Pub Date : 2024-08-24DOI: 10.1016/j.lanwpc.2024.101175
Background
Gay and bisexual men (GBM) remain overrepresented among syphilis diagnoses in Australia and globally. The extent to which changes in sexual networks associated with HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) may have influenced syphilis transmission among GBM at the population-level is poorly understood. We describe trends in syphilis testing and incidence among GBM in Australia over eleven years spanning widespread uptake of HIV PrEP and TasP.
Methods
We analysed linked clinical data from GBM aged 16 years or older across a sentinel surveillance network in Australia from January 1, 2012, to December 31, 2022. Individuals with at least two clinic visits and with at least two syphilis tests during the observations period were included in testing and incidence analyses, respectively. Annual rates of testing and infectious syphilis incidence from 2012 to 2022 were disaggregated by HIV status and PrEP use (record of PrEP prescription; retrospectively categorised as ever or never-PrEP user). Cox regression explored associations between demographics, PrEP use and history of bacterial sexually transmissible infections (STIs) and infectious syphilis diagnosis.
Findings
Among 129,278 GBM (mean age, 34.6 years [SD, 12.2]) included in testing rate analyses, 7.4% were living with HIV at entry and 31.1% were prescribed PrEP at least once during the study period. Overall syphilis testing rate was 114.0/100 person-years (py) and highest among GBM with HIV (168.4/100 py). Syphilis testing increased from 72.8/100 py to 151.8/100 py; driven largely by increases among ever-PrEP users. Among 94,710 GBM included in incidence analyses, there were 14,710 syphilis infections diagnosed over 451,560 person-years (incidence rate = 3.3/100 py). Syphilis incidence was highest among GBM with HIV (6.5/100 py), followed by ever-PrEP users (3.5/100 py) and never-PrEP users (1.4/100 py). From 2012 to 2022, syphilis incidence increased among ever-PrEP users from 1.3/100 py to 5.1/100 py, and fluctuated between 5.4/100 py and 6.6/100 py among GBM with HIV. In multivariable Cox regression, previous syphilis diagnosis (adjusted hazard ratio [aHR] = 1.98, 95% CI = 1.83–2.14), living with HIV (aHR = 1.83, 95% CI = 1.12–1.25) and recent (past 12 m) prescription of PrEP (aHR = 1.78, 95% CI = 1.61–1.97) were associated with syphilis diagnosis.
Interpretation
Syphilis trends between GBM with HIV and GBM with evidence of PrEP use have converged over the past decade in Australia. Our findings recommend targeting emergent syphilis control strategies (e.g. doxycycline post-exposure prophylaxis) to GBM with prior syphilis diagnoses, using HIV PrEP or who are living with HIV.
Funding
Australian Department of Health and Aged Care, National Health and Medical Research Council.
{"title":"Syphilis testing, incidence, and reinfection among gay and bisexual men in Australia over a decade spanning HIV PrEP implementation: an analysis of surveillance data from 2012 to 2022","authors":"","doi":"10.1016/j.lanwpc.2024.101175","DOIUrl":"10.1016/j.lanwpc.2024.101175","url":null,"abstract":"<div><h3>Background</h3><p>Gay and bisexual men (GBM) remain overrepresented among syphilis diagnoses in Australia and globally. The extent to which changes in sexual networks associated with HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) may have influenced syphilis transmission among GBM at the population-level is poorly understood. We describe trends in syphilis testing and incidence among GBM in Australia over eleven years spanning widespread uptake of HIV PrEP and TasP.</p></div><div><h3>Methods</h3><p>We analysed linked clinical data from GBM aged 16 years or older across a sentinel surveillance network in Australia from January 1, 2012, to December 31, 2022. Individuals with at least two clinic visits and with at least two syphilis tests during the observations period were included in testing and incidence analyses, respectively. Annual rates of testing and infectious syphilis incidence from 2012 to 2022 were disaggregated by HIV status and PrEP use (record of PrEP prescription; retrospectively categorised as ever or never-PrEP user). Cox regression explored associations between demographics, PrEP use and history of bacterial sexually transmissible infections (STIs) and infectious syphilis diagnosis.</p></div><div><h3>Findings</h3><p>Among 129,278 GBM (mean age, 34.6 years [SD, 12.2]) included in testing rate analyses, 7.4% were living with HIV at entry and 31.1% were prescribed PrEP at least once during the study period. Overall syphilis testing rate was 114.0/100 person-years (py) and highest among GBM with HIV (168.4/100 py). Syphilis testing increased from 72.8/100 py to 151.8/100 py; driven largely by increases among ever-PrEP users. Among 94,710 GBM included in incidence analyses, there were 14,710 syphilis infections diagnosed over 451,560 person-years (incidence rate = 3.3/100 py). Syphilis incidence was highest among GBM with HIV (6.5/100 py), followed by ever-PrEP users (3.5/100 py) and never-PrEP users (1.4/100 py). From 2012 to 2022, syphilis incidence increased among ever-PrEP users from 1.3/100 py to 5.1/100 py, and fluctuated between 5.4/100 py and 6.6/100 py among GBM with HIV. In multivariable Cox regression, previous syphilis diagnosis (adjusted hazard ratio [aHR] = 1.98, 95% CI = 1.83–2.14), living with HIV (aHR = 1.83, 95% CI = 1.12–1.25) and recent (past 12 m) prescription of PrEP (aHR = 1.78, 95% CI = 1.61–1.97) were associated with syphilis diagnosis.