTS notification rate increased, and infection regions expanded between 2013 and 2023, with persistently high CFRs and increased testing. Veterinary healthcare workers appear to be a potential high-risk group. These findings highlight that SFTS remains a public health concern in Japan, requiring a comprehensive health strategy.
Funding
This work was supported by the Japan Society for the Promotion of Science Kakenhi Grants-in-Aid for Young Scientists (grant number: 24K19277).
发热伴血小板减少综合征（SFTS）是一种蜱传人畜共患疾病，在一些亚洲国家构成了严重的公共卫生挑战。在本研究中，我们旨在利用基于分母的检测数据描述日本SFTS的最新流行病学特征。方法利用2013年3月至2024年4月日本国家监测数据，对报告的SFTS病例进行分析。使用2013-2022年国家生命统计监测系统（NVSSS）计算病死率（CFR）。使用年度报告和公共卫生研究所调查的数据检查了检测次数和阳性率的趋势。研究期间共报告病例931例，其中兽医卫生工作者11例。年通报率从2013年的每千万人3.12例上升到2023年的每千万人10.46例，估计有30个（64%）感染县，主要在日本西部和中部。NVSSS的cfr仍然很高，约为20%。检测数量和阳性结果从2013年（n = 350, n = 41）增加到2022年（n = 923, n = 95）；然而，积极性从12%下降到10%。在2013年至2023年期间，SFTS年度报告率上升，感染区域扩大，持续高CFRs和增加检测。兽医保健工作者似乎是一个潜在的高风险群体。这些发现强调，在日本，SFTS仍然是一个公共卫生问题，需要一个全面的卫生战略。本研究由日本科学促进会Kakenhi青年科学家资助项目（资助号：24K19277）资助。
{"title":"Comprehensive epidemiological analysis of severe fever with thrombocytopenia syndrome in Japan, 2013–2023: descriptive observational study","authors":"Tomohiro Ohno , Hirofumi Kato , Yusuke Kobayashi , Masami Kitaoka , Minako Kanesaki , Shimpei Murai , Masaru Jinushi , Mitsuki Aoki , Takuri Takahashi , Tomoe Shimada , Taro Kamigaki , Tomimasa Sunagawa","doi":"10.1016/j.lanwpc.2025.101747","DOIUrl":"10.1016/j.lanwpc.2025.101747","url":null,"abstract":"<div><h3>Background</h3><div>Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that poses a serious public health challenge in several Asian countries. In this study, we aimed to describe the recent epidemiological characteristics of SFTS in Japan using denominator-based test data.</div></div><div><h3>Methods</h3><div>We analysed reported SFTS case-patients in Japan using national surveillance data from March 2013 to April 2024. The case-fatality ratio (CFR) was calculated using the National Vital Statistics Surveillance System (NVSSS) for 2013–2022. Trends in test numbers and positivity rates were examined using data from annual reports and public health institute surveys.</div></div><div><h3>Findings</h3><div>During the study period, 931 case-patients were reported, including 11 veterinary healthcare workers. The annual notification rate rose from 3.12 per ten million in 2013 to 10.46 in 2023, with 30 (64%) estimated infection prefectures, primarily in western and central Japan. The NVSSS CFRs remained high at approximately 20%. Test numbers and positive results increased from 2013 (n = 350, n = 41) to 2022 (n = 923, n = 95); however, positivity decreased from 12% to 10%.</div></div><div><h3>Interpretation</h3><div>The annual SFTS notification rate increased, and infection regions expanded between 2013 and 2023, with persistently high CFRs and increased testing. Veterinary healthcare workers appear to be a potential high-risk group. These findings highlight that SFTS remains a public health concern in Japan, requiring a comprehensive health strategy.</div></div><div><h3>Funding</h3><div>This work was supported by the Japan Society for the Promotion of <span>Science Kakenhi</span> Grants-in-Aid for Young Scientists (grant number: <span><span>24K19277</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101747"},"PeriodicalIF":8.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-20DOI: 10.1016/j.lanwpc.2025.101750
Zhi Sheng , Tianhang Zhou , Chunyu Du , Tingfang Wu , Liping Wen , Xianmei Yang , Wencai Chen , Xuehong Ma , Hua Deng , Ling Ge , Changchun Zhang , Xu Hong , Rui He , Xiangdong Du , Lingyan Zhu , Hu Xiang , Sijing Chen , Jiachen Liu , Yongzhuo Ding , Guangming Liang , Xin Yu
Background
Parental schizophrenia confers intergenerational mental health risks. The sex-specific transmission patterns remain poorly quantified. This study examined parent-reported transmission rate and familial risk factors among Chinese offspring of schizophrenia probands.
Methods
In this cross-sectional study, we enrolled 27,315 schizophrenia probands and 35,772 offspring. Psychiatric disorder diagnoses of offspring were parent-reported and subsequently verified via the medical management system. Age- and sex-standardized rate referenced China's 2020 census. Robust Poisson regression generated adjusted rate ratios (aRR). Multivariable logistic models were used to identify risk factors for young offspring. This study was registered with ClinicalTrials (NCT07005245).
