Pub Date : 2026-02-01Epub Date: 2026-01-27DOI: 10.1016/j.lanwpc.2025.101786
Hui You , Nicola Creighton , Richard J. Walton , Sarah J. Lord , Andrea L. Smith , Belinda E. Kiely , David M. Roder , Shelley Rushton , Tracey A. O'Brien
Background
The paucity of population-level data on people with metastatic breast cancer (MBC) means there is a critical information gap for planning cancer services tailored to meet the needs of people with MBC. The aims of this study were to estimate MBC prevalence and report the characteristics of people with MBC using linked routinely collected health data.
Methods
This was a population-based retrospective study. Residents of New South Wales (NSW), Australia, diagnosed with breast cancer from 1972 to 2020 were identified from the NSW Cancer Registry. People with MBC at diagnosis (de novo MBC) were identified using degree of spread at diagnosis recorded on the NSW Cancer Registry. Those with progressed or recurrent MBC were identified from linked cancer registry, hospital admission, radiotherapy and chemotherapy records. Vital status was obtained from the National Death Index.
Findings
There were an estimated 6692 people living with MBC on 31 December 2020, a third (32.5%) of those with de novo MBC. Half (52.6%) were aged 65 years and older, one quarter (25.3%) lived in regional and remote areas and one quarter (26.0%) were from non-English speaking countries of birth. Estrogen receptor positive/HER2 negative was the most common subtype (65.3%). Two out of five people (42.6%) had been living with MBC for five or more years. Nearly one quarter (23.3%) of people with progressed or recurrent MBC developed MBC ≥10 years after primary breast cancer diagnosis. The estimated number of people with MBC was 3821 in 2011 and increased 75% by 2020.
Interpretation
We identified a large and rapidly growing cohort of people with MBC. The majority were initially diagnosed with non-metastatic breast cancer. Their demographic and clinical characteristics can be used to understand their distinct needs for tailored and targeted treatment and supportive care. We have demonstrated that comprehensive population-level reporting of MBC is feasible using linked routinely collected health data.
Funding
This work was funded through the operational budget of the Cancer Institute NSW. A.L.S. is supported by a Daffodil Fellowship. S.J.L. received funding from an NHMRC Project Grant ID: 1125433.
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Pub Date : 2026-02-01Epub Date: 2026-01-15DOI: 10.1016/j.lanwpc.2025.101790
Hitomi Kimura , Sovandara Kao , Sareth Khann , ChanPeou Phan , Daravuth Yel , Ada Moadsiri , Mikiko Kanda , Siwon Lee
<div><h3>Background</h3><div>Social prescribing supports individual well-being and community engagement by linking people to local resources. In Cambodia, members of the existing Village Health Support Groups have been trained as link workers to deliver social prescribing activities by leveraging existing resources in a limited-resource setting. However, the nature and functioning of social prescribing in limited-resource settings remain poorly understood. This study aims to describe the implementation of social prescribing in Cambodia and examine how a social prescribing intervention for older adults was associated with improved access to healthcare, greater community support, and reduced loneliness, providing initial insights to inform future implementation research.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted across ten Cambodian provinces among 1200 older adults aged 60 and above between 1 December 2024 and 31 January 2025. We interviewed older adults in each of the following groups using a structured questionnaire: Group 1 (n = 400, received social prescribing), Group 2 (n = 400, did not receive but lived in areas with trained link workers), and Group 3 (n = 400, lived in areas without trained link workers). Descriptive analyses were conducted to summarise the demographic and contextual characteristics of participants across the three groups. Additional descriptive analyses were conducted for Group 1 to summarise the characteristics of social prescribing activities, and qualitative responses were thematically analysed. Logistic regression analyses were conducted to examine associations between social prescribing exposure and key outcomes. The primary outcomes were overall health status and loneliness. Secondary outcomes included consultation opportunities, healthcare access, unmet needs, and health status. Two comparisons were made: recipients versus non-recipients within trained areas (Group 1 vs Group 2) and non-recipients in trained versus non-trained areas (Group 2 vs Group 3). Models were adjusted for age, sex, marital status, education, household size, and IDPoor Equity Card status–a government measure of household poverty.