</p></div><div><h3>Interpretation</h3><p>Syphilis trends between GBM with HIV and GBM with evidence of PrEP use have converged over the past decade in Australia. Our findings recommend targeting emergent syphilis control strategies (e.g. doxycycline post-exposure prophylaxis) to GBM with prior syphilis diagnoses, using HIV PrEP or who are living with HIV.</p></div><div><h3>Funding</h3><p><span>Australian Department of Health and Aged Care</span>, <span>National Health and Medical Research Council</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660652400169X/pdfft?md5=c1001306691e5137cc14e1640134cdcf&pid=1-s2.0-S266660652400169X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-21DOI: 10.1016/j.lanwpc.2024.101161
Background
Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system.
Methods
We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics.
Findings
We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners.
Interpretation
Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments.
Funding
No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.
{"title":"Primary care quality and provider disparities in China: a standardized-patient-based study","authors":"","doi":"10.1016/j.lanwpc.2024.101161","DOIUrl":"10.1016/j.lanwpc.2024.101161","url":null,"abstract":"<div><h3>Background</h3><p>Primary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world's largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in-sights for enhancing China's primary care system.</p></div><div><h3>Methods</h3><p>We merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen-ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics.</p></div><div><h3>Findings</h3><p>We document a poor quality of primary care in China, with no-table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor-rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en-hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners.</p></div><div><h3>Interpretation</h3><p>Primary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po-tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em-phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments.</p></div><div><h3>Funding</h3><p>No founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266660652400155X/pdfft?md5=53abfef01e0edf9a2e99c642d7d70023&pid=1-s2.0-S266660652400155X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1016/j.lanwpc.2024.101172
Background
Evidence on the long-term benefits and cost-effectiveness of colorectal cancer (CRC) screening strategies in China remains limited. This modelling study aims to address this issue for various CRC screening strategies in China between 2020 and 2060.
Methods
Using a previously developed microsimulation model (MIMIC-CRC) with Chinese epidemiological data, we evaluated four CRC screening strategies targeting population aged 45–74 years: no screening, colonoscopy every 10 years, biennial faecal immunochemical testing (FIT), and a roll-out FIT screening strategy. Screening coverage (invitation) rates from 5% to 100% were analysed. Single-cohort analysis of 100,000 individuals was conducted to estimate the relative cost-effectiveness of each strategy. A multiple-cohort analysis of 100,000 people aged 40+ over 2020–2060 was conducted to project nation-wide long-term benefits and cost-effectiveness.
Findings
In single-cohort analysis, all strategies yielded reductions in CRC incidence and mortality compared to no screening, with colonoscopy outperforming FIT-based strategies at the same invitation rates. In multiple-cohort analysis, among people over 40 years of age in China over 2020–2060, compared to no screening, at invitation rate of 5%, screening by colonoscopy, biennial FIT and roll-out FIT-based approach were estimated to avert 1.2, 0.4, and 0.3 million incident CRCs and 0.2, 0.1, and 0.1 million CRC-related deaths, respectively, compared to no screening (25.4 million incident CRCs and 4.4 million CRC-related deaths), and this preventive effect enlarged as the screening coverage rate increased. At full coverage, colonoscopy achieved the largest reductions (38.2% lower incidence and 43.2% lower mortality) but required the most resources. Biennial FIT and roll-out FIT-based approach screening was slightly less effective but had significant reduced colonoscopy needs (reduction of 83.8% and 85.2%, respectively) and overall cost (reduction of 23.4% and 37.8%, respectively) compared to colonoscopy screening.
Interpretation
Nation-wide implementation of screening would be effective in reducing the burden of CRC in China. Biennial FIT and roll-out FIT-based screening strategies could prevent incident CRC cases and CRC-related deaths with considerably fewer resources than colonoscopy screening. Efforts should be made to increase the screening coverage in China.
Funding
Chinese Academy of Medical Science Innovation Fund for Medical Science (2022-I2M-1-0031); National Natural Science Foundation of China (82173606; 82273726); Beijing Nova Program of Science and Technology (20230484397).