Findings
The parent-reported transmission rate in offspring was 2.68% (95% CI, 2.52%–2.85%), dominated by schizophrenia spectrum disorders (1.42%). Standardized rates reached 2.53% (95% CI, 2.01%–3.05%) after demographic standardization. Offspring risk increased by 86.0% when conception occurred post-parental illness onset. Firstborn status (aRR = 1.67), low-income household (aRR = 1.43), and being a male child (aRR = 1.14) were significantly associated with elevated risk. Sex-specific parental age effects were also observed. In the subgroup analysis of underage (<17 years) offspring, maternal transmission was associated with post-parental-onset birth (OR = 2.48, p < 0.001), lower household income (OR = 2.32, p < 0.001), and prenatal antipsychotic exposure (OR = 1.69, p < 0.001). Paternal transmission was related to father-only caregiving (OR = 2.15, p < 0.001), lower household income (OR = 1.97, p < 0.001), and male offspring (OR = 1.79, p = 0.001). Dual-parent care demonstrated a robust protective effect across both maternal and paternal schizophrenia groups (OR = 0.75, 95% CI, 0.51–1.10).
Interpretation
Our findings highlighted critical interactions between familial aggregation, sex-differentiated perinatal exposures, and caregiving environments. Policy priorities should integrate sex-stratified genetic counselling, prenatal medication monitoring, and family support programs targeting caregiving inequalities.
Funding
This study was supported by the National Natural Science Foundation of China (32070589).
父母精神分裂症会带来代际心理健康风险。性别特异性传播模式的量化仍然很差。本研究考察了中国精神分裂症先证者后代中父母报告的传播率和家族危险因素。方法在这项横断面研究中，我们招募了27,315名精神分裂症先证者和35,772名后代。后代的精神障碍诊断由父母报告，随后通过医疗管理系统进行验证。年龄和性别标准化率参考了中国2020年人口普查数据。稳健泊松回归生成调整率比（aRR）。使用多变量逻辑模型来确定年轻后代的危险因素。本研究已在ClinicalTrials注册（NCT07005245）。结果父母报告的后代传播率为2.68% (95% CI, 2.52% ~ 2.85%)，以精神分裂症谱系障碍（1.42%）为主。人口统计学标准化后，标准化率达到2.53% （95% CI, 2.01% ~ 3.05%）。当受孕发生在父母发病后，后代风险增加86.0%。长子身份（aRR = 1.67）、低收入家庭（aRR = 1.43）和男孩身份（aRR = 1.14）与风险升高显著相关。性别差异的父母年龄效应也被观察到。在未成年（17岁）后代的亚组分析中，母体传播与父母后发病分娩（OR = 2.48, p < 0.001）、较低的家庭收入（OR = 2.32, p < 0.001）和产前抗精神病药物暴露（OR = 1.69, p < 0.001）有关。父系遗传与仅由父亲照料（OR = 2.15, p < 0.001）、较低的家庭收入（OR = 1.97, p < 0.001）和男性后代（OR = 1.79, p = 0.001）有关。双亲护理在母亲和父亲精神分裂症组中都显示出强大的保护作用（OR = 0.75, 95% CI, 0.51-1.10）。解释：我们的研究结果强调了家族聚集、性别分化的围产期暴露和护理环境之间的关键相互作用。政策重点应包括按性别分层的遗传咨询、产前药物监测和针对照顾不平等的家庭支持计划。本研究由国家自然科学基金（32070589）资助。
{"title":"Sex-differences in the intergenerational transmission of mental disorders among schizophrenia probands: familial risk and protective factors in a population-based study","authors":"Zhi Sheng , Tianhang Zhou , Chunyu Du , Tingfang Wu , Liping Wen , Xianmei Yang , Wencai Chen , Xuehong Ma , Hua Deng , Ling Ge , Changchun Zhang , Xu Hong , Rui He , Xiangdong Du , Lingyan Zhu , Hu Xiang , Sijing Chen , Jiachen Liu , Yongzhuo Ding , Guangming Liang , Xin Yu","doi":"10.1016/j.lanwpc.2025.101750","DOIUrl":"10.1016/j.lanwpc.2025.101750","url":null,"abstract":"<div><h3>Background</h3><div>Parental schizophrenia confers intergenerational mental health risks. The sex-specific transmission patterns remain poorly quantified. This study examined parent-reported transmission rate and familial risk factors among Chinese offspring of schizophrenia probands.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we enrolled 27,315 schizophrenia probands and 35,772 offspring. Psychiatric disorder diagnoses of offspring were parent-reported and subsequently verified via the medical management system. Age- and sex-standardized rate referenced China's 2020 census. Robust Poisson regression generated adjusted rate ratios (aRR). Multivariable logistic models were used to identify risk factors for young offspring. This study was registered with ClinicalTrials (<span><span>NCT07005245</span><svg><path></path></svg></span>).</div></div><div><h3>Findings</h3><div>The parent-reported transmission rate in offspring was 2.68% (95% CI, 2.52%–2.85%), dominated by schizophrenia spectrum disorders (1.42%). Standardized rates reached 2.53% (95% CI, 2.01%–3.05%) after demographic standardization. Offspring risk increased by 86.0% when conception occurred post-parental illness onset. Firstborn status (aRR = 1.67), low-income household (aRR = 1.43), and being a male child (aRR = 1.14) were significantly associated with elevated risk. Sex-specific parental age effects were also observed. In the subgroup analysis of underage (<17 years) offspring, maternal transmission was associated with post-parental-onset birth (OR = 2.48, <em>p</em> < 0.001), lower household income (OR = 2.32, <em>p</em> < 0.001), and prenatal antipsychotic exposure (OR = 1.69, <em>p</em> < 0.001). Paternal transmission was related to father-only caregiving (OR = 2.15, <em>p</em> < 0.001), lower household income (OR = 1.97, <em>p</em> < 0.001), and male offspring (OR = 1.79, <em>p</em> = 0.001). Dual-parent care demonstrated a robust protective effect across both maternal and paternal schizophrenia groups (OR = 0.75, 95% CI, 0.51–1.10).