Pub Date : 2026-02-01DOI: 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}
Clinical and cost-effectiveness of a Birthing on Country service has been demonstrated in a metropolitan centre. We sought to evaluate feasibility, clinical effectiveness and wrap-around supports in the rural setting by evaluating Waminda's Birthing on Country service.
Methods
This prospective, non-randomised, interventional study was conducted in Nowra, Australia (ANZCTR: 12620000874910, study completed). Pre-defined primary outcomes were first assessment with health service in 1st trimester, ≥5 antenatal visits, normal birth, preterm birth, healthy baby and exclusive breastfeeding at discharge. Propensity score matching balanced confounders to calculate treatment effect. Waminda's wrap-around services and their interactions are represented using a network analysis.
Findings
Relative to standard care, the Birthing on Country service was associated with significantly less women having ≥5 antenatal visits (80·6% versus 94·4%, odds ratio 0·22, 95% CI 0·10, 0·50) (with differences in measurements impacting this outcome), more normal births (32·8% versus 21·7%, odds ratio 1·77, 95% CI 1·08, 2·79), and exclusive breastfeeding at discharge (75·6% versus 63·3%, odds ratio 1·88, 95% CI 1·16, 3·05). No significant differences were observed in other primary outcomes. More than 90% of women accessing Waminda received at least one wrap-around service, some received intensive support.
Interpretation
This study is the first to provide evidence towards successful implementation and effectiveness of a Birthing on Country service and the wrap around care in a rural setting and supports the urgent need for maternity service redesign for Aboriginal families.
Funding
National Health Medical Research Council of Australia Partnership grant (grant 1135125).
背景：农村分娩服务的临床和成本效益已在一个大都市中心得到证明。我们试图通过评估Waminda的分娩服务来评估农村环境中的可行性、临床有效性和一揽子支持。该前瞻性、非随机、干预性研究在澳大利亚Nowra进行（ANZCTR: 12620000874910，研究完成）。预先定义的主要结局是在妊娠早期与卫生服务进行首次评估，产前检查≥5次，正常分娩，早产，健康婴儿和出院时纯母乳喂养。倾向评分匹配平衡混杂因素来计算治疗效果。Waminda的环绕式服务及其交互使用网络分析来表示。结果：与标准护理相比，乡村分娩服务与产前检查次数≥5次的妇女显著减少（83.6%对93.4%，比值比0.22,95% CI 0.10, 0.50）（测量差异影响该结果）、更多正常分娩（32.8%对21.7%，比值比1.77,95% CI 1.08, 2.79）和出院时纯母乳喂养（75.6%对63%，比值比1.88,95% CI 1.16, 3.05）相关。其他主要结局无显著差异。90%以上使用Waminda的妇女至少接受了一次包罗万象的服务，其中一些人得到了密集的支持。本研究首次为在农村环境中成功实施分娩服务和围护的有效性提供了证据，并支持了对土著家庭产妇服务重新设计的迫切需要。澳大利亚国家卫生医学研究委员会伙伴关系赠款（赠款1135125）。
{"title":"Effect of the implementation of a Birthing on Country service at a rural site, Waminda, compared to standard care for First Nations Australians: a prospective, non-randomised, interventional trial","authors":"Yu Gao , Sue Kildea , Rebecca Coddington , Melanie Briggs , Cleone Wellington , Faye Worner , Donna Hartz , Juanita Sherwood , Yvette Roe","doi":"10.1016/j.lanwpc.2025.101796","DOIUrl":"10.1016/j.lanwpc.2025.101796","url":null,"abstract":"<div><h3>Background</h3><div>Clinical and cost-effectiveness of a Birthing on Country service has been demonstrated in a metropolitan centre. We sought to evaluate feasibility, clinical effectiveness and wrap-around supports in the rural setting by evaluating Waminda's Birthing on Country service.</div></div><div><h3>Methods</h3><div>This prospective, non-randomised, interventional study was conducted in Nowra, Australia (ANZCTR: 12620000874910, study completed). Pre-defined primary outcomes were first assessment with health service in 1st trimester, ≥5 antenatal visits, normal birth, preterm birth, healthy baby and exclusive breastfeeding at discharge. Propensity score matching balanced confounders to calculate treatment effect. Waminda's wrap-around services and their interactions are represented using a network analysis.</div></div><div><h3>Findings</h3><div>Relative to standard care, the Birthing on Country service was associated with significantly less women having ≥5 antenatal visits (80·6% versus 94·4%, odds ratio 0·22, 95% CI 0·10, 0·50) (with differences in measurements impacting this outcome), more normal births (32·8% versus 21·7%, odds ratio 1·77, 95% CI 1·08, 2·79), and exclusive breastfeeding at discharge (75·6% versus 63·3%, odds ratio 1·88, 95% CI 1·16, 3·05). No significant differences were observed in other primary outcomes. More than 90% of women accessing Waminda received at least one wrap-around service, some received intensive support.</div></div><div><h3>Interpretation</h3><div>This study is the first to provide evidence towards successful implementation and effectiveness of a Birthing on Country service and the wrap around care in a rural setting and supports the urgent need for maternity service redesign for Aboriginal families.</div></div><div><h3>Funding</h3><div><span>National Health Medical Research Council</span> of Australia Partnership grant (grant <span><span>1135125</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"67 ","pages":"Article 101796"},"PeriodicalIF":8.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077561","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 : 2026-01-22DOI: 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 : 2026-01-01DOI: 10.1016/j.lanwpc.2026.101799
