Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101393
Xiangran Feng, Yi Xiang
<div><h3>Background</h3><div>BRAF oncogene is a rare genetic alteration in NSCLC. Acquired BRAF mutations are an emerging resistance mechanism to EGFR TKIs. The differences in clinical and genetic characteristics, therapeutic strategies, and outcomes in NSCLC patients harboring primary and acquired BRAF mutations are still poorly understood.</div></div><div><h3>Methods</h3><div>From Oct 2017 to Dec 2023, 10, 211 lung cancer patients at Shanghai Ruijin Hospital were reviewed. 88 primary BRAF-mutated and 15 acquired BRAF-mutated NSCLC patients resistant to EGFR TKIs were included in the study.</div></div><div><h3>Findings</h3><div>Primary BRAF-mutated patients preferentially occurred in the elderly (median age: 67 versus 61, p=0.015), males (53.4% vs 26.7%, p=0.056), former/current smokers (36.5% vs 6.7%, p=0.033), non-adenocarcinoma (11.4% vs 0%, P=0.351) compared to acquired BRAF-mutated patient. There were significant differences between the primary BRAF/EGFR co-mutated group and the non-EGFR co-mutated group in terms of gender (males: 33.3% vs 62.3%, p=0.012), smoking history (22.2% vs 43.1%, p=0.063), and histological types (adenocarcinomas: 100% vs 83.6%, p=0.028). The clinical characteristics between primary and acquired BRAF/EGFR co-mutated patients were similar. The most frequently coexisting oncogenes of primary and acquired BRAF-mutated NSCLC patients were EGFR mutations (30.7% and 93.3%). And the genotype of concomitant EGFR mutation differed. In the acquired BRAF-mutated cohorts, the genotype of EGFR mutations was more complex than primary and contained more dual EGFR mutations (35.7%). For primary BRAF/EGFR co-mutated patients, no matter what kinds of therapies, the EGFR 19del patients had a better prognosis than non-19del patients, and the first line mPFS was NR and 9.0 months (95% CI: 7.7-10.3 months) (p=0.0062), respectively. Dabrafenib and trametinib plus 3<sup>rd</sup> EGFR TKIs improved the prognosis of primary BRAF/EGFR non-19del co-mutated patients, achieving ORR and mPFS of 100% (3/3) and 12 months. For acquired co-mutated patients, the mPFS for 5 patients was 8.6 months (95% CI: 5.4-11.8 months). No new safety concerns and > grade 3 AEs were noted.</div></div><div><h3>Interpretation</h3><div>The most frequently coexisting oncogenes of primary and acquired BRAF-mutated NSCLC patients were EGFR mutations. There were significant differences between the primary BRAF/EGFR co-mutated group and the non-EGFR co-mutated group in gender, smoking history, and histological types. The primary and acquired BRAF/EGFR co-mutated patients showed similar clinical characteristics but different co-mutated EGFR genotypes. Triple-target therapy (dabrafenib, trametinib plus 3<sup>rd</sup> EGFR TKIs) could be considered the preferential regimen for acquired BRAF/EGFR co-mutated and primary BRAF/EGFR non-19del co-mutated NSCLC patients. As for the primary BRAF/EGFR 19del co-mutated patients, the preferred first-line treatments still are EGFR TKIs
{"title":"Clinical and molecular characteristics, therapeutic strategy, and prognosis of non-small cell lung cancer patients harboring primary and acquired BRAF mutations","authors":"Xiangran Feng, Yi Xiang","doi":"10.1016/j.lanwpc.2024.101393","DOIUrl":"10.1016/j.lanwpc.2024.101393","url":null,"abstract":"<div><h3>Background</h3><div>BRAF oncogene is a rare genetic alteration in NSCLC. Acquired BRAF mutations are an emerging resistance mechanism to EGFR TKIs. The differences in clinical and genetic characteristics, therapeutic strategies, and outcomes in NSCLC patients harboring primary and acquired BRAF mutations are still poorly understood.</div></div><div><h3>Methods</h3><div>From Oct 2017 to Dec 2023, 10, 211 lung cancer patients at Shanghai Ruijin Hospital were reviewed. 88 primary BRAF-mutated and 15 acquired BRAF-mutated NSCLC patients resistant to EGFR TKIs were included in the study.</div></div><div><h3>Findings</h3><div>Primary BRAF-mutated patients preferentially occurred in the elderly (median age: 67 versus 61, p=0.015), males (53.4% vs 26.7%, p=0.056), former/current smokers (36.5% vs 6.7%, p=0.033), non-adenocarcinoma (11.4% vs 0%, P=0.351) compared to acquired BRAF-mutated patient. There were significant differences between the primary BRAF/EGFR co-mutated group and the non-EGFR co-mutated group in terms of gender (males: 33.3% vs 62.3%, p=0.012), smoking history (22.2% vs 43.1%, p=0.063), and histological types (adenocarcinomas: 100% vs 83.6%, p=0.028). The clinical characteristics between primary and acquired BRAF/EGFR co-mutated patients were similar. The most frequently coexisting oncogenes of primary and acquired BRAF-mutated NSCLC patients were EGFR mutations (30.7% and 93.3%). And the genotype of concomitant EGFR mutation differed. In the acquired BRAF-mutated cohorts, the genotype of EGFR mutations was more complex than primary and contained more dual EGFR mutations (35.7%). For primary BRAF/EGFR co-mutated patients, no matter what kinds of therapies, the EGFR 19del patients had a better prognosis than non-19del patients, and the first line mPFS was NR and 9.0 months (95% CI: 7.7-10.3 months) (p=0.0062), respectively. Dabrafenib and trametinib plus 3<sup>rd</sup> EGFR TKIs improved the prognosis of primary BRAF/EGFR non-19del co-mutated patients, achieving ORR and mPFS of 100% (3/3) and 12 months. For acquired co-mutated patients, the mPFS for 5 patients was 8.6 months (95% CI: 5.4-11.8 months). No new safety concerns and > grade 3 AEs were noted.