Pub Date : 2026-01-29DOI: 10.1016/j.lana.2026.101376
Benedikt Fischer , Wayne Hall , Bernard Le Foll , Patricia Conrod
{"title":"‘Strategic approaches to reducing the substance use-related burden of disease in Canada’ — authors' reply","authors":"Benedikt Fischer , Wayne Hall , Bernard Le Foll , Patricia Conrod","doi":"10.1016/j.lana.2026.101376","DOIUrl":"10.1016/j.lana.2026.101376","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101376"},"PeriodicalIF":7.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.lana.2026.101382
Laura Nicolaou , Carolyn J. Reuland , Mingling Yang , Kendra N. Williams , Stella M. Hartinger , Marilú Chiang , William Checkley
Background
Household air pollution (HAP) is a major global health risk. Observational studies link HAP exposure to impaired child growth, but randomized controlled trial (RCT) evidence is inconsistent.
Methods
We followed children born during an RCT of an 18-month liquefied petroleum gas (LPG) intervention among 800 pregnant women in Puno, Peru. We measured personal exposures to fine particulate matter (PM2.5) and carbon monoxide (CO) three times during pregnancy and three times during infancy. We measured length quarterly between birth and 12 months and height once between age 2–4 years. We assessed the effect of the LPG intervention on growth trajectories and evaluated exposure-response associations between height-for-age z-score (HAZ) and PM2.5 or CO exposures.
Findings
We revisited 683 children (mean age 34.0 ± 6.6 months, 49.3% male, 52.3% intervention). Mean HAZ at age 2–4 years was −0.92 ± 0.83 SDs in intervention children and −1.00 ± 0.80 SDs in controls (p = 0.33). In intention-to-treat analysis, the HAZ difference between groups was 0.08 SDs (95% CI −0.04 to 0.21) favoring the intervention. Neither prenatal nor postnatal PM2.5 or CO exposures were associated with HAZ. A 10 μg/m3 difference in prenatal and postnatal PM2.5 corresponded to a HAZ difference of −0.003 SDs (−0.011 to 0.005) and −0.001 SDs (−0.005 to 0.007), respectively. A 1 ppm difference in prenatal or postnatal CO corresponded to −0.009 SDs (−0.025 to 0.008) and 0.000 (−0.011 to 0.012), respectively.
Interpretation
Children of mothers randomized to LPG were not taller than controls. Personal PM2.5 or CO exposures did not influence child growth.
Funding
US National Institutes of Health; Bill & Melinda Gates Foundation.
{"title":"Long-term effects of cooking with liquefied petroleum gas or biomass on linear growth trajectories from birth to the pre-school years in Puno, Peru: a prospective cohort study","authors":"Laura Nicolaou , Carolyn J. Reuland , Mingling Yang , Kendra N. Williams , Stella M. Hartinger , Marilú Chiang , William Checkley","doi":"10.1016/j.lana.2026.101382","DOIUrl":"10.1016/j.lana.2026.101382","url":null,"abstract":"<div><h3>Background</h3><div>Household air pollution (HAP) is a major global health risk. Observational studies link HAP exposure to impaired child growth, but randomized controlled trial (RCT) evidence is inconsistent.</div></div><div><h3>Methods</h3><div>We followed children born during an RCT of an 18-month liquefied petroleum gas (LPG) intervention among 800 pregnant women in Puno, Peru. We measured personal exposures to fine particulate matter (PM<sub>2.5</sub>) and carbon monoxide (CO) three times during pregnancy and three times during infancy. We measured length quarterly between birth and 12 months and height once between age 2–4 years. We assessed the effect of the LPG intervention on growth trajectories and evaluated exposure-response associations between height-for-age z-score (HAZ) and PM<sub>2.5</sub> or CO exposures.