Xuanchen Tao , Ketaki Sharma , Catherine King , Toan Trong Nguyen , Thu-Anh Nguyen , Huyen Thi Thanh Dang , Linh Thuy Duong , Thi Huynh Mai Duong , Phoebe CM. Williams , Sanjay Jayasinghe , Beth Temple , Kim Mulholland , Kristine Macartney
<div><h3>Background</h3><div><em>Streptococcus pneumoniae</em> (<em>S. pneumoniae</em>) is a leading cause of childhood morbidity and mortality worldwide. While pneumococcal conjugate vaccines (PCVs) have significantly reduced the global burden of pneumococcal disease, Vietnam has yet to introduce PCV into their National Immunisation Program. Better understanding of pneumococcal disease in Vietnamese children is key to informing vaccination policy, including PCV product selection. The aim of this study was to assess the prevalence, serotype distribution, and antimicrobial susceptibility patterns of nasopharyngeal carriage of <em>S. pneumoniae</em> among children in Vietnam.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of <em>S. pneumoniae</em> carriage studies in Vietnamese children under 18 years of age. Seven international biomedical research databases and 13 key Vietnamese-language journals were searched without language or publication date restrictions. The Joanna Briggs Institute critical appraisal tools were used to assess the quality of articles. We extracted data on the prevalence of <em>S. pneumoniae</em> carriage and the serotype distribution. Where available, we also extracted the proportions of isolates that were non-susceptible to selected antibiotics. The pooled prevalence, serotype distribution, and antibiotic resistance rates were calculated with 95% confidence intervals (CIs) using random-effects models.</div></div><div><h3>Findings</h3><div>A total of 1197 studies were searched, of which 594 unique studies were identified and screened. 15 studies, conducted between 1996 and 2020, were included in the systematic review and meta-analysis. The pooled prevalence of nasopharyngeal carriage of <em>S. pneumoniae</em> among Vietnamese children was 33% (95% CI: 28%–39%). The most common vaccine serotypes associated with colonisation were 6A (23%), 19F (17%), 6B (15%), 23F (10%), 14 (8%), and 19A (3%). High non-susceptibility rates were observed for penicillin (64%), macrolides (70%–91%), sulfamethoxazole–trimethoprim (70%), tetracycline (84%), and several other antibiotics. Moderate to low non-susceptibility rates were observed for amoxicillin (22%), amoxicillin-clavulanate (6%), moxifloxacin (1%), vancomycin (1%), and rifampicin (0%).</div></div><div><h3>Interpretation</h3><div>The prevalence of <em>S. pneumoniae</em> nasopharyngeal carriage in children, a surrogate for potential invasive disease, was high in Vietnam, with substantial antimicrobial resistance detected. The predominant serotypes circulating in the community are covered by available PCVs. Inclusion of PCV into the country's National Immunisation Program at the earliest opportunity will have a large impact on childhood disease.</div></div><div><h3>Funding</h3><div><span>Gavi</span>, the <span>Vaccine Alliance</span>, and <span>Australia’s Department of Foreign Affairs and Trade</span> (DFAT) provided funding support for this proje
{"title":"Prevalence and serotype distribution of nasopharyngeal carriage of Streptococcus pneumoniae in Vietnam: a systematic review and meta-analysis","authors":"Xuanchen Tao , Ketaki Sharma , Catherine King , Toan Trong Nguyen , Thu-Anh Nguyen , Huyen Thi Thanh Dang , Linh Thuy Duong , Thi Huynh Mai Duong , Phoebe CM. Williams , Sanjay Jayasinghe , Beth Temple , Kim Mulholland , Kristine Macartney","doi":"10.1016/j.lanwpc.2026.101799","DOIUrl":"10.1016/j.lanwpc.2026.101799","url":null,"abstract":"<div><h3>Background</h3><div><em>Streptococcus pneumoniae</em> (<em>S. pneumoniae</em>) is a leading cause of childhood morbidity and mortality worldwide. While pneumococcal conjugate vaccines (PCVs) have significantly reduced the global burden of pneumococcal disease, Vietnam has yet to introduce PCV into their National Immunisation Program. Better understanding of pneumococcal disease in Vietnamese children is key to informing vaccination policy, including PCV product selection. The aim of this study was to assess the prevalence, serotype distribution, and antimicrobial susceptibility patterns of nasopharyngeal carriage of <em>S. pneumoniae</em> among children in Vietnam.