The Lancet Regional Health: Western Pacific最新文献_第4页

Machine learning prediction of 1-year mortality in older patients with heart failure: a nationwide, multicenter, prospective cohort study 机器学习预测老年心力衰竭患者1年死亡率：一项全国性、多中心、前瞻性队列研究

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-02-01 Epub Date: 2026-02-03 DOI: 10.1016/j.lanwpc.2026.101808

Kanji Yamada , Nobuyuki Kagiyama , Tomoyuki Morisawa , Masakazu Saitoh , Kentaro Iwata , Michitaka Kato , Koji Sakurada , Yuji Kono , Yuki Iida , Masanobu Taya , Yoshinari Funami , Kentaro Kamiya , Tetsuya Takahashi

Background

Risk prediction in older adults with heart failure (HF) often depends on conventional clinical variables and does not incorporate direct measures of physical function. This study aimed to develop and validate a machine learning model that integrates routinely collected functional assessments to predict one-year all-cause mortality.

Methods

We analyzed data from the J-Proof HF Registry, a nationwide prospective cohort encompassing 96 institutions in Japan. Patients aged ≥65 years who were hospitalized for HF and received a prescription for rehabilitation between December 2020 and March 2022 were included. An eXtreme Gradient Boosting (XGBoost) model was developed using 77 candidate predictors, including demographic, clinical, laboratory, echocardiographic, and directly measured functional variables. Validation employed a leave-one-site-out (LOSO) internal–external framework. Discrimination, calibration, and clinical utility were compared with established risk scores. A 20-predictor model was derived using SHAP-based importance and clinical review.

Findings

Among 9700 eligible patients, the median age was 83 years (interquartile range [IQR] 77–88), 4915 (50.7%) were male, and 1601 (16.5%) died within one year. The full XGBoost model achieved an aggregated area under the receiver operating characteristic curve (AUC) of 0.76 (95% confidence interval [CI] 0.75–0.77) across LOSO test sets. The 20-predictor XGBoost model demonstrated similar discrimination (AUC 0.76; 95% CI 0.74–0.77). Both models outperformed the AHEAD and BIOSTAT compact scores. Functional measures at discharge, including Barthel index, the Short Physical Performance Battery, gait speed, and handgrip strength, were among the strongest contributors to model predictions. Reclassification metrics and decision curve analysis indicated greater clinical utility compared with benchmark scores.

Interpretation

A machine learning model incorporating functional assessments predicts one-year mortality in older patients with HF and improves risk stratification beyond established scores. Functional status at discharge is an important prognostic indicator and may inform post-discharge care planning.

Funding

This work was supported by research funding of Japanese Society of Cardiovascular Physical Therapy and JSPS KAKENHI Grant Number JP25K02969.

背景：老年心力衰竭（HF）的风险预测通常依赖于传统的临床变量，而不包括身体功能的直接测量。本研究旨在开发和验证一种机器学习模型，该模型集成了常规收集的功能评估，以预测一年的全因死亡率。方法：我们分析了来自J-Proof HF Registry的数据，这是一个涵盖日本96家机构的全国性前瞻性队列研究。纳入了2020年12月至2022年3月期间因心衰住院并接受康复处方的年龄≥65岁的患者。使用77个候选预测因子，包括人口统计学、临床、实验室、超声心动图和直接测量的功能变量，建立了极端梯度增强（XGBoost）模型。验证采用了留一个站点（LOSO）内部-外部框架。对已建立的风险评分进行区分、校准和临床效用的比较。使用基于shap的重要性和临床回顾推导出一个20预测因子模型。结果：9700例符合条件的患者中位年龄为83岁（四分位间距[IQR] 77-88）， 4915例（50.7%）为男性，1601例（16.5%）在一年内死亡。在LOSO测试集上，完整的XGBoost模型在接收者工作特征曲线（AUC）下的聚合面积为0.76（95%置信区间[CI] 0.75-0.77）。20个预测因子的XGBoost模型也表现出类似的区别（AUC 0.76; 95% CI 0.74-0.77）。两种模型的表现都优于AHEAD和BIOSTAT紧凑型得分。放电时的功能测量，包括Barthel指数、短物理性能电池、步态速度和握力，是模型预测的最强贡献者。与基准评分相比，重新分类指标和决策曲线分析显示更大的临床效用。解释：结合功能评估的机器学习模型可以预测老年心衰患者一年的死亡率，并在现有评分基础上改善风险分层。出院时的功能状态是一个重要的预后指标，可以为出院后的护理计划提供信息。本工作由日本心血管物理治疗学会和JSPS KAKENHI资助号JP25K02969研究基金支持。