</div></div><div><h3>Findings</h3><div>We revisited 683 children (mean age 34.0 ± 6.6 months, 49.3% male, 52.3% intervention). Mean HAZ at age 2–4 years was −0.92 ± 0.83 SDs in intervention children and −1.00 ± 0.80 SDs in controls (p = 0.33). In intention-to-treat analysis, the HAZ difference between groups was 0.08 SDs (95% CI −0.04 to 0.21) favoring the intervention. Neither prenatal nor postnatal PM<sub>2.5</sub> or CO exposures were associated with HAZ. A 10 μg/m<sup>3</sup> difference in prenatal and postnatal PM<sub>2.5</sub> corresponded to a HAZ difference of −0.003 SDs (−0.011 to 0.005) and −0.001 SDs (−0.005 to 0.007), respectively. A 1 ppm difference in prenatal or postnatal CO corresponded to −0.009 SDs (−0.025 to 0.008) and 0.000 (−0.011 to 0.012), respectively.</div></div><div><h3>Interpretation</h3><div>Children of mothers randomized to LPG were not taller than controls. Personal PM<sub>2.5</sub> or CO exposures did not influence child growth.</div></div><div><h3>Funding</h3><div><span>US National Institutes of Health</span>; <span>Bill & Melinda Gates Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101382"},"PeriodicalIF":7.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-28DOI: 10.1016/j.lana.2025.101371
Lucas Almeida Andrade , Maria Amélia dos Santos Lemos Gurgel , Wandklebson Silva da Paz , Glauber Rocha Monteiro , Karina Conceição Gomes de Araújo , Allan Dantas dos Santos , Carlos Dornels Freire de Souza , Álvaro Francisco Lopes de Sousa , Lariane Angel Cepas , Ana Paula Morais Fernandes , Débora dos Santos Tavares , Tatiana Rodrigues de Moura , Márcio Bezerra-Santos
Background
The COVID-19 pandemic has disrupted healthcare services and intensified socio-economic vulnerabilities, potentially escalating harmful substance use. In Brazil, pre-pandemic mortality from alcohol and drug use was stable. However, the pandemic introduced new risks that may have triggered a significant increase in related deaths. This study, therefore, aims to assess the impact of the COVID-19 pandemic on alcohol- and drug-related deaths in Brazil from 2020 to 2022.
Methods
This population-based ecological study analyzed alcohol- and drug-related mortality across Brazil from 2015 to 2022 using data from the Brazilian Mortality Information System (SIM). Temporal trends were examined using Joinpoint regression, while interrupted time-series analyses assessed deviations post-pandemic onset. Spatial variations were visualized using choropleth maps.
Findings
Alcohol- and drug-related mortality increased by 18.3% in 2020, 22.4% in 2021, and 26.0% in 2022. The Northeast (2020 = 24.9%; 2021 = 24.0%; 2022 = 31.8%), Southeast (2020 = 18.2%; 2021 = 24.3%; 2022 = 21.0%), and South (2020 = 13.1%; 2021 = 23.6%; 2022 = 35.2%) regions recorded the highest increases, with most states showing significant growth in deaths. We also observed an increase in mortality associated with the use of Psychoactive substances (PAS) in both sexes (male: average annual percentage changes (AAPCs) = 3.6%; female: AAPC = 4.6%), individuals aged 20 to 39 (AAPC = 2.0%), and those aged 60 and above (AAPC = 1.8%). Interrupted time-series analyses confirmed a marked and statistically significant increase in mortality post-March 2020.
Interpretation
The findings suggest a collateral epidemic of substance-related deaths fueled by the COVID-19 pandemic's disruptions to harm reduction services, treatment access, and socio-economic stability. These results underscore the urgent need to enhance healthcare systems, reinforce harm reduction services, and develop intersectoral policies targeting social inequalities to mitigate future crises.
Funding
This research is part of the PEGA@ACAO study and was funded by the São Paulo Research Foundation (FAPESP, grant #2024/15320-5 and #2025/04763-6); the National Council for Scientific and Technological Development (CNPq, grant #405741/2024-3); and the Coordination for the Improvement of Higher Education Personnel (CAPES, finance code #001).