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis of <em>S. pneumoniae</em> carriage studies in Vietnamese children under 18 years of age. Seven international biomedical research databases and 13 key Vietnamese-language journals were searched without language or publication date restrictions. The Joanna Briggs Institute critical appraisal tools were used to assess the quality of articles. We extracted data on the prevalence of <em>S. pneumoniae</em> carriage and the serotype distribution. Where available, we also extracted the proportions of isolates that were non-susceptible to selected antibiotics. The pooled prevalence, serotype distribution, and antibiotic resistance rates were calculated with 95% confidence intervals (CIs) using random-effects models.</div></div><div><h3>Findings</h3><div>A total of 1197 studies were searched, of which 594 unique studies were identified and screened. 15 studies, conducted between 1996 and 2020, were included in the systematic review and meta-analysis. The pooled prevalence of nasopharyngeal carriage of <em>S. pneumoniae</em> among Vietnamese children was 33% (95% CI: 28%–39%). The most common vaccine serotypes associated with colonisation were 6A (23%), 19F (17%), 6B (15%), 23F (10%), 14 (8%), and 19A (3%). High non-susceptibility rates were observed for penicillin (64%), macrolides (70%–91%), sulfamethoxazole–trimethoprim (70%), tetracycline (84%), and several other antibiotics. Moderate to low non-susceptibility rates were observed for amoxicillin (22%), amoxicillin-clavulanate (6%), moxifloxacin (1%), vancomycin (1%), and rifampicin (0%).</div></div><div><h3>Interpretation</h3><div>The prevalence of <em>S. pneumoniae</em> nasopharyngeal carriage in children, a surrogate for potential invasive disease, was high in Vietnam, with substantial antimicrobial resistance detected. The predominant serotypes circulating in the community are covered by available PCVs. Inclusion of PCV into the country's National Immunisation Program at the earliest opportunity will have a large impact on childhood disease.</div></div><div><h3>Funding</h3><div><span>Gavi</span>, the <span>Vaccine Alliance</span>, and <span>Australia’s Department of Foreign Affairs and Trade</span> (DFAT) provided funding support for this proje","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101799"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037668","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101737
Charlene Wright , Sharina Riva , Megan Crichton , Helena Rodi , Hannah Jongebloed , Lucy Leigh , Elizabeth A. Johnston , Rebecca J. Bergin , Anna Chapman , Laura Alston , Fiona Crawford–Williams , Nicolas H. Hart , Joel Rhee , Lan Gao , Kate Gunn , Harry Gasper , Anna Ugalde , Skye Marshall
Geographic disparities in cancer outcomes represent a critical health equity challenge, with rural populations consistently experiencing poorer outcomes than urban populations. The lack of harmonised rurality measures creates substantial barriers to evidence synthesis and has precluded meta-analyses. This perspectives paper discusses concepts of rurality, identifies rurality classification systems used by cancer researchers in OECD countries that can be harmonised with the OECD Extended Typology, and develops recommendations for consistent rural-urban coding. Targeted searches of grey and published literature on cancer policy and rurality classification systems were conducted. The secondary analysis examined studies identified through systematic database searching of OVID Medline, Elsevier Embase, CINAHL, and Web of Science. From 289 studies across 22 OECD countries, twenty-seven rurality classification systems were identified, with eleven systems harmonised to create the Rural-Urban Classification System Harmonisation Framework featuring a consistent five-point rurality scale and standardised urban-rural dichotomisation. Implementation recommendations address system selection, standardised categorisation, and reporting standards. Adopting this harmonisation framework will improve research comparability and strengthen evidence to inform equitable cancer policies.
Funding
Commonwealth of Australia's Medical Research Future Fund (MRF2030313).