</div></div><div><h3>Interpretation</h3><div>The most frequently coexisting oncogenes of primary and acquired BRAF-mutated NSCLC patients were EGFR mutations. There were significant differences between the primary BRAF/EGFR co-mutated group and the non-EGFR co-mutated group in gender, smoking history, and histological types. The primary and acquired BRAF/EGFR co-mutated patients showed similar clinical characteristics but different co-mutated EGFR genotypes. Triple-target therapy (dabrafenib, trametinib plus 3<sup>rd</sup> EGFR TKIs) could be considered the preferential regimen for acquired BRAF/EGFR co-mutated and primary BRAF/EGFR non-19del co-mutated NSCLC patients. As for the primary BRAF/EGFR 19del co-mutated patients, the preferred first-line treatments still are EGFR TKIs","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101393"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427814","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101407
Juan Zhu , Bingjie Jiang , Ruyi Xia , Chen Zhu , Weimiao Wu , Lingbin Du
<div><h3>Background</h3><div>Colorectal cancer (CRC) poses a significant public health challenge worldwide. The burden of CRC has rapidly increased in China. Screening has been proven effective in reducing CRC incidence and mortality. However, China faces challenges with insufficient screening coverage and limited cost-effectiveness evidence for sequential screening strategies. This study aims to evaluate the effectiveness and cost-effectiveness of a large-scale, population-based sequential screening program for CRC, leveraging a pioneering effort to expand screening coverage.</div></div><div><h3>Methods</h3><div>Based on a population-based, provincial-wide CRC program in Zhejiang (PCCSP), this study was conducted from January 2020 to December 2023. Free sequential screening services are offered to residents aged 50-74, using the “Revised Optimized Asia-Pacific Colorectal Screening (APCS) Score” combined with fecal immunochemical testing (FIT)(RF-FIT strategy). Individuals are classified as screening-positive if they are high-risk based on APCS or had positive FIT results, and those screening-positive are referred for colonoscopy. The outcomes included colonoscopy participation rates, costs and yield (detection rate, colonoscopies to detect one lesion, and yield per 10,000 invitees). For economic evaluation, a Markov model was constructed from a healthcare system perspective to assess six screening strategies with different frequencies (once per lifetime, every 10 years, 5 years, 3 years, 2 years, and every year) and initial screening at different ages. A closed cohort of 100,000 participants was assumed to enter the model. Cost-effectiveness was measured by calculating the incremental cost-effectiveness ratio (ICER), with the willingness-to-pay threshold set at 3 times the per capita GDP in Zhejiang (US $52,964). Univariate and probabilistic sensitivity analyses were performed to evaluate the robustness of model findings.</div></div><div><h3>Findings</h3><div>A total of 8,152,854 eligible participants were consecutively enrolled in the PCCSP, with 1,319,217 (16.18%) identified as high-risk and invited for colonoscopy. The coloscopy participation rate was 32.16%. 47,540 AAs and 4572 CRCs were detected. Colonoscopies to detect one advanced adenoma (AA) and CRC were 25 and 286, respectively. Screening yield per 10,000 invitees were 181 AAs and 17 CRCs, respectively. The cost per AA and CRC detected was $1594 and $16,572, respectively. All screening strategies improved effectiveness, adding 1940 to 15,824 quality-adjusted life-years (QALYs) and increasing costs by $252 to $21,561 compared with no screening over a lifetime, leading to ICERs of $112 to $2113 per QALY. More frequent screening was associated with an increase in QALYs and costs; ICERs for higher frequency screening compared with the next-lower frequency screening were between $112 and $3618 per QALY. Annual screening using the RF-FIT strategy would be the most cost-effective strategy at
{"title":"Estimated cost-effectiveness of sequential screening for colorectal cancer: evidence from the largest province-wide colorectal cancer screening program in China","authors":"Juan Zhu , Bingjie Jiang , Ruyi Xia , Chen Zhu , Weimiao Wu , Lingbin Du","doi":"10.1016/j.lanwpc.2024.101407","DOIUrl":"10.1016/j.lanwpc.2024.101407","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) poses a significant public health challenge worldwide. The burden of CRC has rapidly increased in China. Screening has been proven effective in reducing CRC incidence and mortality. However, China faces challenges with insufficient screening coverage and limited cost-effectiveness evidence for sequential screening strategies. This study aims to evaluate the effectiveness and cost-effectiveness of a large-scale, population-based sequential screening program for CRC, leveraging a pioneering effort to expand screening coverage.