{"title":"Evaluation of long-term benefits and cost-effectiveness of nation-wide colorectal cancer screening strategies in China in 2020–2060: a modelling analysis","authors":"","doi":"10.1016/j.lanwpc.2024.101172","DOIUrl":"10.1016/j.lanwpc.2024.101172","url":null,"abstract":"<div><h3>Background</h3><p>Evidence on the long-term benefits and cost-effectiveness of colorectal cancer (CRC) screening strategies in China remains limited. This modelling study aims to address this issue for various CRC screening strategies in China between 2020 and 2060.</p></div><div><h3>Methods</h3><p>Using a previously developed microsimulation model (MIMIC-CRC) with Chinese epidemiological data, we evaluated four CRC screening strategies targeting population aged 45–74 years: no screening, colonoscopy every 10 years, biennial faecal immunochemical testing (FIT), and a roll-out FIT screening strategy. Screening coverage (invitation) rates from 5% to 100% were analysed. Single-cohort analysis of 100,000 individuals was conducted to estimate the relative cost-effectiveness of each strategy. A multiple-cohort analysis of 100,000 people aged 40+ over 2020–2060 was conducted to project nation-wide long-term benefits and cost-effectiveness.</p></div><div><h3>Findings</h3><p>In single-cohort analysis, all strategies yielded reductions in CRC incidence and mortality compared to no screening, with colonoscopy outperforming FIT-based strategies at the same invitation rates. In multiple-cohort analysis, among people over 40 years of age in China over 2020–2060, compared to no screening, at invitation rate of 5%, screening by colonoscopy, biennial FIT and roll-out FIT-based approach were estimated to avert 1.2, 0.4, and 0.3 million incident CRCs and 0.2, 0.1, and 0.1 million CRC-related deaths, respectively, compared to no screening (25.4 million incident CRCs and 4.4 million CRC-related deaths), and this preventive effect enlarged as the screening coverage rate increased. At full coverage, colonoscopy achieved the largest reductions (38.2% lower incidence and 43.2% lower mortality) but required the most resources. Biennial FIT and roll-out FIT-based approach screening was slightly less effective but had significant reduced colonoscopy needs (reduction of 83.8% and 85.2%, respectively) and overall cost (reduction of 23.4% and 37.8%, respectively) compared to colonoscopy screening.</p></div><div><h3>Interpretation</h3><p>Nation-wide implementation of screening would be effective in reducing the burden of CRC in China. Biennial FIT and roll-out FIT-based screening strategies could prevent incident CRC cases and CRC-related deaths with considerably fewer resources than colonoscopy screening. Efforts should be made to increase the screening coverage in China.</p></div><div><h3>Funding</h3><p><span>Chinese Academy of Medical Science Innovation Fund</span> for Medical Science (<span><span>2022-I2M-1-0031</span></span>); <span>National Natural Science Foundation of China</span> (<span><span>82173606</span></span>; <span><span>82273726</span></span>); <span>Beijing Nova Program of Science and Technology</span> (<span><span>20230484397</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001664/pdfft?md5=952e8293cf81537a62b5ab8d9f4942b1&pid=1-s2.0-S2666606524001664-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142006661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1016/j.lanwpc.2024.101173
Background
Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.
Methods
This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2–3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1–4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529.
Findings
From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, ηp2 = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support.
Interpretation
A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited.
Funding
Emerging Researcher First Grant from the Health Research Council of New Zealand.
{"title":"Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial","authors":"","doi":"10.1016/j.lanwpc.2024.101173","DOIUrl":"10.1016/j.lanwpc.2024.101173","url":null,"abstract":"<div><h3>Background</h3><p>Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.</p></div><div><h3>Methods</h3><p>This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2–3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1–4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529.</p></div><div><h3>Findings</h3><p>From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, η<sub>p</sub><sup>2</sup> = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support.</p></div><div><h3>Interpretation</h3><p>A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited.</p></div><div><h3>Funding</h3><p>Emerging Researcher First Grant from the <span>Health Research Council of New Zealand</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001676/pdfft?md5=396053697bdb50c4b8934f9924913e49&pid=1-s2.0-S2666606524001676-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.lanwpc.2024.101171
Background
Suicide rates have been increasing in Australia since the mid-2000s, especially for women aged ≤25 years. We conducted an age-period-cohort study to investigate these recent trends in the context of historical Australian suicide rates.
Methods
Data on annual suicides in Australia from 1907 to 2020 were extracted from the General Record of Incidence of Mortality. We modelled age-specific effects for a reference cohort, after adjustment for period effects.