</div></div><div><h3>Findings</h3><div>Among those who received social prescribing, information was most commonly provided by Village Health Support Groups (82.7%) and village leaders (76.9%) and were most often delivered at home (55.2%). Referrals were mainly to health facilities (84.3%) and community activities (77.2%), and also included counselling at pagoda (20.6%), mental health support (21.4%), and daily life assistance (17.0%). 98.9% of participants reported that social prescribing was helpful. Enhanced health literacy, practical support, and improved psychosocial well-being emerged as themes from the qualitative analysis of the semi-structured interviews, health literacy, practical support, and improved psychosocial well-being emerged as themes from the qualitative analysis of t
背景：社会处方通过将人们与当地资源联系起来，支持个人福祉和社区参与。在柬埔寨，现有村保健支助小组的成员接受了作为联络员的培训，以便在资源有限的情况下利用现有资源开展社会处方活动。然而，在资源有限的情况下，社会处方的性质和功能仍然知之甚少。本研究旨在描述社会处方在柬埔寨的实施情况，并研究老年人社会处方干预如何与改善获得医疗保健的机会、更大的社区支持和减少孤独感相关，为未来的实施研究提供初步见解。方法：在2024年12月1日至2025年1月31日期间，在柬埔寨10个省对1200名60岁及以上的老年人进行了横断面研究。我们使用结构化问卷采访了以下每一组的老年人：第一组（n = 400，接受社会处方），第二组（n = 400，不接受社会处方，但生活在有训练有素的联系工作者的地区），第三组（n = 400，生活在没有训练有素的联系工作者的地区）。进行描述性分析，以总结三组参与者的人口统计学和背景特征。对第一组进行了额外的描述性分析，以总结社会处方活动的特征，并对定性反应进行了主题分析。进行逻辑回归分析以检验社会处方暴露与关键结果之间的关系。主要结局是总体健康状况和孤独感。次要结局包括咨询机会、医疗服务可及性、未满足的需求和健康状况。进行了两项比较：训练区域内的接受者与非接受者（第1组与第2组）和训练区域内的非接受者与非接受者（第2组与第3组）。模型根据年龄、性别、婚姻状况、教育程度、家庭规模和贫困公平卡状态（政府对家庭贫困的衡量标准）进行了调整。结果：在接受社会处方的患者中，信息最常由村卫生支持小组（82.7%）和村领导（76.9%）提供，最常在家中提供（55.2%）。转诊主要是卫生设施（84.3%）和社区活动（77.2%），还包括宝塔咨询（20.6%）、心理健康支持（21.4%）和日常生活援助（17.0%）。98.9%的参与者报告社会处方是有帮助的。从半结构化访谈的定性分析得出的主题是加强卫生知识普及、实际支持和改善社会心理健康，从半结构化访谈的定性分析得出的主题是卫生知识普及、实际支持和改善社会心理健康。与第2组相比，第1组与更多的社区支持者咨询机会显著相关（多变量调整OR (aOR) 1.65, 95% CI 1.24-2.20, p = 0.00054），经Bonferroni校正后仍具有统计学意义。与第2组相比，第1组报告医疗保健可获得性差（aOR = 0.73, 95% CI: 0.53-1.00, p = 0.048）和孤独感（aOR = 0.60, 95% CI: 0.37-0.97, p = 0.039）的可能性较小，尽管经Bonferroni校正后这些关联并不显著。解释：在柬埔寨，通过现有的乡村卫生支持小组提供的社会处方似乎是可行的，并且被认为对老年人非常有帮助。描述性研究结果表明，在资源有限的情况下，训练有素的联络员可以加强社区支持。这些见解提供了对社会处方在低资源环境下如何发挥作用的初步理解，并可以为未来的实施研究提供信息。供资：世界卫生组织西太平洋区域办事处。
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Pub Date : 2026-02-01Epub Date: 2026-01-15DOI: 10.1016/j.lanwpc.2025.101793
Naoki Kondo
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Pub Date : 2026-02-01Epub Date: 2026-02-27DOI: 10.1016/j.lanwpc.2026.101824
The Lancet Regional Health – Western Pacific
{"title":"Advancing understanding of social prescribing in the Western Pacific region","authors":"The Lancet Regional Health – Western Pacific","doi":"10.1016/j.lanwpc.2026.101824","DOIUrl":"10.1016/j.lanwpc.2026.101824","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101824"},"PeriodicalIF":8.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366622","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 : 2026-02-01Epub Date: 2025-12-16DOI: 10.1016/j.lanwpc.2025.101772
Lianping Yang , Zishu Ma , Fanqian Meng , Ruonan Wang , Shanquan Chen , Chaojie Liu , Hung Chak Ho , Mingli Xu , Alvin Qijia Chua , Li Yang Hsu , Yanhui Jia , Yi Zhang , Cunrui Huang , John S. Ji
<div><h3>Background</h3><div>Climate change and antimicrobial resistance (AMR) are escalating public health threats globally. The Western Pacific Region faces unique climatic and socioeconomic vulnerabilities, but evidence on this climate-AMR intersection is limited. We aimed to systematically provide evidence on this critical issue.</div></div><div><h3>Methods</h3><div>We conducted a three-stage mixed-methods systematic analysis: (1) a narrative review mapping the regional AMR landscape and summarizing potential climate-driven mechanisms; (2) a systematic review (PubMed and Google Scholar, January 2000–March 2025) of regional quantitative studies; and (3) an empirical quantitative analysis using a longitudinal panel dataset. This analysis completes our systematic approach by visualizing AMR mortality trends (using data from the GRAM project) and applying regression analysis to model AMR-attributable death rates based on climatic and socioeconomic factors, providing quantitative evidence of the regional situation and its potential drivers.