</div></div><div><h3>Methods</h3><div>Based on a population-based, provincial-wide CRC program in Zhejiang (PCCSP), this study was conducted from January 2020 to December 2023. Free sequential screening services are offered to residents aged 50-74, using the “Revised Optimized Asia-Pacific Colorectal Screening (APCS) Score” combined with fecal immunochemical testing (FIT)(RF-FIT strategy). Individuals are classified as screening-positive if they are high-risk based on APCS or had positive FIT results, and those screening-positive are referred for colonoscopy. The outcomes included colonoscopy participation rates, costs and yield (detection rate, colonoscopies to detect one lesion, and yield per 10,000 invitees). For economic evaluation, a Markov model was constructed from a healthcare system perspective to assess six screening strategies with different frequencies (once per lifetime, every 10 years, 5 years, 3 years, 2 years, and every year) and initial screening at different ages. A closed cohort of 100,000 participants was assumed to enter the model. Cost-effectiveness was measured by calculating the incremental cost-effectiveness ratio (ICER), with the willingness-to-pay threshold set at 3 times the per capita GDP in Zhejiang (US $52,964). Univariate and probabilistic sensitivity analyses were performed to evaluate the robustness of model findings.</div></div><div><h3>Findings</h3><div>A total of 8,152,854 eligible participants were consecutively enrolled in the PCCSP, with 1,319,217 (16.18%) identified as high-risk and invited for colonoscopy. The coloscopy participation rate was 32.16%. 47,540 AAs and 4572 CRCs were detected. Colonoscopies to detect one advanced adenoma (AA) and CRC were 25 and 286, respectively. Screening yield per 10,000 invitees were 181 AAs and 17 CRCs, respectively. The cost per AA and CRC detected was $1594 and $16,572, respectively. All screening strategies improved effectiveness, adding 1940 to 15,824 quality-adjusted life-years (QALYs) and increasing costs by $252 to $21,561 compared with no screening over a lifetime, leading to ICERs of $112 to $2113 per QALY. More frequent screening was associated with an increase in QALYs and costs; ICERs for higher frequency screening compared with the next-lower frequency screening were between $112 and $3618 per QALY. Annual screening using the RF-FIT strategy would be the most cost-effective strategy at ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101407"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429432","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101463
Weiping Jia , Rong Yu , Limin Wang , Dalong Zhu , Lixin Guo , Jianping Weng , Hong Li , Mei Zhang , Xiaoqi Ye , Zhiguang Zhou , Dajin Zou , Qiuhe Ji , Xiaohui Guo , Yinan Zhang , Dong Lang , Jiarui Wu , Jing Wu , Xuhong Hou
<div><h3>Background</h3><div>To date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes.</div></div><div><h3>Methods</h3><div>A nationally community-based cross-sectional survey was conducted in 2018–2020. 58,560 residents diagnosed with diabetes aged 18–74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m<sup>2</sup>). The latter was calculated using the CKD-EPI equation incorporating serum cystatin C and creatinine. CVH was evaluated using the “life's essential 8” (LE8) score, which ranged from 0 to 100 and included 8 components: diet, sleep duration, physical activity, nicotine exposure, hemoglobin A1c, blood pressure, non–high-density lipoprotein cholesterol, and body mass index. The total LE8 scores were categorized into low (0–49), middle (50–79), and high (80–100) according to the American Heart Association. The associations of albuminuria and decreased eGFR with potential associated factors, including CVH, socioeconomic status, clinical characteristics, sub-regional divisions, comorbidities, treatments, and metabolic controls, were evaluated using survey logistic regression.</div></div><div><h3>Findings</h3><div>The weighted prevalence rates (95% CI) of CKD, albuminuria, and decreased eGFR were 32.6% (31.3%–33.8%), 30.8% (29.6%–32.1%), and 5.5% (5.1%–5.9%), respectively. Among those with CKD, 25.7% had diabetic retinopathy (DR) and 22.3% had cardiovascular disease (CVD). The weighted prevalence rates of albuminuria and decreased eGFR were consistently higher among southern residents, rural residents, and individuals with more severe DR and a history of CVD than their counterparts (all p < 0.05). After adjustment for age, sex, sub-regional division, setting, educational level, annual household income, family history of diabetes, diabetes duration, glucose-lowering treatment, any DR, CVD, and drinking status, the logistic models showed that the odds ratios (ORs) (95% CI) for albuminuria and decreased eGFR were 0.46 (0.42–0.51) and 0.61 (0.55–0.67) for the participants with moderate scores, and 0.14 (0.10–0.21) and 0.28 (0.19–0.41) for those with high scores, compared with those with low total LE8 scores. Furthermore, the restricted cubic spline curves depicted that the disparities in the odds of having albuminuria or decreased eGFR among subpopulations grouped by sex, age, setting, and geographical region, significantly decreased and even disappeared in so
{"title":"Prevalence of chronic kidney disease among Chinese adults with diabetes: a nationwide population-based cross-sectional study","authors":"Weiping Jia , Rong Yu , Limin Wang , Dalong Zhu , Lixin Guo , Jianping Weng , Hong Li , Mei Zhang , Xiaoqi Ye , Zhiguang Zhou , Dajin Zou , Qiuhe Ji , Xiaohui Guo , Yinan Zhang , Dong Lang , Jiarui Wu , Jing Wu , Xuhong Hou","doi":"10.1016/j.lanwpc.2024.101463","DOIUrl":"10.1016/j.lanwpc.2024.101463","url":null,"abstract":"<div><h3>Background</h3><div>To date, comprehensive data on the distribution of chronic kidney disease (CKD), the most prevalent comorbidity in diabetes, among Chinese adults with diabetes is lacking. Additionally, research gaps exist in understanding the association between CKD and cardiovascular health (CVH), an integrated indicator of lifestyle and metabolic control, within a nationwide sample of Chinese adults with diabetes.