</div></div><div><h3>Interpretation</h3><div>Our findings highlighted critical interactions between familial aggregation, sex-differentiated perinatal exposures, and caregiving environments. Policy priorities should integrate sex-stratified genetic counselling, prenatal medication monitoring, and family support programs targeting caregiving inequalities.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Natural Science Foundation of China</span> (32070589).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101750"},"PeriodicalIF":8.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-18DOI: 10.1016/j.lanwpc.2025.101749
Raymond Javan Chan , Reegan Knowles , Carolyn Taylor , Nirmala Bhoo Pathy , Ke Yu , Karolina Lisy , Julia Lai-Kwon , Miyako Tsuchiya , Yan Lou , Wendy Lam , Michael Jefford
The Western Pacific region consists of 38 countries and approximately one quarter of the world population. Over 17 million people in the region have a personal history of cancer, necessitating effective survivorship care approaches for optimal outcomes and experiences. There are substantial differences in population and income and resource availability between countries within the region which impacts cancer survivorship care. Likewise, varying healthcare systems and models of survivorship care (e.g., primary care-led, patient-led etc.) affect the survivorship experience and outcome of people affected by cancer. Despite differences across Western Pacific countries, issues facing cancer survivors are similar, with shared challenges including lack of focus on survivorship care, adoption of a holistic approach, and workforce availability. Various approaches to cancer survivorship are being developed and implemented across the region, but a region-wide, coordinated approach is needed, involving thoughtful leadership and sharing of ideas to achieve better outcomes.
{"title":"Cancer survivorship in the Western Pacific: from differences to shared-goals and from challenges to opportunities","authors":"Raymond Javan Chan , Reegan Knowles , Carolyn Taylor , Nirmala Bhoo Pathy , Ke Yu , Karolina Lisy , Julia Lai-Kwon , Miyako Tsuchiya , Yan Lou , Wendy Lam , Michael Jefford","doi":"10.1016/j.lanwpc.2025.101749","DOIUrl":"10.1016/j.lanwpc.2025.101749","url":null,"abstract":"<div><div>The Western Pacific region consists of 38 countries and approximately one quarter of the world population. Over 17 million people in the region have a personal history of cancer, necessitating effective survivorship care approaches for optimal outcomes and experiences. There are substantial differences in population and income and resource availability between countries within the region which impacts cancer survivorship care. Likewise, varying healthcare systems and models of survivorship care (e.g., primary care-led, patient-led etc.) affect the survivorship experience and outcome of people affected by cancer. Despite differences across Western Pacific countries, issues facing cancer survivors are similar, with shared challenges including lack of focus on survivorship care, adoption of a holistic approach, and workforce availability. Various approaches to cancer survivorship are being developed and implemented across the region, but a region-wide, coordinated approach is needed, involving thoughtful leadership and sharing of ideas to achieve better outcomes.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101749"},"PeriodicalIF":8.1,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.lanwpc.2025.101745
Yi Yang , Jiani Jiang , Can Chen , Rongrong Qu , Yi Liu , Chen Xu , Xiangkun Zeng , Xiaofan Li , Yi Li , Weili Lin , Lili Huang , Mi Zhou , Mengsha Chen , Rong Zhang , Shigui Yang , Ning Dong
Background
Antimicrobial resistance (AMR) represents an escalating global health challenge, with socioeconomic status (SES) being a significant influencing factor. This study aimed to quantify area-level SES and assess its association with drug-resistant bacteria in China.
Methods
AMR data were collected from China Antimicrobial Resistance Surveillance System (CARSS, 2014–2023). Area-level SES across China was captured by County-level Area Deprivation Index (CADI) and Townsend Deprivation Index (TDI). Spatiotemporal distributions of drug-resistant bacteria were explored by spatial autocorrelation and spatiotemporal scan analyses. Key AMR risk factors were identified by GeoDetector analysis. Six Bayesian models were established through the Bayesian spatiotemporal modelling analysis. The Bayesian Spatiotemporal Interaction Hierarchy Model (BSTIHM), demonstrating superior estimative accuracy, was selected to forecast nationwide AMR patterns.