</div></div><div><h3>Findings</h3><div>Literature review evidence showed that increasing temperature caused by climate change directly accelerates bacterial growth and resistance mutation rates and indirectly affects healthcare disruptions and antibiotic misuse during extreme weather events. We included 18 quantitative studies synthesised using the SWiM framework, which provided more specific evidence that higher temperatures are associated with increased clinical resistance rates and enhanced environmental dissemination of antibiotic resistance genes (ARGs). Our quantitative analysis found that a 1 °C increase in mean ambient temperature was associated with higher AMR-attributable mortality from carbapenem-resistant <em>Acinetobacter baumannii</em> (CRAB; β = 0.652, 95% CI 0.579–0.724, p < 0.001) and carbapenem-resistant <em>Pseudomonas aeruginosa</em> (CRPA; β = 0.422, 95% CI 0.304–0.541, p < 0.001). It also revealed that socioeconomic factors have heterogeneous effects.</div></div><div><h3>Interpretation</h3><div>Climatic conditions and socioeconomic vulnerabilities jointly shape AMR risks in the Western Pacific Region. Projected increases in extreme weather events threaten to strain healthcare systems further and worsen antibiotic misuse. Strengthening climate-resilient health systems, improving multisectoral AMR governance, and establishing integrated AMR–climate surveillance networks are essential regional priorities.</div></div><div><h3>Funding</h3><div>This work is supported by <span>World Health Organization</span> (WPRO/2024-02/AGE-DHP/22552 4), <span>National Natural Science Foundation of China</span> (<span><span>82422064</span></span>, <span><span>82250610230</span></span>, <span><span>72374228</span></span>, <span><span>72074234</span></span>), <span>Natural Science Foundation of Beijing</span> (<span><span>IS23105</span></span>), <span>National Bureau for Disease Control and Prevention</span
气候变化和抗菌素耐药性（AMR）正在加剧全球公共卫生威胁。西太平洋地区面临着独特的气候和社会经济脆弱性，但关于这种气候-抗菌素耐药性交叉的证据有限。我们的目标是系统地提供有关这一关键问题的证据。方法采用三阶段混合方法进行系统分析：(1)通过叙述性综述，绘制区域抗菌素耐药性格局，总结潜在的气候驱动机制；(2)区域定量研究的系统综述（PubMed and谷歌Scholar， 2000年1月- 2025年3月）；(3)利用纵向面板数据进行实证定量分析。该分析通过可视化AMR死亡率趋势（使用来自GRAM项目的数据）和应用回归分析对基于气候和社会经济因素的AMR归因死亡率进行建模，从而完成了我们的系统方法，为区域情况及其潜在驱动因素提供了定量证据。研究结果文献综述证据表明，气候变化引起的温度升高直接加速了细菌生长和耐药性突变率，并间接影响极端天气事件期间医疗保健中断和抗生素滥用。我们纳入了使用SWiM框架合成的18项定量研究，这些研究提供了更具体的证据，表明较高的温度与临床耐药率增加和抗生素耐药基因（ARGs）的环境传播增强有关。我们的定量分析发现，平均环境温度升高1°C与耐碳青霉烯鲍曼不动杆菌（CRAB; β = 0.652, 95% CI 0.579-0.724, p < 0.001）和耐碳青霉烯铜绿假单胞菌（CRPA; β = 0.422, 95% CI 0.304-0.541, p < 0.001）的amr导致的死亡率升高相关。研究还表明，社会经济因素具有异质性影响。气候条件和社会经济脆弱性共同影响了西太平洋地区的抗菌素耐药性风险。预计极端天气事件的增加可能会进一步给卫生保健系统带来压力，并加剧抗生素滥用。加强适应气候变化的卫生系统、改善多部门抗菌素耐药性治理以及建立抗菌素耐药性气候综合监测网络是本区域的重要优先事项。世界卫生组织（WPRO/2024-02/年龄- dhp / 225524）、国家自然科学基金项目（82422064,82250610230,72374228,72074234）、北京市自然科学基金项目（IS23105）、国家疾病预防控制局项目（20241660047）、广州市基础与应用基础研究计划项目（2025A04J5118）、中央高校基本科研业务费项目（SYSU-25wkjc02）资助。中国国家科技重大专项（No. 2024ZD0524500）和新加坡国家医学研究理事会（CoSTAR-HS CG21APR2005; AMRITS MOH-001326-01）。
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Pub Date : 2026-02-01Epub Date: 2026-02-09DOI: 10.1016/j.lanwpc.2026.101813
Karinna Saxby , Sasha Bailey , Dennis Petrie , Brendan J. Nolan
Background
Transgender and gender diverse (‘trans’) people may be at increased risk of mortality, particularly from external causes, however, large-scale, population-based evidence remains scarce. This study aims to document all-cause and cause-specific mortality among trans people.
Methods
We source administrative data on healthcare and death records (2012–2023) from all Australians aged 15 years and above. Individuals identified as trans (initiated gender-affirming hormone therapy) were matched to the general population who visited a General Practitioner during the same period. Cox proportional hazard models were used to estimate all-cause and cause-specific mortality risk for trans people, with models estimated separately for people who were assigned female sex at birth (AFAB) and people who were assigned male sex at birth (AMAB). Inverse probability weights were applied to balance comparators on month-year and age at entry. Results were additionally stratified by age (15–24, 25–39, 40–59, and ≥60 years).