</div></div><div><h3>Methods</h3><div>A nationally community-based cross-sectional survey was conducted in 2018–2020. 58,560 residents diagnosed with diabetes aged 18–74 years nationwide were invited to participate, and 52,000 participants with complete CKD data were included in this study. CKD was identified by the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or decreased estimated glomerular filtration rate (eGFR, <60 mL/min/1.73 m<sup>2</sup>). The latter was calculated using the CKD-EPI equation incorporating serum cystatin C and creatinine. CVH was evaluated using the “life's essential 8” (LE8) score, which ranged from 0 to 100 and included 8 components: diet, sleep duration, physical activity, nicotine exposure, hemoglobin A1c, blood pressure, non–high-density lipoprotein cholesterol, and body mass index. The total LE8 scores were categorized into low (0–49), middle (50–79), and high (80–100) according to the American Heart Association. The associations of albuminuria and decreased eGFR with potential associated factors, including CVH, socioeconomic status, clinical characteristics, sub-regional divisions, comorbidities, treatments, and metabolic controls, were evaluated using survey logistic regression.</div></div><div><h3>Findings</h3><div>The weighted prevalence rates (95% CI) of CKD, albuminuria, and decreased eGFR were 32.6% (31.3%–33.8%), 30.8% (29.6%–32.1%), and 5.5% (5.1%–5.9%), respectively. Among those with CKD, 25.7% had diabetic retinopathy (DR) and 22.3% had cardiovascular disease (CVD). The weighted prevalence rates of albuminuria and decreased eGFR were consistently higher among southern residents, rural residents, and individuals with more severe DR and a history of CVD than their counterparts (all p < 0.05). After adjustment for age, sex, sub-regional division, setting, educational level, annual household income, family history of diabetes, diabetes duration, glucose-lowering treatment, any DR, CVD, and drinking status, the logistic models showed that the odds ratios (ORs) (95% CI) for albuminuria and decreased eGFR were 0.46 (0.42–0.51) and 0.61 (0.55–0.67) for the participants with moderate scores, and 0.14 (0.10–0.21) and 0.28 (0.19–0.41) for those with high scores, compared with those with low total LE8 scores. Furthermore, the restricted cubic spline curves depicted that the disparities in the odds of having albuminuria or decreased eGFR among subpopulations grouped by sex, age, setting, and geographical region, significantly decreased and even disappeared in so","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101463"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067700","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101476
Qi Chwen Ong , Chin-Siang Ang , Nai Ming Lai , Ana Luísa Neves , Josip Car
{"title":"Dearth of digital health education: the need for an accelerated medical curriculum reform in Malaysia","authors":"Qi Chwen Ong , Chin-Siang Ang , Nai Ming Lai , Ana Luísa Neves , Josip Car","doi":"10.1016/j.lanwpc.2025.101476","DOIUrl":"10.1016/j.lanwpc.2025.101476","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101476"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123678","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101467
Jacqueline M. Morris , Jake A. Lacey , Kerrie Stevens , Lamali Sadeesh Kumar , Mathilda Wilmot , Janet Strachan , Marion Easton , Daneeta Hennessy , Tony M. Korman , Andrew J. Daley , Katherine B. Gibney , Adam W.J. Jenney , Steven Y.C. Tong , Benjamin P. Howden , Norelle L. Sherry
Background
Invasive group A Streptococcus (iGAS) cases have increased globally in 2022–2023, raising concerns within the medical and public health communities, including in Australia, while this impact is polyclonal in nature the worldwide spread and dominance of M1UK has been particularly concerning.
Methods
To investigate these changes and prepare to implement routine genomic surveillance of iGAS for public health purposes, we performed whole genome sequencing (WGS) on iGAS isolates from Victoria, Australia between 2017 and 2022. Genomic analyses were conducted to determine the epidemiology, genetic diversity, and population dynamics of iGAS.
Findings
Analysis of 955 confirmed iGAS cases over a 6-year period revealed a polyclonal population. Fewer iGAS cases were noted between 2020 and 2021 in addition to genetic bottlenecks, likely reflecting the implementation of strict public health measures during the COVID pandemic, followed by a resurgence in cases post-COVID. Low levels of antimicrobial resistance were observed, primarily to macrolides and tetracyclines. Phylogenetic analysis identified a previously undescribed emm1 sub-lineage, designated M1Aus, detected in Australia (Victoria and Queensland), Belgium and the United Kingdom. In Victoria, M1Aus was the dominant emm1 variant in 2017 and 2018, more recently replaced by the M1UK lineage as the dominant variant, further demonstrating the worldwide impact of M1UK.
Interpretation
This comprehensive genomic study of iGAS in Victoria, Australia provides valuable insights into the population dynamics, genetic diversity, and impact of pandemic public health measures on iGAS epidemiology. The identification of the M1Aus sub-lineage emphasises the need for continued genomic surveillance and monitoring of iGAS strains, particularly in the context of emerging global sub-lineages and shifts in population structure.
Funding
MDU PHL—Department of Health, Victoria. NHMRC (GNT1196103 to BPH; Partnership Grant GNT1149991).