Findings
AMR profiles were obtained for totally 34,442,268 isolates of thirteen types of drug-resistant bacteria. The distributions of these bacteria exhibited manifest spatiotemporal heterogeneity nationwide. Both CADI and TDI consistently revealed a distinct socioeconomic gradient, with low area-level SES in western regions, medium in central regions, and high in eastern regions. Spatiotemporal clusters of drug-resistant bacteria were mainly observed in low SES regions. Lower area-level SES (odds ratio (OR) range: 1.054–1.254) and higher antimicrobial usage intensity (OR range: 1.022–1.174) contributed to higher risk of all thirteen types of drug-resistant bacteria. Meanwhile, total wastewater discharge (OR range: 1.064–1.280), PM2.5 (OR range: 1.031–1.135), and number of healthcare technicians per 10,000 people (OR range: 1.035–1.310) were correlated with risks of most drug-resistant bacteria. Estimated risks for all thirteen types of drug-resistant bacteria were increased in low and middle area-level SES regions based on the BSTIHM.
Interpretation
Area-level SES is a pivotal driver of AMR risk, which might be caused by antibiotic overuse and environmental pollution. Targeted investments in healthcare and environmental systems in lower area-level SES regions are essential to effectively reduce AMR burden.
Funding
National Key R&D Program of China, National Natural Science Foundation of China, Natural Science Foundation of Zhejiang Province, and Natural Science Foundation of Jiangsu Province.
{"title":"Area-level socioeconomic status inequalities shape patterns of antimicrobial resistance in China, 2014–2023: a Bayesian spatiotemporal modelling analysis","authors":"Yi Yang , Jiani Jiang , Can Chen , Rongrong Qu , Yi Liu , Chen Xu , Xiangkun Zeng , Xiaofan Li , Yi Li , Weili Lin , Lili Huang , Mi Zhou , Mengsha Chen , Rong Zhang , Shigui Yang , Ning Dong","doi":"10.1016/j.lanwpc.2025.101745","DOIUrl":"10.1016/j.lanwpc.2025.101745","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance (AMR) represents an escalating global health challenge, with socioeconomic status (SES) being a significant influencing factor. This study aimed to quantify area-level SES and assess its association with drug-resistant bacteria in China.</div></div><div><h3>Methods</h3><div>AMR data were collected from China Antimicrobial Resistance Surveillance System (CARSS, 2014–2023). Area-level SES across China was captured by County-level Area Deprivation Index (CADI) and Townsend Deprivation Index (TDI). Spatiotemporal distributions of drug-resistant bacteria were explored by spatial autocorrelation and spatiotemporal scan analyses. Key AMR risk factors were identified by GeoDetector analysis. Six Bayesian models were established through the Bayesian spatiotemporal modelling analysis. The Bayesian Spatiotemporal Interaction Hierarchy Model (BSTIHM), demonstrating superior estimative accuracy, was selected to forecast nationwide AMR patterns.</div></div><div><h3>Findings</h3><div>AMR profiles were obtained for totally 34,442,268 isolates of thirteen types of drug-resistant bacteria. The distributions of these bacteria exhibited manifest spatiotemporal heterogeneity nationwide. Both CADI and TDI consistently revealed a distinct socioeconomic gradient, with low area-level SES in western regions, medium in central regions, and high in eastern regions. Spatiotemporal clusters of drug-resistant bacteria were mainly observed in low SES regions. Lower area-level SES (odds ratio (OR) range: 1.054–1.254) and higher antimicrobial usage intensity (OR range: 1.022–1.174) contributed to higher risk of all thirteen types of drug-resistant bacteria. Meanwhile, total wastewater discharge (OR range: 1.064–1.280), PM<sub>2.5</sub> (OR range: 1.031–1.135), and number of healthcare technicians per 10,000 people (OR range: 1.035–1.310) were correlated with risks of most drug-resistant bacteria. Estimated risks for all thirteen types of drug-resistant bacteria were increased in low and middle area-level SES regions based on the BSTIHM.</div></div><div><h3>Interpretation</h3><div>Area-level SES is a pivotal driver of AMR risk, which might be caused by antibiotic overuse and environmental pollution. Targeted investments in healthcare and environmental systems in lower area-level SES regions are essential to effectively reduce AMR burden.</div></div><div><h3>Funding</h3><div>National Key R&D Program of China, National Natural Science Foundation of China, Natural Science Foundation of Zhejiang Province, and Natural Science Foundation of Jiangsu Province.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101745"},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.lanwpc.2025.101748
Michael Jefford , Fiona Crawford-Williams , Carolyn Taylor , Miyako Takahashi , Wendy W.T. Lam , Alexandre Chan , Bogda Koczwara , Yan Lou , Raymond J. Chan
The Western Pacific region faces a significant cancer burden with over 12.8 million cancer survivors. Cancer survivorship care remains inconsistent across the region but is important regardless of diversity in healthcare systems and resources within countries. Cultural factors deeply influence survivorship experiences; thus, recognition of the importance of traditional medicine and the role of community-based support in survivorship care is needed. In this viewpoint, we highlight opportunities for regional collaboration to improve cancer survivorship outcomes, and advocate for incorporation of survivorship priorities into national cancer control plans. We call for coordinated action involving international organizations, local governments, and cancer survivor voices to deliver responsive, equitable survivorship care. Education, policy reform, and multinational partnerships are essential to address disparities and improve outcomes across the region.