{"title":"Alcohol- and drug-related mortality in Brazil: an ecological and population-based study on changes observed during the COVID-19 pandemic","authors":"Lucas Almeida Andrade , Maria Amélia dos Santos Lemos Gurgel , Wandklebson Silva da Paz , Glauber Rocha Monteiro , Karina Conceição Gomes de Araújo , Allan Dantas dos Santos , Carlos Dornels Freire de Souza , Álvaro Francisco Lopes de Sousa , Lariane Angel Cepas , Ana Paula Morais Fernandes , Débora dos Santos Tavares , Tatiana Rodrigues de Moura , Márcio Bezerra-Santos","doi":"10.1016/j.lana.2025.101371","DOIUrl":"10.1016/j.lana.2025.101371","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has disrupted healthcare services and intensified socio-economic vulnerabilities, potentially escalating harmful substance use. In Brazil, pre-pandemic mortality from alcohol and drug use was stable. However, the pandemic introduced new risks that may have triggered a significant increase in related deaths. This study, therefore, aims to assess the impact of the COVID-19 pandemic on alcohol- and drug-related deaths in Brazil from 2020 to 2022.</div></div><div><h3>Methods</h3><div>This population-based ecological study analyzed alcohol- and drug-related mortality across Brazil from 2015 to 2022 using data from the Brazilian Mortality Information System (SIM). Temporal trends were examined using Joinpoint regression, while interrupted time-series analyses assessed deviations post-pandemic onset. Spatial variations were visualized using choropleth maps.</div></div><div><h3>Findings</h3><div>Alcohol- and drug-related mortality increased by 18.3% in 2020, 22.4% in 2021, and 26.0% in 2022. The Northeast (2020 = 24.9%; 2021 = 24.0%; 2022 = 31.8%), Southeast (2020 = 18.2%; 2021 = 24.3%; 2022 = 21.0%), and South (2020 = 13.1%; 2021 = 23.6%; 2022 = 35.2%) regions recorded the highest increases, with most states showing significant growth in deaths. We also observed an increase in mortality associated with the use of Psychoactive substances (PAS) in both sexes (male: average annual percentage changes (AAPCs) = 3.6%; female: AAPC = 4.6%), individuals aged 20 to 39 (AAPC = 2.0%), and those aged 60 and above (AAPC = 1.8%). Interrupted time-series analyses confirmed a marked and statistically significant increase in mortality post-March 2020.</div></div><div><h3>Interpretation</h3><div>The findings suggest a collateral epidemic of substance-related deaths fueled by the COVID-19 pandemic's disruptions to harm reduction services, treatment access, and socio-economic stability. These results underscore the urgent need to enhance healthcare systems, reinforce harm reduction services, and develop intersectoral policies targeting social inequalities to mitigate future crises.</div></div><div><h3>Funding</h3><div>This research is part of the PEGA@ACAO study and was funded by the São Paulo Research Foundation (FAPESP, grant #2024/15320-5 and #2025/04763-6); the National Council for Scientific and Technological Development (CNPq, grant #405741/2024-3); and the Coordination for the Improvement of Higher Education Personnel (CAPES, finance code #001).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101371"},"PeriodicalIF":7.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1016/j.lana.2026.101373
Samantha Rundle , Maryam Iraniparast , David Hammond
Background
The bidirectional relationship between cannabis use and mental health is complex. With the liberalization of cannabis laws in many countries, it is increasingly important to understand the impacts of cannabis legalization on individuals with mental health conditions. This study aimed to examine changes in cannabis use by mental health status pre-versus 5-years post-legalization of recreational cannabis in Canada.
Methods
Data were from the International Cannabis Policy Study's national repeat cross-sectional surveys, conducted annually in Canada between 2018 and 2023, one year before and five years after the legalization of cannabis. The current analysis includes 92,843 Canadians aged 16–65 years. Adjusted logistic regression models examined changes in daily and past 12-month cannabis use pre-versus post-legalization among individuals experiencing each of the five mental health problems in the last year: anxiety, bipolar, depression, post-traumatic stress disorder (PTSD), and schizophrenia.