Findings
A total of 19,347 trans people AMAB (mean age 36.2 years; median follow-up 3.7 years) and 9713 trans people AFAB (mean age 25.4 years; median follow-up 2.8 years) were matched with 9,879,037 general population males (mean age 44.4; median follow-up 11.3 years) and 10,282,651 general population females (mean age 44.9; median follow-up 11.4 years), respectively. All-cause mortality was significantly higher for trans people AMAB [HR = 3.89 (95% CI 33.65; 4.14)] and trans people AFAB [HR = 9.03 (95% CI 6.90; 11.83)]. For trans people AFAB, cause-specific mortality was elevated for cardiovascular disease [HR = 16.39 (95% CI 8.56; 31.37)], suicide [HR = 11.73 (95% CI 6.94; 19.80)], external causes [HR = 8.95 (95% CI 5.69; 14.09)], and cancer [HR = 7.62 (95% CI 4.61; 12.61)]. For trans people AMAB, cause-specific mortality was elevated for cancer [HR = 5.12 (95% CI 4.67; 5.61)], suicide [HR = 4.02 (95% CI 3.12; 5.18)], external causes [HR = 2.78 (95% CI 2.31; 3.35)], and cardiovascular disease [HR = 2.60 (95% CI 2.22; 3.05)]. Older trans people had more pronounced excess risk from cancer and cardiovascular disease. For trans people AFAB, excess mortality from suicide and external causes increased with age, whereas for trans people AMAB relative risks were higher in young and middle adulthood.
Interpretation
In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations.
Funding
University of Melbourne McKenzie Fellowship (2025MCK182); the National Health and Medical Research Council (2008956); Viertel Charitable Foundation; University of Melbourne Faculty Research Grant (2025FRG19).
背景：跨性别者和性别多样化者（“trans”）的死亡风险可能会增加，特别是由于外部原因，然而，大规模的、基于人群的证据仍然很少。本研究旨在记录变性人的全因死亡率和特定原因死亡率。方法：我们从所有15岁及以上的澳大利亚人的医疗保健和死亡记录（2012-2023）中获取行政数据。被认定为跨性别者（开始进行性别确认激素治疗）与在同一时期拜访过全科医生的普通人群相匹配。Cox比例风险模型用于估计变性人的全因和特定原因死亡风险，模型分别估计出生时被分配为女性（AFAB）和出生时被分配为男性（AMAB）的人。应用逆概率权重来平衡比较者的月份、年份和入职年龄。结果还按年龄（15-24岁、25-39岁、40-59岁和≥60岁）进行分层。结果：共有19,347名跨性别者AMAB（平均年龄36.2岁，中位随访3.7年）和9713名跨性别者AFAB（平均年龄25.4岁，中位随访2.8年）分别与9,879,037名普通人群男性（平均年龄44.4岁，中位随访11.3年）和10,282,651名普通人群女性（平均年龄44.9岁，中位随访11.4年）相匹配。变性人AMAB的全因死亡率[HR = 3.89 (95% CI 33.65; 4.14)]和变性人AFAB的全因死亡率[HR = 9.03 (95% CI 6.90; 11.83)]显著高于变性人。对于跨性别AFAB，心血管疾病[HR = 16.39 (95% CI 8.56; 31.37)]、自杀[HR = 11.73 (95% CI 6.94; 19.80)]、外因[HR = 8.95 (95% CI 5.69; 14.09)]和癌症[HR = 7.62 (95% CI 4.61; 12.61)]的原因特异性死亡率升高。对于变性人AMAB，癌症[HR = 5.12 (95% CI 4.67; 5.61)]、自杀[HR = 4.02 (95% CI 3.12; 5.18)]、外因[HR = 2.78 (95% CI 2.31; 3.35)]和心血管疾病[HR = 2.60 (95% CI 2.22; 3.05)]的病因特异性死亡率升高。年龄较大的变性人患癌症和心血管疾病的风险更大。对于AFAB的跨性别者，自杀和外因导致的超额死亡率随着年龄的增长而增加，而跨性别者AMAB的相对风险在青年和中年更高。解释：在这项全国性队列研究中，跨性别澳大利亚人的死亡风险显著升高。需要有针对性的政策对策来解决跨性别人群的过早死亡问题。资助：墨尔本大学麦肯齐奖学金（2025MCK182）；国家卫生和医学研究委员会（2008956）；菲尔特慈善基金会；墨尔本大学教师研究基金（2025FRG19）。
{"title":"All-cause and cause-specific mortality among transgender and gender diverse people: a nationwide cohort study in Australia","authors":"Karinna Saxby , Sasha Bailey , Dennis Petrie , Brendan J. Nolan","doi":"10.1016/j.lanwpc.2026.101813","DOIUrl":"10.1016/j.lanwpc.2026.101813","url":null,"abstract":"<div><h3>Background</h3><div>Transgender and gender diverse (‘trans’) people may be at increased risk of mortality, particularly from external causes, however, large-scale, population-based evidence remains scarce. This study aims to document all-cause and cause-specific mortality among trans people.</div></div><div><h3>Methods</h3><div>We source administrative data on healthcare and death records (2012–2023) from all Australians aged 15 years and above. Individuals identified as trans (initiated gender-affirming hormone therapy) were matched to the general population who visited a General Practitioner during the same period. Cox proportional hazard models were used to estimate all-cause and cause-specific mortality risk for trans people, with models estimated separately for people who were assigned female sex at birth (AFAB) and people who were assigned male sex at birth (AMAB). Inverse probability weights were applied to balance comparators on month-year and age at entry. Results were additionally stratified by age (15–24, 25–39, 40–59, and ≥60 years).