癌症结果的地域差异是一项重大的卫生公平挑战，农村人口的结果始终比城市人口差。缺乏统一的农村性措施为证据综合创造了实质性障碍，并妨碍了荟萃分析。这篇远景论文讨论了乡村性的概念，确定了经合组织国家癌症研究人员使用的乡村性分类系统，这些系统可以与经合组织扩展类型学相协调，并提出了一致的农村-城市编码建议。对灰色和已发表的关于癌症政策和农村分类系统的文献进行了有针对性的搜索。二级分析检查了通过系统检索OVID Medline、Elsevier Embase、CINAHL和Web of Science数据库确定的研究。从22个经合组织国家的289项研究中，确定了27个乡村分类系统，其中11个系统协调创建了农村-城市分类系统协调框架，该框架具有一致的五点乡村性量表和标准化的城乡二分法。实施建议涉及系统选择、标准化分类和报告标准。采用这一协调框架将改善研究的可比性，并加强证据，为公平的癌症政策提供信息。澳大利亚联邦医学研究未来基金（MRF2030313）。
{"title":"Measuring cancer equity globally: harmonising international rural-urban classifications for exploring cancer outcomes","authors":"Charlene Wright , Sharina Riva , Megan Crichton , Helena Rodi , Hannah Jongebloed , Lucy Leigh , Elizabeth A. Johnston , Rebecca J. Bergin , Anna Chapman , Laura Alston , Fiona Crawford–Williams , Nicolas H. Hart , Joel Rhee , Lan Gao , Kate Gunn , Harry Gasper , Anna Ugalde , Skye Marshall","doi":"10.1016/j.lanwpc.2025.101737","DOIUrl":"10.1016/j.lanwpc.2025.101737","url":null,"abstract":"<div><div>Geographic disparities in cancer outcomes represent a critical health equity challenge, with rural populations consistently experiencing poorer outcomes than urban populations. The lack of harmonised rurality measures creates substantial barriers to evidence synthesis and has precluded meta-analyses. This perspectives paper discusses concepts of rurality, identifies rurality classification systems used by cancer researchers in OECD countries that can be harmonised with the OECD Extended Typology, and develops recommendations for consistent rural-urban coding. Targeted searches of grey and published literature on cancer policy and rurality classification systems were conducted. The secondary analysis examined studies identified through systematic database searching of OVID Medline, Elsevier Embase, CINAHL, and Web of Science. From 289 studies across 22 OECD countries, twenty-seven rurality classification systems were identified, with eleven systems harmonised to create the Rural-Urban Classification System Harmonisation Framework featuring a consistent five-point rurality scale and standardised urban-rural dichotomisation. Implementation recommendations address system selection, standardised categorisation, and reporting standards. Adopting this harmonisation framework will improve research comparability and strengthen evidence to inform equitable cancer policies.</div></div><div><h3>Funding</h3><div>Commonwealth of Australia's <span>Medical Research Future Fund</span> (MRF2030313).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101737"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077535","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101744
Skye Marshall , Charlene Wright , Lucy Leigh , Sharina Riva , Megan Crichton , Helena Rodi , Hannah Jongebloed , Elizabeth A. Johnston , Rebecca J. Bergin , Anna Chapman , Fiona Crawford-Williams , Nicolas H. Hart , Laura Alston , Joel Rhee , Lan Gao , Kate Gunn , Anna Ugalde
The association of rurality status with cancer survival has not been consistently reported. In people diagnosed with cancer, this review aims to determine the association of rural and remote living with survival as compared to urban living, and to determine the modifying effects of geographical, medical, demographic, and socioeconomic factors on cancer survival. A systematic review with meta-analysis and meta-regression was conducted, searching four databases in August 2024. Observational cohort studies were eligible if they reported all-cause or cancer-specific survival according to rurality status in Organisation for Economic Co-operation and Development (OECD) countries. All ages, sexes, and cancer types were eligible. Risk of bias was assessed using the Newcastle–Ottawa Scale and pooled models were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Meta-analyses and meta-regressions were performed using R statistical environment. 37 studies reporting on 110 comparator groups were included. People with cancer in rural areas were at a survival disadvantage compared to people in urban areas, with 15% lower odds of all-cause survival (OR 0.85 [95% CI 0.74, 0.97]) and 10% lower odds of cancer-specific survival (OR: 0.90 [95% CI 0.86, 0.95]). Cancer type and degree of geographical remoteness were consistent modifiers of survival in univariable and multivariable regression. Increasing degree of geographical remoteness was associated with lower odds of all-cause survival (OR 0.28 [95% CI 0.12–0.67]). People living in rural areas diagnosed with cancer have lower odds of all-cause and cancer-specific survival which worsened with increasing geographical remoteness. Type of cancer was consistently found to be a modifying factor of cancer survival. Increased recognition of people living in rural areas as a priority population group in health and cancer policies is needed to improve cancer equity.
Funding
Commonwealth of Australia's Medical Research Future Fund (MRF2030313).