{"title":"Global need, regional action: opportunities to improve cancer survivorship care in the Western Pacific","authors":"Michael Jefford , Fiona Crawford-Williams , Carolyn Taylor , Miyako Takahashi , Wendy W.T. Lam , Alexandre Chan , Bogda Koczwara , Yan Lou , Raymond J. Chan","doi":"10.1016/j.lanwpc.2025.101748","DOIUrl":"10.1016/j.lanwpc.2025.101748","url":null,"abstract":"<div><div>The Western Pacific region faces a significant cancer burden with over 12.8 million cancer survivors. Cancer survivorship care remains inconsistent across the region but is important regardless of diversity in healthcare systems and resources within countries. Cultural factors deeply influence survivorship experiences; thus, recognition of the importance of traditional medicine and the role of community-based support in survivorship care is needed. In this viewpoint, we highlight opportunities for regional collaboration to improve cancer survivorship outcomes, and advocate for incorporation of survivorship priorities into national cancer control plans. We call for coordinated action involving international organizations, local governments, and cancer survivor voices to deliver responsive, equitable survivorship care. Education, policy reform, and multinational partnerships are essential to address disparities and improve outcomes across the region.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"65 ","pages":"Article 101748"},"PeriodicalIF":8.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145486314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.lanwpc.2025.101727
Liang En Wee , Jue Tao Lim , An Ting Tay , Borame Dickens , Pei Ma , Calvin Chiew , Po Ying Chia , Yee Sin Leo , Lee Ching Ng , David Chien Lye , Kelvin Bryan Tan
Background
DENV-infection and SARS-CoV-2 are now endemic in tropical regions; interactions may exist, given antigenic cross-reactivity and cross-protection. Risk of subsequent DENV-infection following prior COVID-19 was evaluated in a population-based adult cohort.
Methods
Retrospective cohort study including all Singaporeans ≥18 years. National registries were used to construct contemporaneous SARS-CoV-2-infected/test-negative cohorts from 1st Sept 2021–31st Dec 2022 during Delta/Omicron emergence. COVID-19 vaccination status was classified using the national-immunization-registry. Risk of DENV-infection recorded in the national registry 31–300 days post-COVID-19 was contrasted against test-negatives using overlap-weighted Cox regression. Risk of other infections (invasive-pneumococcal-disease/tuberculosis/melioidosis/leptospirosis) were assessed as negative-outcome controls, and risk of DENV-infection post-influenza vaccination was assessed as a negative-exposure control.
Findings
1,324,250 COVID-19 cases (predominantly vaccine-breakthrough mild Omicron infections) and 1,434,851 test-negatives were included. Significantly increased risk of DENV-infection was observed 31–300 days post-COVID-19 (adjusted-hazards-ratio, aHR = 1.10[95%CI = 1.05–1.15]), during a DENV3 surge. Excess-burden of DENV-infection post-COVID-19 was 0.36 cases (95%CI = 0.11–0.61) per-1000-individuals. Risks of subsequent DENV-infection were numerically highest in unvaccinated COVID-19 cases but not elevated in doubly-boosted cases (≥4 vaccine-doses). Risk of negative-outcome controls (other-infections) was not significantly elevated 31–300 days post-COVID-19, and risk of DENV-infection was not significantly elevated post-influenza vaccination.
Interpretation
Increased risk of DENV-infection (primarily DENV3) was observed up to 300 days post-SARS-CoV-2 infection (predominantly Omicron). While not irrefutable proof for possible antibody-dependent enhancement of DENV3-infection post-Omicron COVID-19, given modest effect sizes, future studies can shed more light on potential interactions. Public health strategies (e.g., vaccination) remain important in tropical/subtropical regions where COVID-19/DENV are now endemic.
{"title":"Risk of dengue following prior SARS-CoV-2 infection: a population-based cohort study","authors":"Liang En Wee , Jue Tao Lim , An Ting Tay , Borame Dickens , Pei Ma , Calvin Chiew , Po Ying Chia , Yee Sin Leo , Lee Ching Ng , David Chien Lye , Kelvin Bryan Tan","doi":"10.1016/j.lanwpc.2025.101727","DOIUrl":"10.1016/j.lanwpc.2025.101727","url":null,"abstract":"<div><h3>Background</h3><div>DENV-infection and SARS-CoV-2 are now endemic in tropical regions; interactions may exist, given antigenic cross-reactivity and cross-protection. Risk of subsequent DENV-infection following prior COVID-19 was evaluated in a population-based adult cohort.