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引用次数: 0

Corrigendum to ‘Playing to extinction’: the commercial determinants of gambling-related harm, suicidality and suicide, The Lancet Regional Health – Western Pacific Volume 63, October 2025, 101685 《玩到灭绝：赌博相关伤害、自杀和自杀的商业决定因素》的勘误表，《柳叶刀》区域卫生——西太平洋第63卷，2025年10月，101685年。

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-02-01 Epub Date: 2026-02-09 DOI: 10.1016/j.lanwpc.2026.101814

Angela Rintoul , Suzanne McLaren , Kerrie Shandley , Britt Klein

引用次数: 0

Alcohol consumption, smoking, and the implications of their cessations for field carcinogenesis in the esophagus: a 10-year prospective cohort study 饮酒、吸烟及其戒烟对食道癌变的影响：一项10年前瞻性队列研究

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-02-01 Epub Date: 2026-01-20 DOI: 10.1016/j.lanwpc.2026.101798

Chikatoshi Katada , Tetsuji Yokoyama , Tomonori Yano , Yasuaki Furue , Haruhisa Suzuki , Kenji Ishido , Keiko Yamamoto , Hiroyoshi Nakanishi , Tomoyuki Koike , Masashi Tamaoki , Noboru Kawata , Motohiro Hirao , Yoshiro Kawahara , Takashi Ogata , Atsushi Katagiri , Takenori Yamanouchi , Hirofumi Kiyokawa , Hirofumi Kawakubo , Maki Konno , Akira Yokoyama , Toshiyuki Yoshio

Background

Alcohol and tobacco are established carcinogens, which promote field carcinogenesis for esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the long-term effects of alcohol and tobacco cessations, and background mucosal status, on risk for metachronous ESCC (mESCC) after endoscopic resection (ER).

Methods

This was a multicentre prospective cohort study of patients with intramucosal ESCC treated by ER. All participants received structured education on cessation, and underwent regular endoscopic surveillance. Patients were stratified by Lugol-voiding lesion (LVL) grade (A: none, B: 1–9, C: ≥10). The impacts of alcohol and smoking cessation on field carcinogenesis were assessed.

Findings

Among 331 enrolled patients, the median follow-up was 120 months (range: 1.3–176.9). The cumulative incidences of mESCC were 10.4%, 27.2%, and 61.8% in grades A, B, and C, respectively. An increment of 1 unit (22 g ethanol) of alcohol consumption and higher LVL grade independently increased the risk for mESCC. Alcohol or smoking cessation reduced this risk (hazard ratio [HR] 0.52, 95% confidence interval [CI]: 0.31–0.88; HR 0.44, 95% CI: 0.25–0.78, respectively), and combined cessation had the greatest impact (HR 0.21, 95% CI: 0.07–0.65). Complete cessation, rather than partial reduction, was necessary to achieve meaningful risk reduction.

Interpretation

Alcohol and tobacco exposure, and a large number of LVL, are major determinants of mESCC. Complete cessation markedly reduces risk, underscoring the importance of behavioural interventions for secondary prevention of field carcinogenesis after ER.

Funding

National Cancer Center Research and Development Fund 36, Japan.