Findings
Past 12-month cannabis consumption increased from pre-legalization versus the year immediately following legalization (2019) among those with anxiety (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.15, 1.53, p < 0.0001), depression (AOR = 1.47, 95% CI = 1.26, 1.73, p < 0.0001), and those reporting ‘no experience’ of a mental health problem in the past year (AOR = 1.52, 95% CI = 1.37, 1.68, p < 0.0001). Past 12-month cannabis use remained significantly higher in 2023 versus pre-legalization for anxiety and depression. Daily cannabis use increased from 2018 to 2019 only among those not reporting any experience of a mental health problem in the past year (AOR = 1.34, 95% CI = 1.10, 1.62, p < 0.0001). No other pre-post legalization differences were observed among individuals who experienced bipolar, PTSD, or schizophrenia.
Interpretation
Few changes in cannabis use were observed pre-versus post-cannabis legalization among Canadians who reported experiencing a mental health problem, whereas daily and past 12-month use increased among Canadians not reporting a mental health problem.
Funding
Funding for the ICPS study was provided by a Canadian Institutes of Health Research Project Grant and Project Bridge Grant (PJT-153342).
大麻使用与心理健康之间的双向关系是复杂的。随着许多国家大麻法律的放宽，了解大麻合法化对有精神健康问题的个人的影响变得越来越重要。本研究旨在研究加拿大娱乐性大麻合法化前与5年后大麻使用心理健康状况的变化。方法数据来自国际大麻政策研究的全国重复横断面调查，该调查于2018年至2023年在加拿大进行，分别是大麻合法化的前一年和后五年。目前的分析包括92,843名年龄在16-65岁之间的加拿大人。调整后的逻辑回归模型检查了去年经历五种精神健康问题（焦虑、双相情感障碍、抑郁、创伤后应激障碍和精神分裂症）的个体在大麻合法化前和合法化后每天和过去12个月大麻使用情况的变化。研究发现，与合法化后的一年（2019年）相比，过去12个月的大麻消费量在焦虑（调整优势比(AOR) = 1.33, 95% CI = 1.15, 1.53, p < 0.0001）、抑郁（AOR = 1.47, 95% CI = 1.26, 1.73, p < 0.0001）和报告在过去一年中“没有经历”精神健康问题的人（AOR = 1.52, 95% CI = 1.37, 1.68, p < 0.0001）中有所增加。与合法化前相比，2023年过去12个月的大麻使用量仍明显高于焦虑和抑郁。从2018年到2019年，只有在过去一年没有任何精神健康问题经历的人群中，每日大麻使用量有所增加（AOR = 1.34, 95% CI = 1.10, 1.62, p < 0.0001）。在经历过双相情感障碍、创伤后应激障碍或精神分裂症的个体中，没有观察到其他的合法化前后差异。解释在报告有精神健康问题的加拿大人中，大麻使用在大麻合法化之前和之后几乎没有变化，而在报告没有精神健康问题的加拿大人中，每天和过去12个月的大麻使用有所增加。ICPS研究的资金由加拿大卫生研究院项目资助和项目桥梁资助（PJT-153342）提供。
{"title":"The prevalence of cannabis use pre-versus post-cannabis legalization in Canada by mental health status: findings from national repeat cross-sectional surveys","authors":"Samantha Rundle , Maryam Iraniparast , David Hammond","doi":"10.1016/j.lana.2026.101373","DOIUrl":"10.1016/j.lana.2026.101373","url":null,"abstract":"<div><h3>Background</h3><div>The bidirectional relationship between cannabis use and mental health is complex. With the liberalization of cannabis laws in many countries, it is increasingly important to understand the impacts of cannabis legalization on individuals with mental health conditions. This study aimed to examine changes in cannabis use by mental health status pre-versus 5-years post-legalization of recreational cannabis in Canada.</div></div><div><h3>Methods</h3><div>Data were from the International Cannabis Policy Study's national repeat cross-sectional surveys, conducted annually in Canada between 2018 and 2023, one year before and five years after the legalization of cannabis. The current analysis includes 92,843 Canadians aged 16–65 years. Adjusted logistic regression models examined changes in daily and past 12-month cannabis use pre-versus post-legalization among individuals experiencing each of the five mental health problems in the last year: anxiety, bipolar, depression, post-traumatic stress disorder (PTSD), and schizophrenia.