{"title":"Genomic interrogation of invasive group A Streptococcus (iGAS) epidemiology and COVID-19 impacts in Victoria, Australia: a 6-year retrospective study","authors":"Jacqueline M. Morris , Jake A. Lacey , Kerrie Stevens , Lamali Sadeesh Kumar , Mathilda Wilmot , Janet Strachan , Marion Easton , Daneeta Hennessy , Tony M. Korman , Andrew J. Daley , Katherine B. Gibney , Adam W.J. Jenney , Steven Y.C. Tong , Benjamin P. Howden , Norelle L. Sherry","doi":"10.1016/j.lanwpc.2025.101467","DOIUrl":"10.1016/j.lanwpc.2025.101467","url":null,"abstract":"<div><h3>Background</h3><div>Invasive group A <em>Streptococcus</em> (iGAS) cases have increased globally in 2022–2023, raising concerns within the medical and public health communities, including in Australia, while this impact is polyclonal in nature the worldwide spread and dominance of M1<sub>UK</sub> has been particularly concerning.</div></div><div><h3>Methods</h3><div>To investigate these changes and prepare to implement routine genomic surveillance of iGAS for public health purposes, we performed whole genome sequencing (WGS) on iGAS isolates from Victoria, Australia between 2017 and 2022. Genomic analyses were conducted to determine the epidemiology, genetic diversity, and population dynamics of iGAS.</div></div><div><h3>Findings</h3><div>Analysis of 955 confirmed iGAS cases over a 6-year period revealed a polyclonal population. Fewer iGAS cases were noted between 2020 and 2021 in addition to genetic bottlenecks, likely reflecting the implementation of strict public health measures during the COVID pandemic, followed by a resurgence in cases post-COVID. Low levels of antimicrobial resistance were observed, primarily to macrolides and tetracyclines. Phylogenetic analysis identified a previously undescribed <em>emm1</em> sub-lineage, designated M1<sub>Aus,</sub> detected in Australia (Victoria and Queensland), Belgium and the United Kingdom. In Victoria, M1<sub>Aus</sub> was the dominant <em>emm1</em> variant in 2017 and 2018, more recently replaced by the M1<sub>UK</sub> lineage as the dominant variant, further demonstrating the worldwide impact of M1<sub>UK</sub>.</div></div><div><h3>Interpretation</h3><div>This comprehensive genomic study of iGAS in Victoria, Australia provides valuable insights into the population dynamics, genetic diversity, and impact of pandemic public health measures on iGAS epidemiology. The identification of the M1<sub>Aus</sub> sub-lineage emphasises the need for continued genomic surveillance and monitoring of iGAS strains, particularly in the context of emerging global sub-lineages and shifts in population structure.</div></div><div><h3>Funding</h3><div>MDU PHL—<span>Department of Health, Victoria</span>. <span>NHMRC</span> (GNT1196103 to BPH; Partnership Grant GNT1149991).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101467"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178036","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101474
Yesol Yim , Jae E. Lee , Yejun Son , Soeun Kim , Hojae Lee , Sooji Lee , Wonwoo Jang , Hanseul Cho , Hayeon Lee , Kyeongmin Lee , Hyesu Jo , Jaeyu Park , Jiyeon Oh , Louis Jacob , Jiseung Kang , Hyunji Sang , Sang Youl Rhee , Dong Keon Yon
Background
The American Heart Association recently introduced a new framework, known as cardiovascular-kidney-metabolic (CKM) syndrome, aimed at the early prevention of cardiovascular disease. However, this syndrome has not been studied extensively outside of the United States. Thus, this study aimed to examine the long-term trends in CKM syndrome and its associated demographic features in South Korea.
Methods
This nationwide, cross-sectional study analyzed data from 61,106 Korean adults aged ≥20 years using the Korea National Health and Nutrition Examination Survey from 2011 to 2021. CKM syndrome was defined using the PREVENT equations, categorizing individuals into five stages (0–4). Age-standardized prevalence rates, annual percent changes (APC), and sociodemographic disparities were analyzed using multinomial logistic regression and Joinpoint regression.
Findings
Among the 61,106 participants (50.4% females [95% CI, 50.0–50.8%] and 49.6% males [95% CI, 49.2–50.0%]), stage 2 CKM syndrome was the most prevalent (43.4% [42.9–43.9]), followed by stages 1 (25.4% [25.0–25.8]), 0 (21.1% [20.7–21.6]), 3 (7.3% [7.0–7.5]), and 4 (2.8% [2.6–2.9]). From 2011 to 2021, advanced stages showed significant increases (APC for stage 4: 3.2%; 95% CI, 1.5–5.2), while stage 0 declined (APC: −1.9%; 95% CI, −3.8 to 0.0). Advanced stages were more common among vulnerable subgroups, including males, older adults, rural residents, smokers, drinkers, individuals with obesity, lower education levels, and lower household incomes.
Interpretation
This is the first study to investigate the long-term prevalence of CKM syndrome based on stages at the national level in an Asian population. Our findings emphasize the urgent need for tailored public health strategies targeting metabolic risk factors, particularly in vulnerable subgroups, to prevent progression to advanced CKM stages.
Funding
National Research Foundation of Korea.
{"title":"Long-term trends in the prevalence of cardiovascular-kidney-metabolic syndrome in South Korea, 2011–2021: a representative longitudinal serial study","authors":"Yesol Yim , Jae E. Lee , Yejun Son , Soeun Kim , Hojae Lee , Sooji Lee , Wonwoo Jang , Hanseul Cho , Hayeon Lee , Kyeongmin Lee , Hyesu Jo , Jaeyu Park , Jiyeon Oh , Louis Jacob , Jiseung Kang , Hyunji Sang , Sang Youl Rhee , Dong Keon Yon","doi":"10.1016/j.lanwpc.2025.101474","DOIUrl":"10.1016/j.lanwpc.2025.101474","url":null,"abstract":"<div><h3>Background</h3><div>The American Heart Association recently introduced a new framework, known as cardiovascular-kidney-metabolic (CKM) syndrome, aimed at the early prevention of cardiovascular disease. However, this syndrome has not been studied extensively outside of the United States. Thus, this study aimed to examine the long-term trends in CKM syndrome and its associated demographic features in South Korea.</div></div><div><h3>Methods</h3><div>This nationwide, cross-sectional study analyzed data from 61,106 Korean adults aged ≥20 years using the Korea National Health and Nutrition Examination Survey from 2011 to 2021. CKM syndrome was defined using the PREVENT equations, categorizing individuals into five stages (0–4). Age-standardized prevalence rates, annual percent changes (APC), and sociodemographic disparities were analyzed using multinomial logistic regression and Joinpoint regression.</div></div><div><h3>Findings</h3><div>Among the 61,106 participants (50.4% females [95% CI, 50.0–50.8%] and 49.6% males [95% CI, 49.2–50.0%]), stage 2 CKM syndrome was the most prevalent (43.4% [42.9–43.9]), followed by stages 1 (25.4% [25.0–25.8]), 0 (21.1% [20.7–21.6]), 3 (7.3% [7.0–7.5]), and 4 (2.8% [2.6–2.9]). From 2011 to 2021, advanced stages showed significant increases (APC for stage 4: 3.2%; 95% CI, 1.5–5.2), while stage 0 declined (APC: −1.9%; 95% CI, −3.8 to 0.0). Advanced stages were more common among vulnerable subgroups, including males, older adults, rural residents, smokers, drinkers, individuals with obesity, lower education levels, and lower household incomes.</div></div><div><h3>Interpretation</h3><div>This is the first study to investigate the long-term prevalence of CKM syndrome based on stages at the national level in an Asian population. Our findings emphasize the urgent need for tailored public health strategies targeting metabolic risk factors, particularly in vulnerable subgroups, to prevent progression to advanced CKM stages.</div></div><div><h3>Funding</h3><div><span>National Research Foundation of Korea</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101474"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179036","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101468
Qi Huang , Limei Ke , Linfeng Liu , Yuyang Liu , Yanjun Li , Guoqing Feng , Bo Yin , Wenxin Xiang , Jiarun Li , Keyi Lyu , Miao Wang , Qiannan Tian , Liqun Wu , Xiaofeng He , Wannian Liang , Huatang Zeng , Jiming Zhu , Kuiying Gu , Qian Di
Background
Global warming is intensifying, exacerbating associated health issues. Heat-related illness, a critical risk during heatwaves, significantly impacts public health, yet its long-term health effects remain poorly understood. We established a cohort to investigate these health impact and explore the mitigative role of heatwave warnings.