背景：酒精和烟草是确定的致癌物，可促进食管鳞状细胞癌（ESCC）的现场癌变。本研究旨在评估戒烟和戒酒对内镜切除（ER）后异时性ESCC （mESCC）风险的长期影响。方法：这是一项多中心前瞻性队列研究，研究对象是经ER治疗的粘膜内ESCC患者。所有参与者都接受了结构化的戒烟教育，并定期进行内窥镜监测。根据lugolo -voiding病变（LVL）分级（A：无，B: 1-9, C:≥10）对患者进行分层。评估了戒酒和戒烟对野外癌变的影响。结果：在331例入组患者中，中位随访时间为120个月（范围：1.3-176.9）。A级、B级和C级的mESCC累积发病率分别为10.4%、27.2%和61.8%。酒精消耗量增加1单位（22克乙醇）和LVL等级升高分别增加mESCC的风险。戒酒或戒烟降低了这种风险（危险比[HR] 0.52, 95%可信区间[CI]: 0.31-0.88；危险比[HR] 0.44, 95%可信区间[CI]: 0.25-0.78），联合戒烟的影响最大（危险比0.21,95%可信区间：0.07-0.65）。完全戒烟，而不是部分减少，是实现有意义的风险降低所必需的。解释：酒精和烟草暴露以及大量LVL是mESCC的主要决定因素。完全戒烟可显著降低风险，强调了行为干预对急诊后现场致癌二级预防的重要性。资助：国家癌症中心研究与发展基金36，日本。

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引用次数: 0

Traditional arts and events for mental and social well-being: a scoping review framed by intangible cultural heritage 促进精神和社会福祉的传统艺术和活动：以非物质文化遗产为框架的范围审查。

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-02-01 Epub Date: 2026-01-15 DOI: 10.1016/j.lanwpc.2025.101789

Yukiko Honda , Ayako Kohno , Hiroshi Habu , Sayaka Honda , Taiji Noguchi , Chie Koga , Makoto Hiramatsu , Sakurako S. Okuzono , Hiroko Sakurai , Mieko Ohsuga , Frances Rom Lunar , Tayzar Tun , Yan Luo , Naoki Kondo

To maintain mental and social well-being, strengthening community environments alongside targeting high-risk individuals is needed. Traditional arts and events may promote connectedness and social bonds, benefiting social and cultural well-being. However, research on non-therapeutic cultural factors remains limited and mostly confined to specific regions. This scoping review mapped current knowledge on the effects of traditional arts and events on mental and social well-being by systematically searching three databases–two global and one specific to Japan. A total of 42 relevant studies were identified, demonstrating that traditional arts and events, from daily practices to festivals, influence well-being. The review highlights the potential of cultural approaches to reduce the global burden of mental and social well-being challenges. Integrating these approaches can help health professionals and policymakers develop more comprehensive strategies beyond conventional frameworks.

为了保持精神和社会福祉，需要在针对高危人群的同时加强社区环境。传统艺术和活动可以促进联系和社会纽带，有利于社会和文化福祉。然而，对非治疗性文化因素的研究仍然有限，而且大多局限于特定地区。通过系统地检索三个数据库（两个全球数据库和一个日本特定数据库），本文对传统艺术和活动对心理和社会福祉的影响进行了范围审查，绘制了当前的知识图谱。总共确定了42项相关研究，表明传统艺术和活动，从日常实践到节日，都会影响幸福感。该综述强调了文化方法在减轻精神和社会福祉挑战的全球负担方面的潜力。综合这些方法可以帮助卫生专业人员和决策者制定超越传统框架的更全面的战略。

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引用次数: 0

Prevalence and serotype distribution of nasopharyngeal carriage of Streptococcus pneumoniae in Vietnam: a systematic review and meta-analysis 越南肺炎链球菌鼻咽携带的患病率和血清型分布：一项系统回顾和荟萃分析

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2026-01-19 DOI: 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