</div></div><div><h3>Methods</h3><div>Retrospective cohort study including all Singaporeans ≥18 years. National registries were used to construct contemporaneous SARS-CoV-2-infected/test-negative cohorts from 1st Sept 2021–31st Dec 2022 during Delta/Omicron emergence. COVID-19 vaccination status was classified using the national-immunization-registry. Risk of DENV-infection recorded in the national registry 31–300 days post-COVID-19 was contrasted against test-negatives using overlap-weighted Cox regression. Risk of other infections (invasive-pneumococcal-disease/tuberculosis/melioidosis/leptospirosis) were assessed as negative-outcome controls, and risk of DENV-infection post-influenza vaccination was assessed as a negative-exposure control.</div></div><div><h3>Findings</h3><div>1,324,250 COVID-19 cases (predominantly vaccine-breakthrough mild Omicron infections) and 1,434,851 test-negatives were included. Significantly increased risk of DENV-infection was observed 31–300 days post-COVID-19 (adjusted-hazards-ratio, aHR = 1.10[95%CI = 1.05–1.15]), during a DENV3 surge. Excess-burden of DENV-infection post-COVID-19 was 0.36 cases (95%CI = 0.11–0.61) per-1000-individuals. Risks of subsequent DENV-infection were numerically highest in unvaccinated COVID-19 cases but not elevated in doubly-boosted cases (≥4 vaccine-doses). Risk of negative-outcome controls (other-infections) was not significantly elevated 31–300 days post-COVID-19, and risk of DENV-infection was not significantly elevated post-influenza vaccination.</div></div><div><h3>Interpretation</h3><div>Increased risk of DENV-infection (primarily DENV3) was observed up to 300 days post-SARS-CoV-2 infection (predominantly Omicron). While not irrefutable proof for possible antibody-dependent enhancement of DENV3-infection post-Omicron COVID-19, given modest effect sizes, future studies can shed more light on potential interactions. Public health strategies (e.g., vaccination) remain important in tropical/subtropical regions where COVID-19/DENV are now endemic.</div></div><div><h3>Funding</h3><div><span>National-Medical-Research-Council</span>, Singapore.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101727"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.lanwpc.2025.101712
Lu Zhang , Frederick L. Altice , Adeeba Kamarulzaman , Ahsan Ahmad , Sangeeth Kaur , Saidatul Hanida Mohd Yukhi , Nor Akma Ibrahim , J. Lucian Davis , Zailiza bt Suli , Sheela V. Shenoi
Background
The World Health Organization (WHO) recommends tuberculosis (TB) screening in prisons but data on specific strategies are lacking.
Methods
Men sequentially entering Kajang Prison, Malaysia's largest prison, underwent standardized WHO symptom screening (SS), chest X-ray (CXR), and c-reactive protein (CRP ≥5 mg/L) screening tests while acid-fast bacilli (AFB) smears and Xpert were diagnostic tests. The reference standard was culture. We defined three screening strategies and compared their sensitivity, specificity, positive predictive value, negative predictive value, receiver operator curves, and area under the curve (AUC).
Findings
We enrolled 588 people in prison, mean age 43 (range: 21–68) years, 60 (10.2%) with HIV, 493 (83.8%) with opioid use disorder, and 265 (45.1%) with HCV. Among these, 34 (5.8%) were diagnosed with culture-positive active pulmonary TB (PTB). For screening, the sensitivity of SS, CRP ≥5 mg/L, and CXR demonstrating PTB was 38.2% (95% CI 22.2–56.4), 47.1% (95% CI 29.8–64.9), and 91.2% (95% CI 76.3–98.1). Among people without HIV, “SS-CXR” had the highest AUC (74.7% [95% CI 68.6–80.7]). For people with HIV, however, “SS-CRP” had the highest AUC (85.5% [95% CI 79.4–91.5]). For diagnosis, Xpert had a higher sensitivity (82.4% [95% CI 65.5–93.2] and specificity (95.5% [95% CI 93.4–97.1]) than AFB smear. Compared to “SS-Xpert”, both “SS-CXR-Xpert” and “SS-CRP-Xpert” had a significantly higher AUC in people without HIV (84.2% p < 0.0001 and 72.9% p = 0.023, respectively) and people with HIV (87.3% p = 0.022 and 88.2% p = 0.018, respectively).
Interpretation
Among people in prison, adding CXR or CRP to symptom screen was more effective than symptom screen alone. In addition to symptom screen, CRP performed better than CXR among people with HIV while CXR was more valuable than CRP among people without HIV.
Funding
U.S. National Institute on Drug Abuse.
背景：世界卫生组织（世卫组织）建议在监狱中进行结核病筛查，但缺乏具体策略的数据。方法对进入马来西亚最大监狱加jang监狱的囚犯进行标准化的WHO症状筛查（SS）、胸部x线检查（CXR）和c反应蛋白（CRP≥5 mg/L）筛查试验，同时对抗酸杆菌（AFB）涂片和Xpert进行诊断试验。参照标准为培养物。我们定义了三种筛查策略，并比较了它们的敏感性、特异性、阳性预测值、阴性预测值、接受者操作曲线和曲线下面积（AUC）。研究结果：我们招募了588名囚犯，平均年龄43岁（范围：21-68岁），60人（10.2%）患有艾滋病，493人（83.8%）患有阿片类药物使用障碍，265人（45.1%）患有丙型肝炎。其中34例（5.8%）被诊断为培养阳性活动性肺结核（PTB）。筛查时，SS、CRP≥5mg /L和CXR显示PTB的敏感性分别为38.2% （95% CI 22.2-56.4）、47.1% （95% CI 29.8-64.9）和91.2% （95% CI 76.3-98.1）。在未感染HIV的人群中，“SS-CXR”的AUC最高（74.7% [95% CI 68.6-80.7]）。然而，对于HIV感染者，“SS-CRP”的AUC最高（85.5% [95% CI 79.4-91.5]）。对于诊断，Xpert比AFB涂片具有更高的敏感性(82.4% [95% CI 65.5-93.2]和特异性（95.5% [95% CI 93.4-97.1]）。与“SS-Xpert”相比，“SS-CXR-Xpert”和“SS-CRP-Xpert”在未感染HIV（分别为84.2% p <； 0.0001和72.9% p = 0.023）和感染HIV（分别为87.3% p = 0.022和88.2% p = 0.018）的人群中的AUC均显著高于“SS-Xpert”。在监狱服刑人员中，在症状筛查中加入CXR或CRP比单独进行症状筛查更有效。除了症状筛查外，CRP在HIV感染者中的表现优于CXR，而在非HIV感染者中，CXR比CRP更有价值。国家药物滥用研究所。