Findings
We found evidence of age, cohort and period effects. For males, compared to the cohort born in 1946–1950, rates were higher for all cohorts born after this year. The period effect showed peaks in the risk of male suicide in the mid 1960s and the early 1990s, followed by a decline in risk until early 2010, after which the risk began to rise again. For females, compared to the cohort born in 1946–1950, the risk of suicide was higher for all cohorts born after this, with the highest risk for those born in 2006–2010. The period effect for females showed an elevated risk of suicide in the mid 1960s followed by a sharp decline, and an increase in risk after 2009.
Interpretation
Suicide rates in Australia have fluctuated substantially over time and appear to be related to age trends as well as period and cohort trends. Advocacy and policy making tends to focus on contemporaneous changes in suicide rates. However, this study shows that focusing only on year-on-year changes in suicide rates ignores underlying trends for specific population birth-cohorts.
{"title":"Age, period and cohort analysis of suicide trends in Australia, 1907–2020","authors":"","doi":"10.1016/j.lanwpc.2024.101171","DOIUrl":"10.1016/j.lanwpc.2024.101171","url":null,"abstract":"<div><h3>Background</h3><p>Suicide rates have been increasing in Australia since the mid-2000s, especially for women aged ≤25 years. We conducted an age-period-cohort study to investigate these recent trends in the context of historical Australian suicide rates.</p></div><div><h3>Methods</h3><p>Data on annual suicides in Australia from 1907 to 2020 were extracted from the General Record of Incidence of Mortality. We modelled age-specific effects for a reference cohort, after adjustment for period effects.</p></div><div><h3>Findings</h3><p>We found evidence of age, cohort and period effects. For males, compared to the cohort born in 1946–1950, rates were higher for all cohorts born after this year. The period effect showed peaks in the risk of male suicide in the mid 1960s and the early 1990s, followed by a decline in risk until early 2010, after which the risk began to rise again. For females, compared to the cohort born in 1946–1950, the risk of suicide was higher for all cohorts born after this, with the highest risk for those born in 2006–2010. The period effect for females showed an elevated risk of suicide in the mid 1960s followed by a sharp decline, and an increase in risk after 2009.</p></div><div><h3>Interpretation</h3><p>Suicide rates in Australia have fluctuated substantially over time and appear to be related to age trends as well as period and cohort trends. Advocacy and policy making tends to focus on contemporaneous changes in suicide rates. However, this study shows that focusing only on year-on-year changes in suicide rates ignores underlying trends for specific population birth-cohorts.</p></div><div><h3>Funding</h3><p>None.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001652/pdfft?md5=c4f47531621b5c0c7f4c0f67c2c413d2&pid=1-s2.0-S2666606524001652-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.lanwpc.2024.101170
Background
Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.
Methods
Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.
Findings
To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families’ involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.
Interpretation
Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs’ ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.
Funding
This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project “Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients’ Voice in Primary Care” [NUHSRO/2022/049/NUSMed/DFM].
{"title":"A qualitative study on general practitioners’ perspectives on late-life depression in Singapore—part I: patient presentations and behaviours","authors":"","doi":"10.1016/j.lanwpc.2024.101170","DOIUrl":"10.1016/j.lanwpc.2024.101170","url":null,"abstract":"<div><h3>Background</h3><p>Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.</p></div><div><h3>Methods</h3><p>Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.</p></div><div><h3>Findings</h3><p>To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families’ involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.</p></div><div><h3>Interpretation</h3><p>Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs’ ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.</p></div><div><h3>Funding</h3><p>This work was funded by the <span>Division of Family Medicine Research Capabilities Building Budget</span> under the project “<span>Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients’ Voice in Primary Care</span>” [<span><span>NUHSRO/2022/049/NUSMed/DFM</span></span>].</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001640/pdfft?md5=bfaafc44b8be72fc36d42e63bf01beb5&pid=1-s2.0-S2666606524001640-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.lanwpc.2024.101169
Background
Synovitis has long been considered a common and modifiable inflammatory feature of osteoarthritis (OA), but current disease-modifying anti-inflammatory treatments appear ineffective in OA clinical trials. Elucidating the temporal relationship between synovitis and OA could provide insight into the role of synovitis in OA.
Methods
We conducted a prospective cohort study based on the baseline and three-year follow-up data from the Xiangya Osteoarthritis (XO) Study. We assessed bidirectional associations between ultrasound-detected synovitis and radiographic and symptomatic OA at knee and hand sites using generalized estimating equations. Additionally, we performed bidirectional Mendelian randomization (MR) analyses to test these hypotheses utilising whole-genome sequencing data in the XO population. Age, sex, body mass index, smoking, alcohol consumption, educational level, physical activity, and joint injury history were adjusted for these analyses.