</div></div><div><h3>Findings</h3><div>A total of 19,347 trans people AMAB (mean age 36.2 years; median follow-up 3.7 years) and 9713 trans people AFAB (mean age 25.4 years; median follow-up 2.8 years) were matched with 9,879,037 general population males (mean age 44.4; median follow-up 11.3 years) and 10,282,651 general population females (mean age 44.9; median follow-up 11.4 years), respectively. All-cause mortality was significantly higher for trans people AMAB [HR = 3.89 (95% CI 33.65; 4.14)] and trans people AFAB [HR = 9.03 (95% CI 6.90; 11.83)]. For trans people AFAB, cause-specific mortality was elevated for cardiovascular disease [HR = 16.39 (95% CI 8.56; 31.37)], suicide [HR = 11.73 (95% CI 6.94; 19.80)], external causes [HR = 8.95 (95% CI 5.69; 14.09)], and cancer [HR = 7.62 (95% CI 4.61; 12.61)]. For trans people AMAB, cause-specific mortality was elevated for cancer [HR = 5.12 (95% CI 4.67; 5.61)], suicide [HR = 4.02 (95% CI 3.12; 5.18)], external causes [HR = 2.78 (95% CI 2.31; 3.35)], and cardiovascular disease [HR = 2.60 (95% CI 2.22; 3.05)]. Older trans people had more pronounced excess risk from cancer and cardiovascular disease. For trans people AFAB, excess mortality from suicide and external causes increased with age, whereas for trans people AMAB relative risks were higher in young and middle adulthood.</div></div><div><h3>Interpretation</h3><div>In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations.</div></div><div><h3>Funding</h3><div><span>University of Melbourne McKenzie Fellowship</span> (2025MCK182); the <span>National Health and Medical Research Council</span> (2008956); <span>Viertel Charitable Foundation; University of Melbourne Faculty Research Grant (2025FRG19)</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101813"},"PeriodicalIF":8.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228875","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 : 2026-02-01Epub Date: 2026-01-22DOI: 10.1016/j.lanwpc.2026.101797
Kelly Jones , Alice Theadom , Nicola Starkey , Irene Zeng , Shanthi Ameratunga , Suzanne Barker-Collo , Laura Wilkinson-Meyers , Braden Te Ao , Nathan Henry , Luke A. McClean , Jennifer Chua , Leah Haumaha , Michael Kahan , Grant Christey , Natalie Hardaker , Amy Jones , Anthony Dowell , Valery Feigin
Background
Monitoring traumatic brain injury (TBI) incidence and epidemiological patterns is important for evidence-based strategic planning, policy, prevention, and resource allocation. We revisited population-based estimates and examined patterns of TBI incidence (all ages, severities) in 2021–2022 compared with 2010–2011 in New Zealand (NZ).
Methods
Examining an urban (Hamilton) and rural (Waikato District) region in NZ (May 2021–April 2022, unintentionally following the start of the COVID-19 pandemic), we calculated crude annual age-, sex-, ethnic-, urban/rural area- and mechanism-specific TBI incidence per 100,000 person-years with 95% Confidence Intervals (CI). Poisson regression was used to derive adjusted Risk Ratios (aRRs) to compare age-standardised rates between sex, ethnicity, and area groups. Direct standardisation was used to age-standardise rates to the world population. We calculated Incidence Rate Ratios (IRRs) with 95% CI to compare 2021–2022 with 2010–2011 age-standardised rates.
Findings
Total TBI incidence per 100,000 person-years was 852 cases (95% CI 816–890), including 791 cases (756–828) of mild TBI, and 61 cases (52–72) of moderate to severe TBI. TBI affected males more than females (IRR 1.31, 95% CI 1.29–1.33), and urban more than rural residents (IRR 1.57, 1.43–1.73). Most TBI (61%) occurred in people aged 15–64 years and were due to falls (48%). European and Asian peoples had lower risk of TBI than Māori (aRRs 0.68, 0.31 respectively). Compared to 2010–2011, total TBI incidence and rates among Māori were stable; TBI incidence was greater among females, urban residents, and adults aged ≥34 years; and TBI due to falls significantly increased (IRR 1.20, 95% CI 1.03–1.40).
Interpretation
Noting increased risks for underestimation due to COVID-19, findings suggest overall TBI incidence rate in NZ was similar in 2021–2022 to 2010–2011, while highlighting changes in TBI distribution. Age-, sex-, area-, ethnic-, and mechanism-specific distributions should be considered when revisiting prevention strategies to reduce TBI incidence.
Funding
Health Research Council of New Zealand of NZ.