{"title":"Screening and diagnostic strategies for active pulmonary tuberculosis among people in prison in Malaysia: a prospective diagnostic study","authors":"Lu Zhang , Frederick L. Altice , Adeeba Kamarulzaman , Ahsan Ahmad , Sangeeth Kaur , Saidatul Hanida Mohd Yukhi , Nor Akma Ibrahim , J. Lucian Davis , Zailiza bt Suli , Sheela V. Shenoi","doi":"10.1016/j.lanwpc.2025.101712","DOIUrl":"10.1016/j.lanwpc.2025.101712","url":null,"abstract":"<div><h3>Background</h3><div>The World Health Organization (WHO) recommends tuberculosis (TB) screening in prisons but data on specific strategies are lacking.</div></div><div><h3>Methods</h3><div>Men sequentially entering Kajang Prison, Malaysia's largest prison, underwent standardized WHO symptom screening (SS), chest X-ray (CXR), and c-reactive protein (CRP ≥5 mg/L) screening tests while acid-fast bacilli (AFB) smears and Xpert were diagnostic tests. The reference standard was culture. We defined three screening strategies and compared their sensitivity, specificity, positive predictive value, negative predictive value, receiver operator curves, and area under the curve (AUC).</div></div><div><h3>Findings</h3><div>We enrolled 588 people in prison, mean age 43 (range: 21–68) years, 60 (10.2%) with HIV, 493 (83.8%) with opioid use disorder, and 265 (45.1%) with HCV. Among these, 34 (5.8%) were diagnosed with culture-positive active pulmonary TB (PTB). For screening, the sensitivity of SS, CRP ≥5 mg/L, and CXR demonstrating PTB was 38.2% (95% CI 22.2–56.4), 47.1% (95% CI 29.8–64.9), and 91.2% (95% CI 76.3–98.1). Among people without HIV, “SS-CXR” had the highest AUC (74.7% [95% CI 68.6–80.7]). For people with HIV, however, “SS-CRP” had the highest AUC (85.5% [95% CI 79.4–91.5]). For diagnosis, Xpert had a higher sensitivity (82.4% [95% CI 65.5–93.2] and specificity (95.5% [95% CI 93.4–97.1]) than AFB smear. Compared to “SS-Xpert”, both “SS-CXR-Xpert” and “SS-CRP-Xpert” had a significantly higher AUC in people without HIV (84.2% p < 0.0001 and 72.9% p = 0.023, respectively) and people with HIV (87.3% p = 0.022 and 88.2% p = 0.018, respectively).</div></div><div><h3>Interpretation</h3><div>Among people in prison, adding CXR or CRP to symptom screen was more effective than symptom screen alone. In addition to symptom screen, CRP performed better than CXR among people with HIV while CXR was more valuable than CRP among people without HIV.</div></div><div><h3>Funding</h3><div>U.S. <span>National Institute on Drug Abuse</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101712"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.lanwpc.2025.101729
Sheng-Hong Lin , Chen-Long Lv , Meng-Jie Geng , Rui-Cheng Gao , Yan-Qun Sun , Yan-He Wang , Ya-Ming Zheng , Tian Tang , Chun-Xi Shan , Yao Tian , Yun-Bo Qiu , Jun Ma , Yan Zhang , Yu-Feng Yang , Qiang Xu , Guo-Lin Wang , Yan-Ping Zhang , Qun Li , Li-Ping Wang , Peng-Tao Bao , Wei Liu
Background
The whole world is undergoing an unprecedented rapid population aging, and the accompanying threat of infectious diseases epidemic among the older people will pose a serious challenge to the national public health.
Methods
We extracted individual data on 21 notifiable infectious diseases (NIDs) among individuals aged ≥60 years from the Chinese Infectious Disease Surveillance and Control Project (CISDCP) from 2014 to 2022 in the mainland of China. We comprehensively analyzed the epidemiological characteristics of NIDs in older people and estimated the impact of age, year, and the COVID-19 pandemic.
Findings
A total of 8,604,064 cases of 21 major NIDs were reported, with an overall annual incidence of 362·10/100,000. Sexually transmitted or bloodborne diseases (STBDs, 45·23%) were the most common diseases. Notably, ranking of syphilis rose from fourth to third, while HIV/AIDS moved from eighth to seventh; respiratory diseases (34·88%) showed sustained declines. Tuberculosis remained the most common respiratory diseases despite a 6·4% annual decline (APC, P < 0·001); gastrointestinal or enteroviral diseases (GEDs, 18·35%) showed sustained declines, except for infectious diarrhea and hepatitis E; vector-borne or zoonotic diseases (VBZDs, 1·54%) remained low, though brucellosis increased during COVID-19 pandemic. Inflection point analysis revealed that 13 diseases, such as tuberculosis, infectious diarrhea, hepatitis B, and others, exhibited a quadratic distribution (inverted “V” shape) in age-specific incidence as age increased. Difference was noticeable between regions, with the older people in Inner Mongolia-Xinjiang region and South China region continuing to carry a disproportionate burden from NIDs.