Methods
Our cohort study enrolled 9,658,745 participants free of cardiovascular disease (CVD) at baseline from 1332 hospitals and 922 primary care centres in Shenzhen, China. The cohort was observed and followed up from January 1, 2017, to July 31, 2023. We utilized Cox proportional hazards model to analyse CVD incidence among participants who had heat-related illness versus those who did not, and further assessed causal relationship using instrumental variable approach. We employed stratified logistic regression to explore the protective effects of heatwave warning policies.
Findings
Among 9,658,745 participants followed up to 6 years, 238,278 (2.47%) developed CVD. People who developed CVD were generally older, male, with a higher degree of education, and with more hospital admissions before baseline. Heat-related illness was associated with CVD, with a hazard ratio of CVD 2.526 (95% CI = 2.301–2.773) among patients with heat-related illness compared with those without heat-related illness, and instrumental variable approach analysis suggested causation. Issuing heatwave warnings reduced hospital admissions for heat-related illness (OR [95% CI] = 0.902 [0.832–0.977]) and future CVD risk (OR [95% CI] = 0.964 [0.946–0.982]). The mitigative role of heatwave warnings suggested delayed effect, with mitigative effect at greatest magnitude one to two days after issuance for heat-related illness admission and three to four days for CVD.
Interpretation
Our study suggested that heat-related illness has significant long-term impacts on future CVD incidence, which can be mitigated by heatwave warnings.
Funding
This study was supported by the National Natural Science Foundation of China (No. 42277419), the Sanming Project of Medicine in Shenzhen (No. SZSM202111001), and the Research Fund of Vanke School of Public Health in Tsinghua University.
{"title":"Heatwave warnings mitigate long-term cardiovascular diseases risk from heat-related illness: a real-world prospective cohort study","authors":"Qi Huang , Limei Ke , Linfeng Liu , Yuyang Liu , Yanjun Li , Guoqing Feng , Bo Yin , Wenxin Xiang , Jiarun Li , Keyi Lyu , Miao Wang , Qiannan Tian , Liqun Wu , Xiaofeng He , Wannian Liang , Huatang Zeng , Jiming Zhu , Kuiying Gu , Qian Di","doi":"10.1016/j.lanwpc.2025.101468","DOIUrl":"10.1016/j.lanwpc.2025.101468","url":null,"abstract":"<div><h3>Background</h3><div>Global warming is intensifying, exacerbating associated health issues. Heat-related illness, a critical risk during heatwaves, significantly impacts public health, yet its long-term health effects remain poorly understood. We established a cohort to investigate these health impact and explore the mitigative role of heatwave warnings.</div></div><div><h3>Methods</h3><div>Our cohort study enrolled 9,658,745 participants free of cardiovascular disease (CVD) at baseline from 1332 hospitals and 922 primary care centres in Shenzhen, China. The cohort was observed and followed up from January 1, 2017, to July 31, 2023. We utilized Cox proportional hazards model to analyse CVD incidence among participants who had heat-related illness versus those who did not, and further assessed causal relationship using instrumental variable approach. We employed stratified logistic regression to explore the protective effects of heatwave warning policies.</div></div><div><h3>Findings</h3><div>Among 9,658,745 participants followed up to 6 years, 238,278 (2.47%) developed CVD. People who developed CVD were generally older, male, with a higher degree of education, and with more hospital admissions before baseline. Heat-related illness was associated with CVD, with a hazard ratio of CVD 2.526 (95% CI = 2.301–2.773) among patients with heat-related illness compared with those without heat-related illness, and instrumental variable approach analysis suggested causation. Issuing heatwave warnings reduced hospital admissions for heat-related illness (OR [95% CI] = 0.902 [0.832–0.977]) and future CVD risk (OR [95% CI] = 0.964 [0.946–0.982]). The mitigative role of heatwave warnings suggested delayed effect, with mitigative effect at greatest magnitude one to two days after issuance for heat-related illness admission and three to four days for CVD.</div></div><div><h3>Interpretation</h3><div>Our study suggested that heat-related illness has significant long-term impacts on future CVD incidence, which can be mitigated by heatwave warnings.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>National Natural Science Foundation of China</span> (No. <span><span>42277419</span></span>), the <span>Sanming Project of Medicine in Shenzhen</span> (No. <span><span>SZSM202111001</span></span>), and the <span>Research Fund of Vanke School of Public Health in Tsinghua University</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101468"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179038","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101477
Ken Wah Teo , Lian Leng Low , Wee Hoe Gan , Luke Sher Guan Low , Chien Earn Lee
Population health encompasses health outcomes, their determinants, and the distribution within the group of individuals. A life course approach, involving residents regardless of health status and disease complexity, and addressing their needs holistically and contextually is a key policy for improving population health. Healthier SG represents Singapore’s transformation towards population health. Under this initiative, Singapore’s three healthcare clusters have been tasked with new roles as population health managers and regional health managers, on top of being healthcare service providers. We propose that beyond intermediate and post-acute care, community hospitals, as service providers, have an opportunity to (a) innovate new models of integrated and appropriate care, (b) adopt life-course approaches which include prevention and end-of-life care extended to community settings, (c) strengthen person-centred and holistic care approaches through social prescribing, (d) lead capability building and sector development for person-centred care, and (e) galvanize the health-social care ecosystem.