农村状况与癌症生存的关系并没有一致的报道。在被诊断为癌症的人群中，本综述旨在确定与城市生活相比，农村和偏远生活与生存的关系，并确定地理、医学、人口统计学和社会经济因素对癌症生存的修正作用。于2024年8月检索4个数据库，采用meta分析和meta回归方法进行系统评价。观察性队列研究如果根据经济合作与发展组织（OECD）国家的农村状况报告了全因或癌症特异性生存率，则符合条件。所有年龄、性别和癌症类型都符合条件。使用纽卡斯尔-渥太华量表评估偏倚风险，使用推荐、评估、发展和评估分级（GRADE）评估合并模型。采用R统计环境进行meta分析和meta回归。纳入了涉及110个比较组的37项研究。农村地区的癌症患者与城市地区的患者相比处于生存劣势，全因生存几率低15% (OR 0.85 [95% CI 0.74, 0.97])，癌症特异性生存几率低10% （OR: 0.90 [95% CI 0.86, 0.95]）。在单变量和多变量回归中，癌症类型和地理偏远程度是生存率的一致修饰因素。地理偏远程度的增加与全因生存率的降低相关（OR 0.28 [95% CI 0.12-0.67]）。生活在农村地区被诊断患有癌症的人的全因生存率和癌症特异性生存率较低，这种情况随着地理位置的偏远而恶化。癌症类型一直被发现是癌症生存的一个修饰因素。为了改善癌症公平，需要更多地认识到生活在农村地区的人是保健和癌症政策中的优先人口群体。澳大利亚联邦医学研究未来基金（MRF2030313）。
{"title":"Association of rurality status with all-cause and cancer-specific survival: a systematic review and meta-analysis adjusting for clinical factors, demographics, and geographical remoteness","authors":"Skye Marshall , Charlene Wright , Lucy Leigh , Sharina Riva , Megan Crichton , Helena Rodi , Hannah Jongebloed , Elizabeth A. Johnston , Rebecca J. Bergin , Anna Chapman , Fiona Crawford-Williams , Nicolas H. Hart , Laura Alston , Joel Rhee , Lan Gao , Kate Gunn , Anna Ugalde","doi":"10.1016/j.lanwpc.2025.101744","DOIUrl":"10.1016/j.lanwpc.2025.101744","url":null,"abstract":"<div><div>The association of rurality status with cancer survival has not been consistently reported. In people diagnosed with cancer, this review aims to determine the association of rural and remote living with survival as compared to urban living, and to determine the modifying effects of geographical, medical, demographic, and socioeconomic factors on cancer survival. A systematic review with meta-analysis and meta-regression was conducted, searching four databases in August 2024. Observational cohort studies were eligible if they reported all-cause or cancer-specific survival according to rurality status in Organisation for Economic Co-operation and Development (OECD) countries. All ages, sexes, and cancer types were eligible. Risk of bias was assessed using the Newcastle–Ottawa Scale and pooled models were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Meta-analyses and meta-regressions were performed using R statistical environment. 37 studies reporting on 110 comparator groups were included. People with cancer in rural areas were at a survival disadvantage compared to people in urban areas, with 15% lower odds of all-cause survival (OR 0.85 [95% CI 0.74, 0.97]) and 10% lower odds of cancer-specific survival (OR: 0.90 [95% CI 0.86, 0.95]). Cancer type and degree of geographical remoteness were consistent modifiers of survival in univariable and multivariable regression. Increasing degree of geographical remoteness was associated with lower odds of all-cause survival (OR 0.28 [95% CI 0.12–0.67]). People living in rural areas diagnosed with cancer have lower odds of all-cause and cancer-specific survival which worsened with increasing geographical remoteness. Type of cancer was consistently found to be a modifying factor of cancer survival. Increased recognition of people living in rural areas as a priority population group in health and cancer policies is needed to improve cancer equity.</div></div><div><h3>Funding</h3><div><span>Commonwealth of Australia's Medical Research Future</span> Fund (MRF2030313).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101744"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077534","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101787
S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , E.A.-L. Holt
This viewpoint piece examines Global Health in the Pacific region. The purpose of the article is to provide a Pacific, female perspective to Global Health by considering the history, context, and current practices in the region. Reflecting on a history of colonialism and exclusion of Indigenous Pacific Peoples worldviews, we re-imagine a future that prioritises Pacific aspirations. Central to this shift is a Global Health approach that ensures Pacific priorities, leadership and aspirations through four action areas of sovereignty, integrating worldviews, connectivity, and equity and participation. We draw on examples of lived experiences that include health systems strengthening, research and policy.
{"title":"Re-imagining Global Health: perspectives from the next generation in the Pacific region","authors":"S. Boladuadua , F. Langridge , R. Qin , R. Ng Shiu , J. McCool , J. Mani , J. Kailawadoko , E.A.-L. Holt","doi":"10.1016/j.lanwpc.2025.101787","DOIUrl":"10.1016/j.lanwpc.2025.101787","url":null,"abstract":"<div><div>This viewpoint piece examines Global Health in the Pacific region. The purpose of the article is to provide a Pacific, female perspective to Global Health by considering the history, context, and current practices in the region. Reflecting on a history of colonialism and exclusion of Indigenous Pacific Peoples worldviews, we re-imagine a future that prioritises Pacific aspirations. Central to this shift is a Global Health approach that ensures Pacific priorities, leadership and aspirations through four action areas of sovereignty, integrating worldviews, connectivity, and equity and participation. We draw on examples of lived experiences that include health systems strengthening, research and policy.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101787"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926784","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101792
Koichiro Wasano , Kasper Jørgensen
Background
As dementia prevalence increases globally, preventive strategies targeting modifiable risk factors have become increasingly important. In Japan, with its super-ageing society, dementia is the leading cause of increased disability-adjusted life years among older adults. This study quantified the contribution of 14 potentially modifiable risk factors for dementia in older adults using Japan-specific prevalence data.