</div></div><div><h3>Findings</h3><div>Past 12-month cannabis consumption increased from pre-legalization versus the year immediately following legalization (2019) among those with anxiety (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.15, 1.53, <em>p</em> < 0.0001), depression (AOR = 1.47, 95% CI = 1.26, 1.73, <em>p</em> < 0.0001), and those reporting ‘no experience’ of a mental health problem in the past year (AOR = 1.52, 95% CI = 1.37, 1.68, <em>p</em> < 0.0001). Past 12-month cannabis use remained significantly higher in 2023 versus pre-legalization for anxiety and depression. Daily cannabis use increased from 2018 to 2019 only among those not reporting any experience of a mental health problem in the past year (AOR = 1.34, 95% CI = 1.10, 1.62, <em>p</em> < 0.0001). No other pre-post legalization differences were observed among individuals who experienced bipolar, PTSD, or schizophrenia.</div></div><div><h3>Interpretation</h3><div>Few changes in cannabis use were observed pre-versus post-cannabis legalization among Canadians who reported experiencing a mental health problem, whereas daily and past 12-month use increased among Canadians not reporting a mental health problem.</div></div><div><h3>Funding</h3><div>Funding for the ICPS study was provided by a <span>Canadian Institutes of Health Research Project Grant and Project Bridge Grant</span> (PJT-153342).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101373"},"PeriodicalIF":7.0,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.lana.2026.101377
Taissa Vila, Orison O. Woolcott
{"title":"Advancing maternal and child health and nutrition in Ecuador: a call for research","authors":"Taissa Vila, Orison O. Woolcott","doi":"10.1016/j.lana.2026.101377","DOIUrl":"10.1016/j.lana.2026.101377","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101377"},"PeriodicalIF":7.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.lana.2026.101372
Tiange P. Zhang , Jennifer L. Dodge , Norah A. Terrault , Brian P. Lee
Background
Asians and Native Hawaiians/Pacific Islanders (NHPIs) comprise 8% of the U.S. population with over 40 subgroups. Health data often aggregate these subpopulations, limiting group-specific estimates. In 2018, modifications to death certificates allowed for the disaggregation of NHPIs from Asians. This study examines differences in gastrointestinal-related mortality between NHPI and Asian adults across all major gastrointestinal disease categories.
Methods
We analyzed mortality data for adults aged ≥25 years from the National Center for Health Statistics 2018–2023. Established definitions classified NHPI and Asian individuals based on single or multi-race listings. Gastrointestinal-related deaths were identified using validated ICD-10 codes and categorized into liver diseases, colorectal cancer, upper gastrointestinal cancers, and non-cancer digestive diseases. Age-standardized mortality rates (ASMRs) per 100,000 and rate ratios were calculated.
Findings
Between 2018 and 2023, there were 3322 gastrointestinal-related deaths among NHPI adults (mean age 63.9 years, standard deviation 14.4; 1373 [41.3%] female decedents) and 47,275 among Asian adults (mean age 70.2 years, standard deviation 14.6; 20,892 [44.2%] female decedents). Overall gastrointestinal-related ASMR for NHPIs was 66.8 (95% CI: 64.5–69.2) per 100,000 adults. NHPIs exhibited higher mortality rates than Asians in all gastrointestinal disease categories. NHPIs had 24% higher overall gastrointestinal-related mortality rate than Asians (RR: 1.24; 95% CI: 1.20–1.29), with 33% higher for liver diseases (RR: 1.33; 95% CI: 1.24–1.44) and 63% higher for non-cancer digestive diseases (RR: 1.63; 95% CI: 1.49–1.77).
Interpretation
NHPIs (vs. Asians) have higher gastrointestinal-related mortality rates, with the greatest disparities observed in liver diseases and non-cancer digestive diseases. By disaggregating data across the full spectrum of gastrointestinal diseases, this study provides a clearer understanding of NHPI-specific disparities and highlights critical areas for targeted public health efforts.
Funding
U.S. National Institute of Diabetes and Digestive and Kidney Diseases.