Interpretation
Although China's success in infectious disease control in older people. Effective prevention and control strategies are needed for highest incidence diseases, such as tuberculosis, hepatitis B, and infectious diarrhea, especially in high-incidence regions and among critical age points.
Funding
National Major Research & Development Program of China (2022YFC2604000).
全球正处于前所未有的人口快速老龄化时期，伴随而来的老年人传染病流行威胁将对国家公共卫生构成严峻挑战。方法提取2014 - 2022年中国传染病监测与控制项目（CISDCP）中年龄≥60岁人群中21种法定传染病（NIDs）的个体数据。我们综合分析了老年人NIDs的流行病学特征，并估计了年龄、年份和COVID-19大流行的影响。结果21种主要NIDs共报告8604064例，年总发病率为362·10/10万。性传播或血源性疾病（STBDs, 45.23%）是最常见的疾病。值得注意的是，梅毒的排名从第四位上升到第三位，而艾滋病毒/艾滋病从第八位上升到第七位；呼吸系统疾病（34.88%）持续下降。结核病仍然是最常见的呼吸道疾病，尽管每年下降6.4% (APC, P < 0.001)；除感染性腹泻和戊型肝炎外，胃肠道或肠病毒疾病（GEDs, 18.35%）持续下降；病媒传播或人畜共患疾病（VBZDs, 1.54%）保持在较低水平，但在COVID-19大流行期间布鲁氏菌病有所增加。拐点分析显示，随着年龄的增长，结核病、传染性腹泻、乙型肝炎等13种疾病的年龄特异性发病率呈二次型分布（倒“V”形）。不同地区之间的差异是明显的，内蒙古-新疆地区和华南地区的老年人继续承担着不成比例的NIDs负担。虽然中国在老年人传染病控制方面取得了成功。对于结核病、乙型肝炎和传染性腹泻等发病率最高的疾病，特别是在高发病率地区和关键年龄点，需要有效的预防和控制战略。国家重大研究发展计划项目（2022YFC2604000）。
{"title":"Epidemiological analysis of infectious diseases in older people in China from 2014 to 2022: a population-based study","authors":"Sheng-Hong Lin , Chen-Long Lv , Meng-Jie Geng , Rui-Cheng Gao , Yan-Qun Sun , Yan-He Wang , Ya-Ming Zheng , Tian Tang , Chun-Xi Shan , Yao Tian , Yun-Bo Qiu , Jun Ma , Yan Zhang , Yu-Feng Yang , Qiang Xu , Guo-Lin Wang , Yan-Ping Zhang , Qun Li , Li-Ping Wang , Peng-Tao Bao , Wei Liu","doi":"10.1016/j.lanwpc.2025.101729","DOIUrl":"10.1016/j.lanwpc.2025.101729","url":null,"abstract":"<div><h3>Background</h3><div>The whole world is undergoing an unprecedented rapid population aging, and the accompanying threat of infectious diseases epidemic among the older people will pose a serious challenge to the national public health.</div></div><div><h3>Methods</h3><div>We extracted individual data on 21 notifiable infectious diseases (NIDs) among individuals aged ≥60 years from the Chinese Infectious Disease Surveillance and Control Project (CISDCP) from 2014 to 2022 in the mainland of China. We comprehensively analyzed the epidemiological characteristics of NIDs in older people and estimated the impact of age, year, and the COVID-19 pandemic.</div></div><div><h3>Findings</h3><div>A total of 8,604,064 cases of 21 major NIDs were reported, with an overall annual incidence of 362·10/100,000. Sexually transmitted or bloodborne diseases (STBDs, 45·23%) were the most common diseases. Notably, ranking of syphilis rose from fourth to third, while HIV/AIDS moved from eighth to seventh; respiratory diseases (34·88%) showed sustained declines. Tuberculosis remained the most common respiratory diseases despite a 6·4% annual decline (APC, P < 0·001); gastrointestinal or enteroviral diseases (GEDs, 18·35%) showed sustained declines, except for infectious diarrhea and hepatitis E; vector-borne or zoonotic diseases (VBZDs, 1·54%) remained low, though brucellosis increased during COVID-19 pandemic. Inflection point analysis revealed that 13 diseases, such as tuberculosis, infectious diarrhea, hepatitis B, and others, exhibited a quadratic distribution (inverted “V” shape) in age-specific incidence as age increased. Difference was noticeable between regions, with the older people in Inner Mongolia-Xinjiang region and South China region continuing to carry a disproportionate burden from NIDs.</div></div><div><h3>Interpretation</h3><div>Although China's success in infectious disease control in older people. Effective prevention and control strategies are needed for highest incidence diseases, such as tuberculosis, hepatitis B, and infectious diarrhea, especially in high-incidence regions and among critical age points.</div></div><div><h3>Funding</h3><div><span>National Major Research</span> & <span>Development Program of China</span> (<span><span>2022YFC2604000</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"64 ","pages":"Article 101729"},"PeriodicalIF":8.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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