背景：监测创伤性脑损伤（TBI）发病率和流行病学模式对循证战略规划、政策、预防和资源分配具有重要意义。我们重新评估了基于人群的估计，并检查了2021-2022年与2010-2011年新西兰TBI发病率（所有年龄、严重程度）的模式。方法研究了新西兰的城市（汉密尔顿）和农村（怀卡托区）地区（2021年5月至2022年4月，在COVID-19大流行开始后无意中），我们计算了每10万人年的年龄、性别、种族、城市/农村地区和机制特异性TBI发病率，置信区间为95% （CI）。泊松回归用于得出校正风险比（aRRs），以比较性别、种族和地区群体之间的年龄标准化发病率。直接标准化被用来对世界人口的年龄比率进行标准化。我们计算了2021-2022年与2010-2011年年龄标准化发病率的95% CI发生率比（IRRs）。发现每10万人年总TBI发病率为852例（95% CI 816-890），其中791例（756-828）为轻度TBI， 61例（52-72）为中度至重度TBI。脑外伤对男性的影响大于女性（IRR 1.31, 95% CI 1.29-1.33），对城市居民的影响大于农村居民（IRR 1.57, 1.43-1.73）。大多数TBI（61%）发生在15-64岁的人群中，由跌倒引起（48%）。欧洲和亚洲人群的TBI风险低于Māori （aRRs分别为0.68和0.31）。与2010-2011年相比，Māori的总TBI发病率和发病率保持稳定；女性、城市居民和年龄≥34岁的成年人的TBI发病率较高；跌落引起的TBI显著增加（IRR 1.20, 95% CI 1.03-1.40）。由于COVID-19导致低估的风险增加，研究结果表明，2021-2022年新西兰的总体TBI发病率与2010-2011年相似，同时突出了TBI分布的变化。在重新制定预防策略以减少TBI发生率时，应考虑年龄、性别、地区、种族和机制特异性分布。资助新西兰卫生研究理事会。
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Pub Date : 2026-02-01Epub Date: 2026-01-30DOI: 10.1016/j.lanwpc.2026.101800
Ho Seok Lee , Min Kyun Sohn , Jongmin Lee , Deog Young Kim , Yong-Il Shin , Gyung-Jae Oh , Yang-Soo Lee , Min Cheol Joo , So Young Lee , Min-Keun Song , Junhee Han , Jeonghoon Ahn , Young-Hoon Lee , Dae Hyun Kim , Young-Taek Kim , Yun-Hee Kim , Won Hyuk Chang
Background
Long-term outcomes of ischemic stroke patients having mild vascular cognitive impairment (VCI) are not well-known. The aim of this study was to investigate the five-year outcomes of ischemic stroke patients with mild VCI.
Methods
This study analyzed data from the Korean Stroke Cohort for Functioning and Rehabilitation study. Patients were recruited from August 2012 through May 2015. We included patients who survived five-year after stroke onset and were classified as having mild VCI at six-month post-onset. Assessments were performed serially from six-month to five-year post-onset. Cognition was assessed by Korean version of Mini-Mental Status Examination (K-MMSE). Functional Independence Measure (FIM) was used to assess activities of daily living (ADL) of the participants. Vascular Impairment of Cognition Classification Consensus Study (VICCCS) guideline was used to define VCI condition. Longitudinal trajectories of VCI condition and K-MMSE, including the specific domains, were identified. Multivariable logistic regression analysis was performed, to demonstrated factors associated with progression to major VCI condition.
Findings
A total of 998 patients were included. At five-year post-onset, 136 (13·6%) patients progressed to major VCI condition. Older age (OR 1·09, 95% CI 1·06∼1·12), presence of diabetes (OR 1·83, 95% CI 1·15∼2·88) and atrial fibrillation (OR 2·47, 95% CI 1·25∼4·79), high level of education (OR 0·32, 95% CI 0·10∼0·90), etiology of small vessel occlusion (OR 1·95, 95% CI 1·18∼3·22), higher FIM score at six-month (OR 0·90, 95% CI 0·85∼0·96), impairment in the attention and calculation domain of the K-MMSE at six-month (OR 2·10, 95% CI 1·25∼3·61), and longer hospitalization (OR 1·04, 95% CI 1·02∼1·05) were associated with the risk of being classified as having major VCI at five-year.
Interpretation
This study investigated the incidence and associated factors of major VCI in patients with mild VCI. The results provide insights into cognitive decline trajectories in this population, enabling the development of targeted management strategies to mitigate disease progression.
Funding
The Research Program funded by Korea Disease Control and Prevention Agency.