{"title":"Differential gastrointestinal mortality in Native Hawaiian/Pacific Islander and Asian subgroups in the U.S.: a cross-sectional analysis of national mortality surveillance data 2018–2023","authors":"Tiange P. Zhang , Jennifer L. Dodge , Norah A. Terrault , Brian P. Lee","doi":"10.1016/j.lana.2026.101372","DOIUrl":"10.1016/j.lana.2026.101372","url":null,"abstract":"<div><h3>Background</h3><div>Asians and Native Hawaiians/Pacific Islanders (NHPIs) comprise 8% of the U.S. population with over 40 subgroups. Health data often aggregate these subpopulations, limiting group-specific estimates. In 2018, modifications to death certificates allowed for the disaggregation of NHPIs from Asians. This study examines differences in gastrointestinal-related mortality between NHPI and Asian adults across all major gastrointestinal disease categories.</div></div><div><h3>Methods</h3><div>We analyzed mortality data for adults aged ≥25 years from the National Center for Health Statistics 2018–2023. Established definitions classified NHPI and Asian individuals based on single or multi-race listings. Gastrointestinal-related deaths were identified using validated ICD-10 codes and categorized into liver diseases, colorectal cancer, upper gastrointestinal cancers, and non-cancer digestive diseases. Age-standardized mortality rates (ASMRs) per 100,000 and rate ratios were calculated.</div></div><div><h3>Findings</h3><div>Between 2018 and 2023, there were 3322 gastrointestinal-related deaths among NHPI adults (mean age 63.9 years, standard deviation 14.4; 1373 [41.3%] female decedents) and 47,275 among Asian adults (mean age 70.2 years, standard deviation 14.6; 20,892 [44.2%] female decedents). Overall gastrointestinal-related ASMR for NHPIs was 66.8 (95% CI: 64.5–69.2) per 100,000 adults. NHPIs exhibited higher mortality rates than Asians in all gastrointestinal disease categories. NHPIs had 24% higher overall gastrointestinal-related mortality rate than Asians (RR: 1.24; 95% CI: 1.20–1.29), with 33% higher for liver diseases (RR: 1.33; 95% CI: 1.24–1.44) and 63% higher for non-cancer digestive diseases (RR: 1.63; 95% CI: 1.49–1.77).</div></div><div><h3>Interpretation</h3><div>NHPIs (vs. Asians) have higher gastrointestinal-related mortality rates, with the greatest disparities observed in liver diseases and non-cancer digestive diseases. By disaggregating data across the full spectrum of gastrointestinal diseases, this study provides a clearer understanding of NHPI-specific disparities and highlights critical areas for targeted public health efforts.</div></div><div><h3>Funding</h3><div><span>U.S. National Institute of Diabetes</span> and <span>Digestive and Kidney Diseases</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101372"},"PeriodicalIF":7.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.lana.2026.101374
Maximin Lange , Leo A. Celi , Ben Carter , Jesse D. Raffa , Sharon C. O'Donoghue , Marzyeh Ghassemi , Tom J. Pollard
Background
Physical restraints are widely used in intensive care units (ICUs) despite uncertain clinical benefit and risks. We aimed to characterise patterns of restraint use, demographic and clinical predictors, and temporal trends before and after introduction of federal restraint-related reporting requirements.
Methods
We conducted a retrospective cross-sectional study of 51,838 adults admitted to ICUs at Beth Israel Deaconess Medical Center, Boston, MA, USA, between 2008 and 2022, using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record repository. Primary outcome was the proportion of ICU days with documented physical restraint use. Associations between restraint use and demographic and clinical factors were estimated using a binomial generalised linear model with a logit link. Propensity score matching compared Black and White patients under varying adjustment specifications.
Findings
Among 51,838 patients (mean age 63.8 years; 57% male), 21,091 (40.7%) experienced restraint. Use increased from 36.9% in 2008–10 to 44.0% in 2020–22 (p < 0.0001). Asian (aOR 0.84, 95% CI 0.79–0.89) and Hispanic/Latino patients (aOR 0.87, 95% CI 0.83–0.92) had lower odds of restraint than White patients. Propensity score matching between Black and White patients revealed ethnic patterns were highly sensitive to model specification: excluding demographic characteristics revealed significant disparities, which were attenuated when psychiatric diagnoses were also excluded. Matched White patients were not representative of all White ICU patients but rather a subset resembling Black patients on observed characteristics.