Methods
We calculated population attributable fractions (PAFs) and potential impact fractions (PIFs) using recent publicly available prevalence data from national surveys and cohort studies in Japan, and relative risks and communality weights from the 2024 Lancet Commission report on dementia. We then modelled how 10% and 20% reductions in each risk factor would affect national dementia prevalence.
Findings
The weighted combined PAF for all 14 risk factors was 38.9%, indicating that nearly 4 in 10 dementia cases in Japan might be preventable. Hearing loss (6.7%), physical inactivity (6.0%), and high LDL cholesterol (4.5%) were the largest contributors. Reducing all risk factors by 10% could prevent ∼208,000 dementia cases; reducing them by 20% could prevent ∼407,000 cases.
Interpretation
Dementia preventive efforts in Japan should prioritise hearing care, physical activity, and metabolic health. Japan-specific data confirmed that hearing loss is a leading contributor to dementia, underscoring the urgency to increase public awareness and access to hearing interventions.
Funding
The Royal Danish Embassy in Japan, Danish Ministry of Foreign Affairs, Danish Ministry of Health, and Japan Agency for Medical Research and Development funded this study.
{"title":"The potential for dementia prevention in Japan: a population attributable fraction calculation for 14 modifiable risk factors and estimates of the impact of risk factor reductions","authors":"Koichiro Wasano , Kasper Jørgensen","doi":"10.1016/j.lanwpc.2025.101792","DOIUrl":"10.1016/j.lanwpc.2025.101792","url":null,"abstract":"<div><h3>Background</h3><div>As dementia prevalence increases globally, preventive strategies targeting modifiable risk factors have become increasingly important. In Japan, with its super-ageing society, dementia is the leading cause of increased disability-adjusted life years among older adults. This study quantified the contribution of 14 potentially modifiable risk factors for dementia in older adults using Japan-specific prevalence data.</div></div><div><h3>Methods</h3><div>We calculated population attributable fractions (PAFs) and potential impact fractions (PIFs) using recent publicly available prevalence data from national surveys and cohort studies in Japan, and relative risks and communality weights from the 2024 <em>Lancet</em> Commission report on dementia. We then modelled how 10% and 20% reductions in each risk factor would affect national dementia prevalence.</div></div><div><h3>Findings</h3><div>The weighted combined PAF for all 14 risk factors was 38.9%, indicating that nearly 4 in 10 dementia cases in Japan might be preventable. Hearing loss (6.7%), physical inactivity (6.0%), and high LDL cholesterol (4.5%) were the largest contributors. Reducing all risk factors by 10% could prevent ∼208,000 dementia cases; reducing them by 20% could prevent ∼407,000 cases.</div></div><div><h3>Interpretation</h3><div>Dementia preventive efforts in Japan should prioritise hearing care, physical activity, and metabolic health. Japan-specific data confirmed that hearing loss is a leading contributor to dementia, underscoring the urgency to increase public awareness and access to hearing interventions.</div></div><div><h3>Funding</h3><div>The <span>Royal Danish Embassy in Japan</span>, <span>Danish Ministry of Foreign Affairs</span>, <span>Danish Ministry of Health</span>, and <span>Japan Agency for Medical Research and Development</span> funded this study.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101792"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077539","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101794
Charlie G.Y. Lim , Crystal C.Y. Chong , Yvonne H.M. Wong , Jiali Yao , Stefen Ma , John C. Chambers , Khung Keong Yeo , E Shyong Tai , Jasper Tromp , Rob M. van Dam , Saima Hilal , Charumathi Sabanayagam , Ching-Yu Cheng , Xueling Sim
Background
The rising burden of cardiovascular diseases (CVD) in Asia requires risk assessment tools tailored to Asian populations. Therefore, we recalibrated the ACC/AHA Pooled Cohort Equations for non-Hispanic Whites (PCE-W) and compared its performance in predicting 10-year CVD risk with two other established CVD prediction models that have been recently recalibrated for Asian populations.
Methods
We used data from the Singapore Multi-Ethnic Cohort (MEC1) and the Singapore Epidemiology of Eye Diseases (SEED) cohort comprising ethnic Chinese, Indian, and Malay participants. The PCE-W was recalibrated using data from MEC1, externally validated in the SEED cohort, and compared against the Singapore-modified Framingham Risk Score (SG-FRS-2023) and the SCORE2 Asia–Pacific model using the concordance index (C-index). Calibration was assessed using the calibration-in-the-large method, the calibration slope, and a goodness-of-fit test.