背景肺炎链球菌（S. pneumoniae）是全球儿童发病和死亡的主要原因。虽然肺炎球菌结合疫苗（PCV）显著减少了肺炎球菌疾病的全球负担，但越南尚未将PCV纳入其国家免疫规划。更好地了解越南儿童的肺炎球菌疾病是告知疫苗接种政策，包括PCV产品选择的关键。本研究的目的是评估越南儿童中肺炎链球菌鼻咽携带的患病率、血清型分布和抗菌药物敏感性模式。方法我们对越南18岁以下儿童肺炎链球菌携带研究进行了系统回顾和荟萃分析。在没有语言或出版日期限制的情况下，检索了7个国际生物医学研究数据库和13种越南语主要期刊。乔安娜布里格斯研究所的关键评估工具被用来评估文章的质量。我们提取了肺炎链球菌携带率和血清型分布的数据。在可能的情况下，我们还提取了对选定抗生素不敏感的分离株的比例。采用随机效应模型，以95%置信区间（ci）计算总患病率、血清型分布和抗生素耐药率。共检索了1197项研究，其中594项独特的研究被确定并筛选。在1996年至2020年间进行的15项研究被纳入系统综述和荟萃分析。越南儿童鼻咽携带肺炎链球菌的总流行率为33% （95% CI: 28%-39%）。与定植相关的最常见疫苗血清型为6A（23%）、19F（17%）、6B（15%）、23F（10%）、14（8%）和19A（3%）。青霉素（64%）、大环内酯类（70% - 91%）、磺胺甲恶唑-甲氧苄啶（70%）、四环素（84%）和其他几种抗生素的非敏感性较高。阿莫西林（22%）、阿莫西林-克拉维酸酯（6%）、莫西沙星（1%）、万古霉素（1%）和利福平（0%）的非敏感性为中低。结论：越南儿童肺炎链球菌（一种潜在侵袭性疾病的替代物）鼻咽携带的流行率很高，并且检测到大量的抗微生物药物耐药性。现有的pcv涵盖了社区流行的主要血清型。尽早将PCV纳入该国的国家免疫规划将对儿童疾病产生重大影响。全球疫苗免疫联盟、疫苗联盟和澳大利亚外交和贸易部为该项目提供了资金支持。

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引用次数: 0

Measuring cancer equity globally: harmonising international rural-urban classifications for exploring cancer outcomes 衡量全球癌症公平性：协调国际城乡分类以探索癌症结果

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 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）。

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引用次数: 0

Vasoactive drug use in children with community acquired septic shock in Australia and New Zealand 澳大利亚和新西兰社区获得性感染性休克儿童血管活性药物的使用

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2025-12-15 DOI: 10.1016/j.lanwpc.2025.101777

Elliot Long , Stephen Hearps , Amanda Williams , Ben Gelbart , Warwick Butt , Thomas Rozen , Sarah McNab , Meredith L. Borland , Simon Erickson , Shefali Jani , Marino Festa , Eunicia Tan , Natalie Phillips , Sainath Raman , Amit Kochar , Subodh Ganu , Simon Craig , Anna Lithgow , Arjun Rao , Emma Whyte , Franz E. Babl

Background

Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis.

Methods

Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0–<18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected.

Findings

6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3–7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall and in 144 (45.8%) of those meeting Phoenix sepsis criteria. The most used first, second, and third-line vasoactive agents were adrenaline (90/179; 50.3%), noradrenaline (49/91; 53.8%), and vasopressin (16/40; 40.0%). When comparing noradrenaline vs adrenaline as first line agents, increasing age was associated with preferential use of noradrenaline (RR 1.06, 95% CI 1.03–1.09; p < 0.001).

Interpretation

Children with suspected community acquired sepsis rarely received treatment with vasoactive agents. Adrenaline and noradrenaline were the most used agents, though there was substantial variation in their use and sequencing.

Funding

This study is funded in part by a National Health and Medical Research Council (NHMRC) Medical Research Future Fund grant (GNT1190814). The full list of funders is presented at the end of the paper.