Findings
A total of 2211, 2420, 2280, and 2600 participants were enrolled for analyses of radiographic knee OA (RKOA), symptomatic knee OA (SKOA), radiographic hand OA (RHOA) and symptomatic hand OA (SHOA), respectively. The baseline synovitis (i.e., with synovitis vs. without synovitis) was associated with the incident RKOA (76/277 vs. 557/3674 knees), SKOA (49/387 vs. 287/4213 knees), RHOA (171/358 vs. 686/3664 hands) and SHOA (35/689 vs. 76/4327 hands), with adjusted odds ratio (aORs) of 2.2 (95% CI 1.7–3.1), 2.0 (1.3–2.9), 3.4 (2.7–4.4), and 2.4 (1.5–3.8), respectively. The baseline RKOA (with OA vs. without OA: 409/1246 vs. 481/3758 knees), SKOA (200/576 vs. 675/4356 knees), RHOA (192/778 vs. 410/3723 hands), and SHOA (41/162 vs. 548/4285 hands) were also associated with the incident synovitis, with aORs of 3.4 (95% CI 2.9–4.1), 2.7 (2.1–3.4), 2.3 (1.8–2.9) and 1.9 (1.2–2.8), respectively. These bidirectional associations were stronger when more active synovitis was compared with the reference group (all P < 0.05). MR analyses further supported bidirectional associations that synovitis significantly increased the odds of incident OA at both sites and vice versa (all ORs ranged from 1.2–1.7).
Interpretation
Our population-based cohort study found novel evidence of a bidirectional association between synovitis and OA, which was further validated through MR analysis and suggested that the bidirectional association is likely causal. Our findings indicated that synovitis is both a risk factor and a consequence of the OA rather than solely a risk factor.
Funding
The National Key Research and Development Plan, the National Natural Science Foundation of China, the Key Research and Development Program of Hunan Province, the Natural Science Foundation of Hunan Province, the Central South University Innovation-Driv
背景长期以来，滑膜炎一直被认为是骨关节炎（OA）的一种常见且可改变的炎症特征，但目前的疾病改变抗炎治疗在 OA 临床试验中似乎效果不佳。方法我们根据湘雅骨关节炎（XO）研究的基线和三年随访数据开展了一项前瞻性队列研究。我们使用广义估计方程评估了超声检测到的滑膜炎与膝关节和手部的影像学和症状性 OA 之间的双向关联。此外，我们还利用XO人群的全基因组测序数据进行了双向孟德尔随机化（MR）分析，以检验这些假设。这些分析对年龄、性别、体重指数、吸烟、饮酒、受教育程度、体力活动和关节损伤史进行了调整。研究结果 共有 2211 人、2420 人、2280 人和 2600 人分别参加了膝关节放射性 OA（RKOA）、症状性膝关节 OA（SKOA）、手部放射性 OA（RHOA）和症状性手部 OA（SHOA）的分析。滑膜炎基线（即与RKOA（76/277 对 557/3674 膝）、SKOA（49/387 对 287/4213 膝）、RHOA（171/358 对 686/3664 手）和无症状手部 OA（SHOA）相关。调整后的几率（aORs）分别为 2.2（95% CI 1.7-3.1）、2.0（1.3-2.9）、3.4（2.7-4.4）和 2.4（1.5-3.8）。基线 RKOA（有 OA 对无 OA：409/1246 对 481/3758 膝）、SKOA（200/576 对 675/4356 膝）、RHOA（192/778 对 410/3723 手）和 SHOA（41/162 对 548/4285 手）分别为：1.0（1.3-2.9）、2.0（1.3-2.9）、3.4（2.7-4.4）和 2.4（1.5-3.8）。RHOA（192/778 对 410/3723 双手）和 SHOA（41/162 对 548/4285 双手）也与滑膜炎的发生有关，其 aOR 分别为 3.4（95% CI 2.9-4.1）、2.7（2.1-3.4）、2.3（1.8-2.9）和 1.9（1.2-2.8）。当活动性滑膜炎与参照组相比时，这些双向关联性更强（所有 P 均为 0.05）。我们基于人群的队列研究发现了滑膜炎与 OA 之间存在双向关联的新证据，并通过 MR 分析进一步验证了这一证据，表明这种双向关联很可能是因果关系。我们的研究结果表明，滑膜炎既是OA的危险因素，也是OA的后果，而不仅仅是危险因素。基金项目国家重点研发计划、国家自然科学基金、湖南省重点研发计划、湖南省自然科学基金、中南大学创新驱动研究计划、中南大学中央高校基础研究基金。
{"title":"Bidirectional association identified between synovitis and knee and hand osteoarthritis: a general population-based study","authors":"","doi":"10.1016/j.lanwpc.2024.101169","DOIUrl":"10.1016/j.lanwpc.2024.101169","url":null,"abstract":"<div><h3>Background</h3><p>Synovitis has long been considered a common and modifiable inflammatory feature of osteoarthritis (OA), but current disease-modifying anti-inflammatory treatments appear ineffective in OA clinical trials. Elucidating the temporal relationship between synovitis and OA could provide insight into the role of synovitis in OA.</p></div><div><h3>Methods</h3><p>We conducted a prospective cohort study based on the baseline and three-year follow-up data from the Xiangya Osteoarthritis (XO) Study. We assessed bidirectional associations between ultrasound-detected synovitis and radiographic and symptomatic OA at knee and hand sites using generalized estimating equations. Additionally, we performed bidirectional Mendelian randomization (MR) analyses to test these hypotheses utilising whole-genome sequencing data in the XO population. Age, sex, body mass index, smoking, alcohol consumption, educational level, physical activity, and joint injury history were adjusted for these analyses.