Findings
All three models demonstrated possibly helpful to clearly useful discrimination in MEC1 and SEED, with overall C-indices ranging from 0.728 to 0.811. The recalibrated PCE-W outperformed the original PCE-W in MEC1 and SEED, although some misestimations remained among Chinese men and women and Malay women (calibration-in-the-large ranged from −0.479 to 0.260). The SG-FRS-2023 displayed generally satisfactory calibration across both MEC1 and SEED but tended to overestimate risk in Chinese (calibration-in-the-large −0.671) and Indian men (calibration-in-the-large −0.214) in the SEED cohort. The SCORE2 Asia–Pacific model performed satisfactorily among Indians but overestimated risk in Chinese (calibration-in-the-large ranged from −0.570 to −1.185) and showed poor model fit in Malays.
Interpretation
The recalibrated PCE-W, SG-FRS-2023, and SCORE2 Asia–Pacific model demonstrated possibly helpful to clearly useful discrimination across two multi-ethnic cohorts in Singapore. In terms of calibration, the recalibrated PCE-W and SG-FRS-2023, both recalibrated using local data, performed better than the SCORE2 Asia–Pacific model. Our study supports the use of the established CVD prediction models in Asian populations following appropriate local recalibration.
Funding
This work was supported by the Singapore Ministry of Health’s National Medical Research Council and the Singapore Biomedical Research Council.
{"title":"Cardiovascular disease risk prediction in multi-ethnic Asian populations: evidence from two population-based cohorts in Singapore","authors":"Charlie G.Y. Lim , Crystal C.Y. Chong , Yvonne H.M. Wong , Jiali Yao , Stefen Ma , John C. Chambers , Khung Keong Yeo , E Shyong Tai , Jasper Tromp , Rob M. van Dam , Saima Hilal , Charumathi Sabanayagam , Ching-Yu Cheng , Xueling Sim","doi":"10.1016/j.lanwpc.2025.101794","DOIUrl":"10.1016/j.lanwpc.2025.101794","url":null,"abstract":"<div><h3>Background</h3><div>The rising burden of cardiovascular diseases (CVD) in Asia requires risk assessment tools tailored to Asian populations. Therefore, we recalibrated the ACC/AHA Pooled Cohort Equations for non-Hispanic Whites (PCE-W) and compared its performance in predicting 10-year CVD risk with two other established CVD prediction models that have been recently recalibrated for Asian populations.</div></div><div><h3>Methods</h3><div>We used data from the Singapore Multi-Ethnic Cohort (MEC1) and the Singapore Epidemiology of Eye Diseases (SEED) cohort comprising ethnic Chinese, Indian, and Malay participants. The PCE-W was recalibrated using data from MEC1, externally validated in the SEED cohort, and compared against the Singapore-modified Framingham Risk Score (SG-FRS-2023) and the SCORE2 Asia–Pacific model using the concordance index (C-index). Calibration was assessed using the calibration-in-the-large method, the calibration slope, and a goodness-of-fit test.</div></div><div><h3>Findings</h3><div>All three models demonstrated possibly helpful to clearly useful discrimination in MEC1 and SEED, with overall C-indices ranging from 0.728 to 0.811. The recalibrated PCE-W outperformed the original PCE-W in MEC1 and SEED, although some misestimations remained among Chinese men and women and Malay women (calibration-in-the-large ranged from −0.479 to 0.260). The SG-FRS-2023 displayed generally satisfactory calibration across both MEC1 and SEED but tended to overestimate risk in Chinese (calibration-in-the-large −0.671) and Indian men (calibration-in-the-large −0.214) in the SEED cohort. The SCORE2 Asia–Pacific model performed satisfactorily among Indians but overestimated risk in Chinese (calibration-in-the-large ranged from −0.570 to −1.185) and showed poor model fit in Malays.</div></div><div><h3>Interpretation</h3><div>The recalibrated PCE-W, SG-FRS-2023, and SCORE2 Asia–Pacific model demonstrated possibly helpful to clearly useful discrimination across two multi-ethnic cohorts in Singapore. In terms of calibration, the recalibrated PCE-W and SG-FRS-2023, both recalibrated using local data, performed better than the SCORE2 Asia–Pacific model. Our study supports the use of the established CVD prediction models in Asian populations following appropriate local recalibration.</div></div><div><h3>Funding</h3><div>This work was supported by the Singapore <span>Ministry of Health’s National Medical Research</span> Council and the Singapore <span>Biomedical Research Council</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101794"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884746","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 : 2026-01-01DOI: 10.1016/j.lanwpc.2025.101784
Xiaomei Zhang , Carl J.E. Suster , Eby M. Sim , Connie Lam , Elena Martinez , Taryn Crighton , Ellen J. Donnan , Ben J. Marais , Vitali Sintchenko
Background
Tuberculosis (TB) remains a global public health challenge. Even low-incidence countries, like Australia, are struggling to achieve ambitious targets to eliminate local TB transmission. Whole genome sequencing (WGS) of Mycobacterium tuberculosis facilitates accurate transmission tracking, but its integration into public health response remains limited. This study conducted spatiotemporal analyses of routine WGS data and assessed its potential value to guide programmatic TB control responses.