背景：血管活性药物是儿童脓毒症的关键支持疗法。我们描述了脓毒症儿童血管活性药物的选择和使用模式。方法于2021年4月至2023年12月，通过儿科急诊科研究国际合作（PREDICT）网络在澳大利亚和新西兰的11家医院进行前瞻性观察研究。年龄0 - 18岁疑似脓毒症的儿童被纳入研究。儿童入院并接受肠外抗生素治疗，1)临时诊断为败血症，和/或2)疑似败血症治疗（液体丸治疗灌注不良）。收集血管活性药物的使用频率和顺序，以及对初始血管活性药物选择的影响因素。结果：6232例疑似脓毒症患儿被纳入研究；中位年龄为2.1岁（IQR为0.3-7.1岁），住院死亡率60人（1.0%），其中306人（4.9%）符合凤凰败血症标准。179名（2.9%）儿童和144名（45.8%）符合凤凰脓毒症标准的儿童使用血管活性药物。使用最多的一线、二线和三线血管活性药物是肾上腺素（90/179;50.3%）、去甲肾上腺素（49/91;53.8%）和加压素（16/40;40.0%）。当比较去甲肾上腺素与肾上腺素作为一线药物时，年龄的增加与优先使用去甲肾上腺素相关（RR 1.06, 95% CI 1.03-1.09; p < 0.001）。解释：怀疑社区获得性脓毒症的儿童很少接受血管活性药物治疗。肾上腺素和去甲肾上腺素是最常用的药物，尽管它们的使用和顺序有很大的差异。本研究部分由国家卫生和医学研究委员会（NHMRC）医学研究未来基金资助（GNT1190814）。完整的资助者名单在论文的末尾。

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引用次数: 0

Interaction between physical activity and deficit-based frailty on all-cause mortality in older adults: a prospective study of five population-based cohorts 老年人身体活动和缺陷性虚弱对全因死亡率的相互作用：一项基于5个人群队列的前瞻性研究

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2025-12-18 DOI: 10.1016/j.lanwpc.2025.101780

Zheng Zhu , Xu Zhou , Mingling Chen , Chun Dou , Dong Liu , Lijie Kong , Chaojie Ye , Min Xu , Yu Xu , Mian Li , Zhiyun Zhao , Jie Zheng , Jieli Lu , Yuhong Chen , Weiqing Wang , Guang Ning , Yufang Bi , Tiange Wang

Background

Whether leisure-time physical activity modifies the association between frailty and mortality in older adults is unclear.

Methods

We analyzed the interactions between physical activity and frailty status on all-cause mortality risk using Cox proportional hazards models across five nationally representative cohorts: Survey of Health, Ageing and Retirement in Europe (56,555 participants, median follow-up 6.5 years), China Health and Retirement Longitudinal Study (12,271 participants, 9.0 years); Health and Retirement Study (13,729 participants, 11.9 years); English Longitudinal Study of Ageing (9100 participants, 9.8 years); and Mexican Health and Aging Study (11,262 participants, 19.3 years). Frailty status was classified as robust, prefrail, and frail based on deficit accumulation models, including common disease, functional, locomotor, sensory, mental, and cognitive deficit. Physical activity was classified as regular (meeting World Health Organization recommendations) or inactive.

Findings

Across five cohorts (median age 58.0–65.0 years), physical activity consistently interacted with frailty on all-cause mortality (all P_interaction ≤ 0.036). In pooled analyses, frailty was associated with higher risks of mortality in inactive participants (multivariable-adjusted HR: 3.72, 95% CI: 2.54–5.45 for frailty) than in regularly active participants (2.40, 1.71–3.36 for frailty; P_interaction < 0.001); results of each cohort were meta-analyzed by random-effects models (I² within-subgroup >78.7%, P < 0.001). Whereby, the inverse association between regular activity and mortality was more evident in frail participants (0.56; 0.53–0.59) than in robust participants (0.80, 0.73–0.87); results were meta-analyzed by fixed effects models (I² within-subgroup >18.6%, P > 0.296). Such interaction patterns remained between each deficit of frailty and physical activity in at least one cohort.