</p></div><div><h3>Findings</h3><p>A total of 2211, 2420, 2280, and 2600 participants were enrolled for analyses of radiographic knee OA (RKOA), symptomatic knee OA (SKOA), radiographic hand OA (RHOA) and symptomatic hand OA (SHOA), respectively. The baseline synovitis (i.e., with synovitis vs. without synovitis) was associated with the incident RKOA (76/277 vs. 557/3674 knees), SKOA (49/387 vs. 287/4213 knees), RHOA (171/358 vs. 686/3664 hands) and SHOA (35/689 vs. 76/4327 hands), with adjusted odds ratio (aORs) of 2.2 (95% CI 1.7–3.1), 2.0 (1.3–2.9), 3.4 (2.7–4.4), and 2.4 (1.5–3.8), respectively. The baseline RKOA (with OA vs. without OA: 409/1246 vs. 481/3758 knees), SKOA (200/576 vs. 675/4356 knees), RHOA (192/778 vs. 410/3723 hands), and SHOA (41/162 vs. 548/4285 hands) were also associated with the incident synovitis, with aORs of 3.4 (95% CI 2.9–4.1), 2.7 (2.1–3.4), 2.3 (1.8–2.9) and 1.9 (1.2–2.8), respectively. These bidirectional associations were stronger when more active synovitis was compared with the reference group (all <em>P</em> < 0.05). MR analyses further supported bidirectional associations that synovitis significantly increased the odds of incident OA at both sites and vice versa (all ORs ranged from 1.2–1.7).</p></div><div><h3>Interpretation</h3><p>Our population-based cohort study found novel evidence of a bidirectional association between synovitis and OA, which was further validated through MR analysis and suggested that the bidirectional association is likely causal. Our findings indicated that synovitis is both a risk factor and a consequence of the OA rather than solely a risk factor.</p></div><div><h3>Funding</h3><p>The <span>National Key Research and Development Plan</span>, the <span>National Natural Science Foundation of China</span>, the <span>Key Research and Development Program of Hunan Province</span>, the <span>Natural Science Foundation of Hunan Province</span>, the <span>Central South University Innovation-Driv","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001639/pdfft?md5=86bbf2864a1d938f8f0879c2f2bb2ab0&pid=1-s2.0-S2666606524001639-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.lanwpc.2024.101168
Background
Recent studies showed increased mortality risks after hot nights, but their effect on hospitalizations, especially in vulnerable populations, remains under-studied.
Methods
Daily hospitalization, meteorological (including hourly), and air pollution data were collected for the hot seasons (May–October) of 2000–19 in Hong Kong. We derived three hot-night metrics: HNday28 °C, daily minimum temperature ≥28 °C, the governmental definition of hot nights; HNe, hot night excess calculated by summing heat excess of hourly temperatures above 28 °C at night; and HNday90th, hot nights classified using the 90th percentile HNe (17.7 °C⋅h) as a cutoff. We fitted time-series regression with distributed lag nonlinear models to examine the associations of hot-night metrics with various hospitalizations.
Findings
During the 3680 study days, 5,002,114 non-cancer non-external (NCNE) hospitalizations were recorded. Half (1874) of the days experienced excess nighttime heat (HNe>0) with a mean (SD) of 8.0 (6.8) °C⋅h; 499 and 187 hot nights were identified by HNday28 °C and HNday90th, respectively. Extreme HNe (99th percentile vs 0 °C⋅h) was significantly associated with increased NCNE hospitalizations over lag 0–4 days by 3.1% [95% confidence interval: 1.5%, 4.8%] overall, with enhanced effects in elderly (5.3% [3.2%, 7.4%]), low-SES individuals (5.3% [2.8%, 8.0%]), and circulatory admissions (3.4% [0.2%, 6.8%]). HNday90th, reflecting extreme HNe, better identified hazardous hot nights than the official HNday28 °C.