{"title":"Expanding the role of community hospitals to promote population health in Singapore","authors":"Ken Wah Teo , Lian Leng Low , Wee Hoe Gan , Luke Sher Guan Low , Chien Earn Lee","doi":"10.1016/j.lanwpc.2025.101477","DOIUrl":"10.1016/j.lanwpc.2025.101477","url":null,"abstract":"<div><div>Population health encompasses health outcomes, their determinants, and the distribution within the group of individuals. A life course approach, involving residents regardless of health status and disease complexity, and addressing their needs holistically and contextually is a key policy for improving population health. Healthier SG represents Singapore’s transformation towards population health. Under this initiative, Singapore’s three healthcare clusters have been tasked with new roles as population health managers and regional health managers, on top of being healthcare service providers. We propose that beyond intermediate and post-acute care, community hospitals, as service providers, have an opportunity to (a) innovate new models of integrated and appropriate care, (b) adopt life-course approaches which include prevention and end-of-life care extended to community settings, (c) strengthen person-centred and holistic care approaches through social prescribing, (d) lead capability building and sector development for person-centred care, and (e) galvanize the health-social care ecosystem.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101477"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178057","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101358
Yunhuan Li , Xiaolin Hu
Background
Chinese lung cancer patients experience various cancer-related symptoms during the course of disease, which usually occur as symptom clusters, leading to heavy symptom burden and low quality of life. Identifying symptom cluster and core symptom is conducive to developing symptom management interventions so as to improve health-related outcomes of patients with lung cancer. To investigate the symptom clusters and core symptom of Chinese patients with lung cancer.
Methods
Approved by the ethics committee, a cross-sectional study was conducted at one of the most influential general hospitals in Southwest China. The MD Anderson Symptom Inventory and the revised lung cancer-specific module were utilized to collect symptom experience of patients with lung cancer. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and network analysis.
Findings
A total of 219 lung cancer patients were recruited. Four symptom clusters were identified as psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters, which could explain 59% of the total variance. The results of the symptom severity network analysis revealed that short of breath (rc= 1.35) was the symptom with the highest closeness score among all symptoms. In the symptom clusters network, short of breath (rc= 1.35), lack of appetite (rc= 1.27), fatigue (rc= 1.04) and feeling drowsy (rc= 0.82) were the symptoms with the closeness score in the four symptom clusters, respectively.
Interpretation
Chinese lung cancer patients experienced four symptom clusters among lung cancer patients, which highlighted the significance of addressing general symptoms and cancer-specific symptoms in cancer symptom cluster management. The identification of core symptoms offered health care professionals potential interventional targets in future clinical practice in symptom management among patients with lung cancer. Tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients’ outcomes.
{"title":"Symptom clusters and core symptoms of Chinese patients with lung cancer: a cross-sectional study","authors":"Yunhuan Li , Xiaolin Hu","doi":"10.1016/j.lanwpc.2024.101358","DOIUrl":"10.1016/j.lanwpc.2024.101358","url":null,"abstract":"<div><h3>Background</h3><div>Chinese lung cancer patients experience various cancer-related symptoms during the course of disease, which usually occur as symptom clusters, leading to heavy symptom burden and low quality of life. Identifying symptom cluster and core symptom is conducive to developing symptom management interventions so as to improve health-related outcomes of patients with lung cancer. To investigate the symptom clusters and core symptom of Chinese patients with lung cancer.</div></div><div><h3>Methods</h3><div>Approved by the ethics committee, a cross-sectional study was conducted at one of the most influential general hospitals in Southwest China. The MD Anderson Symptom Inventory and the revised lung cancer-specific module were utilized to collect symptom experience of patients with lung cancer. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and network analysis.</div></div><div><h3>Findings</h3><div>A total of 219 lung cancer patients were recruited. Four symptom clusters were identified as psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters, which could explain 59% of the total variance. The results of the symptom severity network analysis revealed that short of breath (r<sub>c</sub>= 1.35) was the symptom with the highest closeness score among all symptoms. In the symptom clusters network, short of breath (r<sub>c</sub>= 1.35), lack of appetite (r<sub>c</sub>= 1.27), fatigue (r<sub>c</sub>= 1.04) and feeling drowsy (r<sub>c</sub>= 0.82) were the symptoms with the closeness score in the four symptom clusters, respectively.</div></div><div><h3>Interpretation</h3><div>Chinese lung cancer patients experienced four symptom clusters among lung cancer patients, which highlighted the significance of addressing general symptoms and cancer-specific symptoms in cancer symptom cluster management. The identification of core symptoms offered health care professionals potential interventional targets in future clinical practice in symptom management among patients with lung cancer. Tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients’ outcomes.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101358"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427547","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 : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101290
Yulin Shi , Yuan Cao , Xiurong Liu , Xiao Zhang , Xia Wan