Interpretation

Consistent findings across five cohorts demonstrated that regular physical activity mitigates frailty-associated mortality, and frail adults might gain more survival benefits from regular activity than robust adults.

Funding

The Noncommunicable Chronic Diseases-National Science and Technology Major Project, the National Natural Science Foundation of China, the National Key R&D Program of China, the “Shu-Guang Scholar Programme” from Shanghai Municipal Education Commission, the “Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support” from Shanghai Jiao Tong University School of Medicine, and the Innovative Research Team of High-level Local Universities in Shanghai.

背景：目前尚不清楚闲暇时间的体育活动是否能改变老年人身体虚弱和死亡率之间的关系。方法：采用Cox比例风险模型分析了身体活动和虚弱状态对全因死亡风险的相互作用，研究对象包括5个具有全国代表性的队列：欧洲健康、老龄化和退休调查（56555人，中位随访6.5年）、中国健康和退休纵向研究（12271人，9.0年）；健康和退休研究（13,729名参与者，11.9岁）；英国老龄化纵向研究（9100名参与者，9.8岁）；墨西哥健康与老龄化研究（11,262名参与者，19.3岁）。根据缺陷积累模型，包括常见疾病、功能、运动、感觉、精神和认知缺陷，将虚弱状态分为健壮、体弱和体弱。体育活动被分为定期（符合世界卫生组织的建议）和不活动。在5个队列中（中位年龄58.0-65.0岁），体力活动与虚弱对全因死亡率的影响持续存在相互作用（所有p相互作用≤0.036）。在汇总分析中，不运动的参与者（多变量调整后的HR: 3.72, 95% CI: 2.54-5.45）比经常运动的参与者（2.40,1.71-3.36，p相互作用<； 0.001）的死亡风险更高；每个队列的结果采用随机效应模型进行meta分析（I2 -亚组内>；78.7%, P < 0.001）。因此，身体虚弱的参与者（0.56;0.53-0.59）与健壮的参与者（0.80,0.73-0.87）相比，规律运动与死亡率之间的负相关更为明显；结果采用固定效应模型进行meta分析（I2在亚组内>；18.6%, P > 0.296）。在至少一个队列中，这种相互作用模式仍然存在于每一种虚弱缺陷和身体活动之间。五个队列的一致发现表明，有规律的体育活动可以减轻与虚弱相关的死亡率，体弱多病的成年人可能比健壮的成年人从有规律的体育活动中获得更多的生存益处。资助非传染性慢性病国家科技重大专项、国家自然科学基金、国家重点研发计划、上海市教委“曙光学者计划”、上海交通大学医学院“上海市教委高峰临床医学资助项目”、上海市地方高水平大学创新科研团队。

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引用次数: 0

Trends in lung cancer incidence and stage at diagnosis in Singapore: a population-based joinpoint regression analysis by age, sex, and smoking status 新加坡肺癌发病率和诊断阶段的趋势：基于年龄、性别和吸烟状况的人群联合点回归分析

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 10.1016/j.lanwpc.2025.101779

Yah Ru Juang , Meijing Hu , Miao Hui , Adeline Seow , Iain Bee Huat Tan , Dawn Qingqing Chong , Cheng Ean Chee , Wei Jie Seow

Background

Lung cancer remains a leading cause of cancer-related deaths globally. Although evidence indicates rising early-onset cases and increasing incidence among females and never-smokers in Asia, these trends remain underexplored in Singapore. This study comprehensively examined historical incidence trends by age, sex, smoking status, and stage to inform targeted prevention and management strategies.