Interpretation
Excessive nighttime heat is significantly associated with increased hospitalizations, particularly affecting the elderly and socioeconomically disadvantaged individuals. Nighttime heat intensity should be incorporated in defining hot nights with public health relevance.
{"title":"The risk of hospitalization associated with hot nights and excess nighttime heat in a subtropical metropolis: a time-series study in Hong Kong, 2000–2019","authors":"","doi":"10.1016/j.lanwpc.2024.101168","DOIUrl":"10.1016/j.lanwpc.2024.101168","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies showed increased mortality risks after hot nights, but their effect on hospitalizations, especially in vulnerable populations, remains under-studied.</p></div><div><h3>Methods</h3><p>Daily hospitalization, meteorological (including hourly), and air pollution data were collected for the hot seasons (May–October) of 2000–19 in Hong Kong. We derived three hot-night metrics: HNday<sub>28 °C</sub>, daily minimum temperature ≥28 °C, the governmental definition of hot nights; HNe, hot night excess calculated by summing heat excess of hourly temperatures above 28 °C at night; and HNday<sub>90th</sub>, hot nights classified using the 90th percentile HNe (17.7 °C⋅h) as a cutoff. We fitted time-series regression with distributed lag nonlinear models to examine the associations of hot-night metrics with various hospitalizations.</p></div><div><h3>Findings</h3><p>During the 3680 study days, 5,002,114 non-cancer non-external (NCNE) hospitalizations were recorded. Half (1874) of the days experienced excess nighttime heat (HNe>0) with a mean (SD) of 8.0 (6.8) °C⋅h; 499 and 187 hot nights were identified by HNday<sub>28 °C</sub> and HNday<sub>90th</sub>, respectively. Extreme HNe (99th percentile vs 0 °C⋅h) was significantly associated with increased NCNE hospitalizations over lag 0–4 days by 3.1% [95% confidence interval: 1.5%, 4.8%] overall, with enhanced effects in elderly (5.3% [3.2%, 7.4%]), low-SES individuals (5.3% [2.8%, 8.0%]), and circulatory admissions (3.4% [0.2%, 6.8%]). HNday<sub>90th</sub>, reflecting extreme HNe, better identified hazardous hot nights than the official HNday<sub>28 °C</sub>.</p></div><div><h3>Interpretation</h3><p>Excessive nighttime heat is significantly associated with increased hospitalizations, particularly affecting the elderly and socioeconomically disadvantaged individuals. Nighttime heat intensity should be incorporated in defining hot nights with public health relevance.</p></div><div><h3>Funding</h3><p><span>British Heart Foundation</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001627/pdfft?md5=f91b9d585c0b143a643a6676adf68b50&pid=1-s2.0-S2666606524001627-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1016/j.lanwpc.2024.101167
Background
The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors.
Methods
We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1–2), medium- (3–4), and long-term (6–7 years) effects.
Findings
We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (−1.78% [−4.51%, 0.96%]), passive smoking (−8.09% [−14.27%, −1.90%]), and drinking in last month (−4.04% [−8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: −1.84, −0.26), 1.15 medium-term (95% CI: −2.08, −0.22), 2.82 long-term (95% CI: −4.79, −0.85), and 1.54 overall (95% CI: −2.51, −0.56).
Interpretation
The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges.
Funding
The China National Key Research and Development Program (2018YFC1315304 and 2017YFC1310902); National Natural Science Foundation of China (81872721).
{"title":"Effect of the national integrated demonstration area for the prevention and control of noncommunicable diseases programme on behavioural risk factors in China: a synthetic difference-in-differences study","authors":"","doi":"10.1016/j.lanwpc.2024.101167","DOIUrl":"10.1016/j.lanwpc.2024.101167","url":null,"abstract":"<div><h3>Background</h3><p>The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors.</p></div><div><h3>Methods</h3><p>We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1–2), medium- (3–4), and long-term (6–7 years) effects.</p></div><div><h3>Findings</h3><p>We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (−1.78% [−4.51%, 0.96%]), passive smoking (−8.09% [−14.27%, −1.90%]), and drinking in last month (−4.04% [−8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: −1.84, −0.26), 1.15 medium-term (95% CI: −2.08, −0.22), 2.82 long-term (95% CI: −4.79, −0.85), and 1.54 overall (95% CI: −2.51, −0.56).</p></div><div><h3>Interpretation</h3><p>The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges.</p></div><div><h3>Funding</h3><p>The China <span>National Key Research and Development Program</span> (<span><span>2018YFC1315304</span></span> and <span><span>2017YFC1310902</span></span>); <span>National Natural Science Foundation of China</span> (<span><span>81872721</span></span>).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001615/pdfft?md5=e174671e4f3400c936ab3f0ea599051d&pid=1-s2.0-S2666606524001615-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1016/j.lanwpc.2024.101162
Background
School-based targeted preventive chemotherapy (PC), the primary strategy for soil-transmitted helminth (STH) control, typically focusing on primary schoolchildren, was expanded to secondary school students in the Philippines in 2016. This program still excludes adults, who may also suffer from considerable morbidity and can be a significant reservoir of infection. Mass drug administration (MDA), where the entire population is treated, would bring additional health benefits but will also increase implementation costs. The incremental cost of implementing MDA for STH control compared to expanded school-based targeted PC, however, is unknown.