Methods
WGS and geolocation data from 2492 M. tuberculosis isolates were examined, representing 94.9% of culture-confirmed and 64.2% of all notified TB cases in New South Wales, Australia (2017–2023). We performed genomic clustering, assessed genetic and geographic distances between cases, and applied Bayesian dated phylogeny to estimate the likely time of strain introduction.
Findings
Most notified TB cases were successfully sequenced and geolocated, with 88.3% (2200/2492) residing in metropolitan Sydney. The local health districts (LHDs) with the highest case counts were South Western (523/2492, 21.0%) and Western Sydney (476/2492, 19.1%). Using a 5-SNP threshold, WGS identified 106 putative transmission clusters involving 288 cases (11.7%), with 50% spanning multiple LHDs. Eight large clusters (≥5 members) were identified, containing 64 cases (2.6%). The largest cluster (17 members) was caused by a Lineage 1 strain, although most large clusters were associated with Lineage 2 strains; two were isoniazid resistant. There was poor correlation between genetic and geographic distances, which showed some improvement with removal of outliers. Most recent common ancestor estimates suggested recent introduction of strains associated with local transmission. Strain clustering and lineage-through-time analyses revealed temporal patterns in cluster expansion and contraction, facilitating accurate monitoring of cluster spread across all of NSW.
Interpretation
The findings demonstrate the added value of integrating genomic and spatiotemporal clustering data to detect persistent transmission and guide targeted interventions to pursue the aspirational goal of “zero local TB transmission”.
Funding
NHMRC Centre for Research Excellence in Tuberculosis (www.tbcre.org.au) and New South Wales Health Prevention Research Support Program.
{"title":"Spatio-temporal patterns of tuberculosis revealed by routine Mycobacterium tuberculosis sequencing in Australia: an extended patient cohort analysis (2017–2023)","authors":"Xiaomei Zhang , Carl J.E. Suster , Eby M. Sim , Connie Lam , Elena Martinez , Taryn Crighton , Ellen J. Donnan , Ben J. Marais , Vitali Sintchenko","doi":"10.1016/j.lanwpc.2025.101784","DOIUrl":"10.1016/j.lanwpc.2025.101784","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a global public health challenge. Even low-incidence countries, like Australia, are struggling to achieve ambitious targets to eliminate local TB transmission. Whole genome sequencing (WGS) of <em>Mycobacterium tuberculosis</em> facilitates accurate transmission tracking, but its integration into public health response remains limited. This study conducted spatiotemporal analyses of routine WGS data and assessed its potential value to guide programmatic TB control responses.</div></div><div><h3>Methods</h3><div>WGS and geolocation data from 2492 <em>M. tuberculosis</em> isolates were examined, representing 94.9% of culture-confirmed and 64.2% of all notified TB cases in New South Wales, Australia (2017–2023). We performed genomic clustering, assessed genetic and geographic distances between cases, and applied Bayesian dated phylogeny to estimate the likely time of strain introduction.</div></div><div><h3>Findings</h3><div>Most notified TB cases were successfully sequenced and geolocated, with 88.3% (2200/2492) residing in metropolitan Sydney. The local health districts (LHDs) with the highest case counts were South Western (523/2492, 21.0%) and Western Sydney (476/2492, 19.1%). Using a 5-SNP threshold, WGS identified 106 putative transmission clusters involving 288 cases (11.7%), with 50% spanning multiple LHDs. Eight large clusters (≥5 members) were identified, containing 64 cases (2.6%). The largest cluster (17 members) was caused by a Lineage 1 strain, although most large clusters were associated with Lineage 2 strains; two were isoniazid resistant. There was poor correlation between genetic and geographic distances, which showed some improvement with removal of outliers. Most recent common ancestor estimates suggested recent introduction of strains associated with local transmission. Strain clustering and lineage-through-time analyses revealed temporal patterns in cluster expansion and contraction, facilitating accurate monitoring of cluster spread across all of NSW.</div></div><div><h3>Interpretation</h3><div>The findings demonstrate the added value of integrating genomic and spatiotemporal clustering data to detect persistent transmission and guide targeted interventions to pursue the aspirational goal of “zero local TB transmission”.</div></div><div><h3>Funding</h3><div>NHMRC Centre for <span>Research Excellence in Tuberculosis</span> (<span><span>www.tbcre.org.au</span><svg><path></path></svg></span>) and <span>New South Wales Health Prevention Research</span> Support Program.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"66 ","pages":"Article 101784"},"PeriodicalIF":8.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926782","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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