<div><h3>Background</h3><div>In China, strict COVID-19 mitigation measures brought substantial public health benefits, but ending the zero-COVID policy in December 2022 resulted in a surge in other COVID-19-related incidence and hospitalizations. The actual impact of this policy shift on chronic obstructive pulmonary disease (COPD) hospitalizations has not been empirically estimated. We aim to quantify the effects of implementing and ending COVID-19 related non-pharmaceutical interventions (NPIs) on COPD hospitalization rate.</div></div><div><h3>Method</h3><div>This cohort study analyzed data on hospital in-patient admissions from all the secondary and tertiary hospitals in Beijing during 2015 to 2023. The study period was divided into three phases: pre-pandemic period (January 1, 2015, to January 31, 2020), zero COVID policy period (February 1, 2020 to December 31, 2022), and ending zero COVID policy period (January 1, 2023 to December 31, 2023). We performed an interrupted time series analysis using negative binomial regression to estimate the immediate and gradual changes in the weekly admissions for COPD patients attributable to the implementation and ending of the Zero COVID Policy. Excess risk (ER) estimates representing the overall changes in the relative risks of COPD hospitalizations associated with the implementation and ending of the Zero COVID Policy were derived.</div></div><div><h3>Findings</h3><div>We extracted data for 229,525 cases of COPD in Beijing, China. A stable and unchanged secular trend in COPD hospitalization rates was observed before the COVD-19 outbreak. After the COVID-19 outbreak, we noted significant immediate decreases COPD hospitalizations (RR=0.50, 95% CI: 0.46 to 0.54; p<0.001). Hospitalizations gradually rebounded over time since April 2020 when many government-imposed mobility restrictions were lifted. Though an 8% (RR=1.08, 95% CI: 1.04 to 1.12; p<0.001) gradual increase in COPD hospitalization rates per year was detected, it had not achieved their pre-pandemic forecasted levels before ending the zero COVID policy. An overall reduction of 38% (ER=0.62, 95%CI: 0.55 to 0.69; p<0.001) in COPD hospitalization rates was observed during the zero COVID policy period. After ending the zero COVID policy, the immediate change in COPD hospitalizations was not statistically significant (RR=0.90, 95% CI: 0.79 to 1.01; p=0.0785). An 33% (RR=1.33, 95% CI: 1.18 to 1.59; p=0.001) gradual increase per year was observed, which resulted in an overall increase of 19% (ER=1.19, 95%CI: 1.18 to 1.21; p<0.001) within 12 months of follow-up.</div></div><div><h3>Interpretation</h3><div>Our study provided evidence for the effectiveness of COVID-19 related NPIs on the significant reductions in COPD hospitalization rates. Importantly, COPD hospitalizations quickly rebounded after ending the zero COVID policy, warranting targeted approaches to address potentially increased the burden of COPD in China due to the cancellation of
{"title":"Trends in hospital admissions for chronic obstructive pulmonary diseases during COVID-19 in Beijing: a population-based cohort study","authors":"Yulin Shi , Yuan Cao , Xiurong Liu , Xiao Zhang , Xia Wan","doi":"10.1016/j.lanwpc.2024.101290","DOIUrl":"10.1016/j.lanwpc.2024.101290","url":null,"abstract":"<div><h3>Background</h3><div>In China, strict COVID-19 mitigation measures brought substantial public health benefits, but ending the zero-COVID policy in December 2022 resulted in a surge in other COVID-19-related incidence and hospitalizations. The actual impact of this policy shift on chronic obstructive pulmonary disease (COPD) hospitalizations has not been empirically estimated. We aim to quantify the effects of implementing and ending COVID-19 related non-pharmaceutical interventions (NPIs) on COPD hospitalization rate.</div></div><div><h3>Method</h3><div>This cohort study analyzed data on hospital in-patient admissions from all the secondary and tertiary hospitals in Beijing during 2015 to 2023. The study period was divided into three phases: pre-pandemic period (January 1, 2015, to January 31, 2020), zero COVID policy period (February 1, 2020 to December 31, 2022), and ending zero COVID policy period (January 1, 2023 to December 31, 2023). We performed an interrupted time series analysis using negative binomial regression to estimate the immediate and gradual changes in the weekly admissions for COPD patients attributable to the implementation and ending of the Zero COVID Policy. Excess risk (ER) estimates representing the overall changes in the relative risks of COPD hospitalizations associated with the implementation and ending of the Zero COVID Policy were derived.</div></div><div><h3>Findings</h3><div>We extracted data for 229,525 cases of COPD in Beijing, China. A stable and unchanged secular trend in COPD hospitalization rates was observed before the COVD-19 outbreak. After the COVID-19 outbreak, we noted significant immediate decreases COPD hospitalizations (RR=0.50, 95% CI: 0.46 to 0.54; p<0.001). Hospitalizations gradually rebounded over time since April 2020 when many government-imposed mobility restrictions were lifted. Though an 8% (RR=1.08, 95% CI: 1.04 to 1.12; p<0.001) gradual increase in COPD hospitalization rates per year was detected, it had not achieved their pre-pandemic forecasted levels before ending the zero COVID policy. An overall reduction of 38% (ER=0.62, 95%CI: 0.55 to 0.69; p<0.001) in COPD hospitalization rates was observed during the zero COVID policy period. After ending the zero COVID policy, the immediate change in COPD hospitalizations was not statistically significant (RR=0.90, 95% CI: 0.79 to 1.01; p=0.0785). An 33% (RR=1.33, 95% CI: 1.18 to 1.59; p=0.001) gradual increase per year was observed, which resulted in an overall increase of 19% (ER=1.19, 95%CI: 1.18 to 1.21; p<0.001) within 12 months of follow-up.</div></div><div><h3>Interpretation</h3><div>Our study provided evidence for the effectiveness of COVID-19 related NPIs on the significant reductions in COPD hospitalization rates. Importantly, COPD hospitalizations quickly rebounded after ending the zero COVID policy, warranting targeted approaches to address potentially increased the burden of COPD in China due to the cancellation of ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101290"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427661","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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