Methods
A cost survey was conducted in Zamboanga Peninsula region in 2021 to estimate the economic and financial cost of implementing MDA compared to the expanded school-based targeted PC from a government payer perspective. A budget impact analysis was conducted to estimate the financial cost to the government of implementing MDA over a five-year timeframe. Monte Carlo simulation accounted for uncertainty in cost estimates. Costs were reported in 2021 United States Dollars ($).
Findings
The economic cost of MDA was $809,000 per year (95% CI: $679,000–$950,000) or $0.22 per person targeted (95% CI: $0.19–$0.26), while the expanded school-based targeted PC would cost $625,000 (95% CI: $549,000–$706,000) or $0.57 per person targeted (95% CI: $0.50–$0.64). Over five years, the financial cost to the government for MDA would be $3,113,000 (95% CI: $2,475,000–$3,810,000); $740,000 (95% CI: $486,000–$1,019,000) higher than expanded school-based targeted PC.
Interpretation
Implementing MDA in the region will increase the economic and financial costs by 29% and 31%, respectively, when compared to expanded school-based targeted PC. Implementing MDA would require the Department of Health to increase their total expenditure for STH control by 0.2% and could be key in addressing the ongoing STH burden.
Funding
The project was funded by the Australian Centre for the Control and Elimination of Neglected Tropical Diseases (NHMRC GA19028), and JPCDT was supported by a UNSW Scientia PhD Scholarship. SVN is funded by an NHMRC Investigator Grant (APP 2018220).
{"title":"Cost and budget impact of mass drug administration compared to expanded school-based targeted preventive chemotherapy for soil-transmitted helminth control in Zamboanga Peninsula, the Philippines","authors":"","doi":"10.1016/j.lanwpc.2024.101162","DOIUrl":"10.1016/j.lanwpc.2024.101162","url":null,"abstract":"<div><h3>Background</h3><p>School-based targeted preventive chemotherapy (PC), the primary strategy for soil-transmitted helminth (STH) control, typically focusing on primary schoolchildren, was expanded to secondary school students in the Philippines in 2016. This program still excludes adults, who may also suffer from considerable morbidity and can be a significant reservoir of infection. Mass drug administration (MDA), where the entire population is treated, would bring additional health benefits but will also increase implementation costs. The incremental cost of implementing MDA for STH control compared to expanded school-based targeted PC, however, is unknown.</p></div><div><h3>Methods</h3><p>A cost survey was conducted in Zamboanga Peninsula region in 2021 to estimate the economic and financial cost of implementing MDA compared to the expanded school-based targeted PC from a government payer perspective. A budget impact analysis was conducted to estimate the financial cost to the government of implementing MDA over a five-year timeframe. Monte Carlo simulation accounted for uncertainty in cost estimates. Costs were reported in 2021 United States Dollars ($).</p></div><div><h3>Findings</h3><p>The economic cost of MDA was $809,000 per year (95% CI: $679,000–$950,000) or $0.22 per person targeted (95% CI: $0.19–$0.26), while the expanded school-based targeted PC would cost $625,000 (95% CI: $549,000–$706,000) or $0.57 per person targeted (95% CI: $0.50–$0.64). Over five years, the financial cost to the government for MDA would be $3,113,000 (95% CI: $2,475,000–$3,810,000); $740,000 (95% CI: $486,000–$1,019,000) higher than expanded school-based targeted PC.</p></div><div><h3>Interpretation</h3><p>Implementing MDA in the region will increase the economic and financial costs by 29% and 31%, respectively, when compared to expanded school-based targeted PC. Implementing MDA would require the Department of Health to increase their total expenditure for STH control by 0.2% and could be key in addressing the ongoing STH burden.</p></div><div><h3>Funding</h3><p>The project was funded by the Australian Centre for the <span>Control and Elimination of Neglected Tropical Diseases</span> (NHMRC GA19028), and <span>JPCDT</span> was supported by a <span>UNSW</span> Scientia PhD Scholarship. SVN is funded by an <span>NHMRC</span> Investigator Grant (APP 2018220).</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001561/pdfft?md5=8abc026dd71d2fd411345bd741dd6c90&pid=1-s2.0-S2666606524001561-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141962896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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