Methods

We analyzed lung cancer cases from administrative health records in Singapore (1968–2021) to calculate age-standardized and age-specific incidence by age (30–49 years, 50–64 years, ≥65 years), sex (male, female), smoking status (ever-, never-smokers), and stage (I–IV). Joinpoint regression identified significant trend changes, reporting annual percent change (APC), average annual percent change (AAPC), and 95% confidence intervals (CIs). AAPCs were evaluated for the full study period and the most recent five years, with Benjamini-Hochberg adjustment for multiple comparisons.

Findings

From 1968 to 2021, 53,308 lung cancer cases were recorded in Singapore, predominantly in males (67.7%) and Chinese (87.8%), with 81.6% at advanced stages (III–IV). Incidence rose significantly only in females aged 30–49 years (AAPC = 0.79%, 95% CI: 0.41–1.18) and declined in all male age groups, especially 50–64 years (AAPC = −1.34%, 95% CI: −1.53 to −1.12). Stage I diagnoses increased significantly in both sexes (females: AAPC = 7.19%, 95% CI: 5.24–9.22; males: AAPC = 3.79%, 95% CI: 1.94–5.46) and incidence among never-smokers rose significantly, particularly among females (AAPC = 4.06%, 95% CI: 2.99–5.11).

Interpretation

The narrowing male-female gap, rising early-onset cases among females, and increasing incidence in female never-smokers, particularly those ≥65 years, highlight a shifting lung cancer burden in Singapore. Despite improvements in early-stage detection, most cases remained advanced, emphasizing the need to strengthen lung cancer management and screening strategies in Singapore.

Funding

This work is supported by the National Medical Research Council (Singapore) Health Promotion, Preventive Health, Population Health and Health Services Research (HPHSR) Clinician Scientist Award (HCSAINV24jul-0002).

肺癌仍然是全球癌症相关死亡的主要原因。尽管有证据表明，亚洲女性和从不吸烟者的早发病例和发病率不断上升，但这些趋势在新加坡仍未得到充分探讨。本研究全面考察了年龄、性别、吸烟状况和阶段的历史发病率趋势，为有针对性的预防和管理策略提供信息。方法分析新加坡行政卫生记录（1968-2021）中的肺癌病例，按年龄（30-49岁、50-64岁、≥65岁）、性别（男性、女性）、吸烟状况（曾经吸烟、从不吸烟）和分期（I-IV期）计算年龄标准化和年龄特异性发病率。连接点回归确定了显著的趋势变化，报告了年变化百分比（APC），平均年变化百分比（AAPC）和95%置信区间（CIs）。对整个研究期间和最近5年的AAPCs进行评估，采用benjamin - hochberg调整进行多重比较。研究结果：从1968年到2021年，新加坡记录了53308例肺癌病例，主要是男性（67.7%）和中国人（87.8%），其中81.6%为晚期（III-IV）。发病率仅在30-49岁的女性中显著升高（AAPC = 0.79%, 95% CI: 0.41-1.18），在所有男性年龄组中均下降，尤其是50-64岁（AAPC = - 1.34%, 95% CI: - 1.53 ~ - 1.12）。一期诊断在两性中均显著增加（女性：AAPC = 7.19%, 95% CI: 5.24-9.22；男性：AAPC = 3.79%, 95% CI: 1.94-5.46），不吸烟者的发病率显著增加，尤其是女性（AAPC = 4.06%, 95% CI: 2.99-5.11）。男女差距的缩小，女性早发病例的增加，以及女性不吸烟者（特别是≥65岁的女性）发病率的增加，突显了新加坡肺癌负担的变化。尽管早期检测有所改善，但大多数病例仍然处于晚期，这强调了新加坡加强肺癌管理和筛查策略的必要性。本研究得到新加坡国家医学研究委员会健康促进、预防健康、人口健康和卫生服务研究（HPHSR）临床科学家奖（hcsainv24july -0002）的支持。

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引用次数: 0

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 农村状况与全因和癌症特异性生存的关系：一项系统回顾和荟萃分析，调整了临床因素、人口统计学和地理偏远

IF 8.1 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 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）。

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引用次数: 0