背景缺血性脑卒中患者有轻度血管性认知障碍（VCI）的长期预后尚不清楚。本研究的目的是调查缺血性脑卒中合并轻度VCI患者的5年预后。方法本研究分析了韩国卒中患者功能与康复研究的数据。患者于2012年8月至2015年5月招募。我们纳入了中风发作后存活5年并在发病后6个月被分类为轻度VCI的患者。发病后6个月至5年连续进行评估。认知能力评估采用韩文迷你精神状态测验（K-MMSE）。采用功能独立性量表（FIM）评估受试者的日常生活活动能力（ADL）。血管认知障碍分类共识研究（VICCCS）指南定义VCI情况。确定了VCI条件和K-MMSE的纵向轨迹，包括特定的域。进行多变量logistic回归分析，以证明与VCI进展相关的因素。结果共纳入998例患者。发病5年后，136例（13.6%）患者进展为严重VCI。年龄较大（OR 1.09, 95% CI 1.06 ~ 1.12），存在糖尿病（OR 1.83, 95% CI 1.15 ~ 2.88）和房颤（OR 2.47, 95% CI 1.25 ~ 4.79），受教育程度高（OR 0.32, 95% CI 0.10 ~ 0.90），小血管闭塞的病因（OR 1.95, 95% CI 1.18 ~ 3.22）， 6个月时较高的FIM评分（OR 0.90, 95% CI 0.85 ~ 0.96）， 6个月时K-MMSE的注意力和计算域受损（OR 2.10, 95% CI 1.25 ~ 3.61），住院时间较长(OR 1.04，95% CI 1.02 ~ 1.05)与5年时被分类为严重VCI的风险相关。本研究探讨轻度VCI患者重度VCI的发生率及相关因素。该结果提供了对该人群认知能力下降轨迹的见解，使有针对性的管理策略的发展能够缓解疾病进展。研究项目由韩国疾病控制和预防机构资助。
{"title":"Incidence and associated factors of major VCI in first-ever ischemic stroke patients with mild VCI: a five-year prospective cohort study","authors":"Ho Seok Lee , Min Kyun Sohn , Jongmin Lee , Deog Young Kim , Yong-Il Shin , Gyung-Jae Oh , Yang-Soo Lee , Min Cheol Joo , So Young Lee , Min-Keun Song , Junhee Han , Jeonghoon Ahn , Young-Hoon Lee , Dae Hyun Kim , Young-Taek Kim , Yun-Hee Kim , Won Hyuk Chang","doi":"10.1016/j.lanwpc.2026.101800","DOIUrl":"10.1016/j.lanwpc.2026.101800","url":null,"abstract":"<div><h3>Background</h3><div>Long-term outcomes of ischemic stroke patients having mild vascular cognitive impairment (VCI) are not well-known. The aim of this study was to investigate the five-year outcomes of ischemic stroke patients with mild VCI.</div></div><div><h3>Methods</h3><div>This study analyzed data from the Korean Stroke Cohort for Functioning and Rehabilitation study. Patients were recruited from August 2012 through May 2015. We included patients who survived five-year after stroke onset and were classified as having mild VCI at six-month post-onset. Assessments were performed serially from six-month to five-year post-onset. Cognition was assessed by Korean version of Mini-Mental Status Examination (K-MMSE). Functional Independence Measure (FIM) was used to assess activities of daily living (ADL) of the participants. Vascular Impairment of Cognition Classification Consensus Study (VICCCS) guideline was used to define VCI condition. Longitudinal trajectories of VCI condition and K-MMSE, including the specific domains, were identified. Multivariable logistic regression analysis was performed, to demonstrated factors associated with progression to major VCI condition.</div></div><div><h3>Findings</h3><div>A total of 998 patients were included. At five-year post-onset, 136 (13·6%) patients progressed to major VCI condition. Older age (OR 1·09, 95% CI 1·06∼1·12), presence of diabetes (OR 1·83, 95% CI 1·15∼2·88) and atrial fibrillation (OR 2·47, 95% CI 1·25∼4·79), high level of education (OR 0·32, 95% CI 0·10∼0·90), etiology of small vessel occlusion (OR 1·95, 95% CI 1·18∼3·22), higher FIM score at six-month (OR 0·90, 95% CI 0·85∼0·96), impairment in the attention and calculation domain of the K-MMSE at six-month (OR 2·10, 95% CI 1·25∼3·61), and longer hospitalization (OR 1·04, 95% CI 1·02∼1·05) were associated with the risk of being classified as having major VCI at five-year.</div></div><div><h3>Interpretation</h3><div>This study investigated the incidence and associated factors of major VCI in patients with mild VCI. The results provide insights into cognitive decline trajectories in this population, enabling the development of targeted management strategies to mitigate disease progression.</div></div><div><h3>Funding</h3><div>The Research Program funded by <span>Korea Disease Control and Prevention Agency</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101800"},"PeriodicalIF":8.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077562","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 : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.lanwpc.2025.101760
Siwon Lee, Mikiko Kanda, Hiromasa Okayasu
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Pub Date : 2026-02-01Epub Date: 2026-01-28DOI: 10.1016/j.lanwpc.2026.101802
Shu Su , Meng Jia , Qingxian Song , Linlu Guo , Ningjing Peng , Yingni Yu , Ying Jiang , Fanpu Ji , Zhuoru Zou , Lei Zhang
<div><h3>Background</h3><div>Key populations bear a disproportionate burden of hepatitis B virus (HBV). We synthesized evidence on the HBV care cascade among key populations to inform strategies toward WHO's 2030 elimination targets.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of observational studies published during 2019.01.01–2025.10.31, identified from PubMed, Web of Science, Ovid, and Embase. Eligible studies reported HBV care cascade indicators (vaccination, screening, linkage to care, treatment, adherence, positivity, virological suppression and functional cure) among people living with HIV (PLHIV), men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and detainees across WHO regions. Meta-analysis (PROSPERO CRD42024569607) was performed using generalized linear mixed models. Heterogeneity was assessed with <em>I</em><sup>2</sup>.</div></div><div><h3>Findings</h3><div>We included 693 data points from 329 studies. Cascade varied substantially among key populations. PLHIV were the only group with full-cascade estimates, showing vaccination at 16.3% (95% CI, 11.4–22.8), screening 68.8% (53.4–80.9), linkage to care 88.1% (49.5–98.3), treatment 88.9% (84.3–92.3), adherence 86.1% (71.1–93.9), HBV positivity 7.6% (6.8–8.6), virological suppression 75.7% (66.3–83.1) and functional cure 8.4% (6.0–11.5). Data for other key populations were sparse. MSM had the highest vaccination (48.0%, 42.1–53.9), but the lowest screening uptake (59.9%, 47.9–70.8). FSW had the lowest vaccination (10.3%, 3.7–25.8) and relatively high positivity (7.1%, 4.9–10.3). DU achieved the highest functional cure (15.4%, 10.1–23.0). Detainees had low vaccination (25.6%, 13.1–44.2) and low HBV positivity (2.6%, 1.8–3.7). Regional variation was significant (all <em>p</em> < 0.05): the Western Pacific had higher HBV positivity but stronger treatment adherence and virological suppression, whereas Africa showed the lowest vaccination, screening, and treatment coverage despite the highest burden.</div></div><div><h3>Interpretation</h3><div>HBV care cascade data remain inadequate for key populations. Vaccination and screening are suboptimal in all populations, although PLHIV show strong treatment coverage and adherence.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>National Key R&D Program of China</span> (<span><span>2022YFC2304900</span></span>, <span><span>2022YFC2505100</span></span>), The <span>National Natural Science Foundation of China</span> (<span><span>81950410639</span></span>, <span><span>82304246</span></span>); <span>Outstanding Young Scholars Support Program</span> (<span><span>3111500001</span></span>); <span>Xi'an Jiaotong University Basic Research and Profession Grant</span> (<span><span>xtr022019003</span></span>, <span><span>xzy032020032</span></span>) and <span>Xi'an Jiaotong University Young Scholar Support Grant</span> (<span><span>YX6J004</span></span>); the <
{"title":"The hepatitis B care cascade among key populations towards global elimination: a systematic review and meta-analysis","authors":"Shu Su , Meng Jia , Qingxian Song , Linlu Guo , Ningjing Peng , Yingni Yu , Ying Jiang , Fanpu Ji , Zhuoru Zou , Lei Zhang","doi":"10.1016/j.lanwpc.2026.101802","DOIUrl":"10.1016/j.lanwpc.2026.101802","url":null,"abstract":"<div><h3>Background</h3><div>Key populations bear a disproportionate burden of hepatitis B virus (HBV). We synthesized evidence on the HBV care cascade among key populations to inform strategies toward WHO's 2030 elimination targets.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of observational studies published during 2019.01.01–2025.10.31, identified from PubMed, Web of Science, Ovid, and Embase. Eligible studies reported HBV care cascade indicators (vaccination, screening, linkage to care, treatment, adherence, positivity, virological suppression and functional cure) among people living with HIV (PLHIV), men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and detainees across WHO regions. Meta-analysis (PROSPERO CRD42024569607) was performed using generalized linear mixed models. Heterogeneity was assessed with <em>I</em><sup>2</sup>.</div></div><div><h3>Findings</h3><div>We included 693 data points from 329 studies. Cascade varied substantially among key populations. PLHIV were the only group with full-cascade estimates, showing vaccination at 16.3% (95% CI, 11.4–22.8), screening 68.8% (53.4–80.9), linkage to care 88.1% (49.5–98.3), treatment 88.9% (84.3–92.3), adherence 86.1% (71.1–93.9), HBV positivity 7.6% (6.8–8.6), virological suppression 75.7% (66.3–83.1) and functional cure 8.4% (6.0–11.5). Data for other key populations were sparse. MSM had the highest vaccination (48.0%, 42.1–53.9), but the lowest screening uptake (59.9%, 47.9–70.8). FSW had the lowest vaccination (10.3%, 3.7–25.8) and relatively high positivity (7.1%, 4.9–10.3). DU achieved the highest functional cure (15.4%, 10.1–23.0). Detainees had low vaccination (25.6%, 13.1–44.2) and low HBV positivity (2.6%, 1.8–3.7). Regional variation was significant (all <em>p</em> < 0.05): the Western Pacific had higher HBV positivity but stronger treatment adherence and virological suppression, whereas Africa showed the lowest vaccination, screening, and treatment coverage despite the highest burden.</div></div><div><h3>Interpretation</h3><div>HBV care cascade data remain inadequate for key populations. Vaccination and screening are suboptimal in all populations, although PLHIV show strong treatment coverage and adherence.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>National Key R&D Program of China</span> (<span><span>2022YFC2304900</span></span>, <span><span>2022YFC2505100</span></span>), The <span>National Natural Science Foundation of China</span> (<span><span>81950410639</span></span>, <span><span>82304246</span></span>); <span>Outstanding Young Scholars Support Program</span> (<span><span>3111500001</span></span>); <span>Xi'an Jiaotong University Basic Research and Profession Grant</span> (<span><span>xtr022019003</span></span>, <span><span>xzy032020032</span></span>) and <span>Xi'an Jiaotong University Young Scholar Support Grant</span> (<span><span>YX6J004</span></span>); the <","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101802"},"PeriodicalIF":8.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077560","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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