Interpretation
Restraint practices appear to vary with patient acuity, institutional factors, and communication barriers. The sensitivity of ethnic disparities to psychiatric diagnosis adjustment suggests these diagnoses may function as mediators rather than confounders, potentially reflecting systematic differences in clinical assessment along the causal pathway between ethnicity and restraint decisions. The non-representativeness of matched cohorts underscores that disparities depend on which patient subgroups are compared. Prospective multisite studies with standardized assessment protocols are needed to validate findings, disentangle true clinical variation from systematic bias and provide a more comprehensive understanding of restraint practices across US ICU settings.
Funding
No study-specific funding was received.
背景物理约束被广泛应用于重症监护病房（icu），尽管临床效益和风险不确定。我们的目的是描述约束使用模式、人口统计学和临床预测因素，以及引入联邦约束相关报告要求前后的时间趋势。方法我们对2008年至2022年期间在美国马萨诸塞州波士顿Beth Israel Deaconess医疗中心入住icu的51,838名成年人进行了回顾性横断面研究，使用重症监护医疗信息市场IV （MIMIC-IV）电子健康记录库的数据。主要终点是有记录的使用身体约束的ICU天数的比例。约束使用与人口统计学和临床因素之间的关联使用具有logit链接的二项广义线性模型进行估计。倾向评分匹配比较黑人和白人患者在不同的调整规范。在51,838例患者（平均年龄63.8岁，57%为男性）中，21,091例（40.7%）经历过约束。使用量从2008 - 2010年的36.9%增加到2020 - 2022年的44.0% （p < 0.0001）。亚洲患者（aOR 0.84, 95% CI 0.79-0.89）和西班牙裔/拉丁裔患者（aOR 0.87, 95% CI 0.83-0.92）约束的几率低于白人患者。黑人和白人患者的倾向评分匹配显示种族模式对模型规格高度敏感；排除人口统计学特征显示显著差异，当排除精神病学诊断时，这种差异减弱。匹配的白人患者并不代表所有白人ICU患者，而是在观察特征上与黑人患者相似的一个子集。约束实践似乎因患者的敏锐度、制度因素和沟通障碍而异。种族差异对精神病诊断调整的敏感性表明，这些诊断可能起到中介作用，而不是混杂因素，潜在地反映了沿着种族和约束决策之间因果路径的临床评估的系统差异。匹配队列的非代表性强调了差异取决于比较哪些患者亚组。需要采用标准化评估方案的前瞻性多地点研究来验证研究结果，从系统偏倚中理清真正的临床差异，并对美国ICU环境中的约束实践提供更全面的了解。没有收到研究专项资金。
{"title":"Physical restraint use in a United States intensive care unit—a retrospective cross sectional, single center cohort study from 2008 to 2022","authors":"Maximin Lange , Leo A. Celi , Ben Carter , Jesse D. Raffa , Sharon C. O'Donoghue , Marzyeh Ghassemi , Tom J. Pollard","doi":"10.1016/j.lana.2026.101374","DOIUrl":"10.1016/j.lana.2026.101374","url":null,"abstract":"<div><h3>Background</h3><div>Physical restraints are widely used in intensive care units (ICUs) despite uncertain clinical benefit and risks. We aimed to characterise patterns of restraint use, demographic and clinical predictors, and temporal trends before and after introduction of federal restraint-related reporting requirements.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study of 51,838 adults admitted to ICUs at Beth Israel Deaconess Medical Center, Boston, MA, USA, between 2008 and 2022, using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) electronic health record repository. Primary outcome was the proportion of ICU days with documented physical restraint use. Associations between restraint use and demographic and clinical factors were estimated using a binomial generalised linear model with a logit link. Propensity score matching compared Black and White patients under varying adjustment specifications.</div></div><div><h3>Findings</h3><div>Among 51,838 patients (mean age 63.8 years; 57% male), 21,091 (40.7%) experienced restraint. Use increased from 36.9% in 2008–10 to 44.0% in 2020–22 (p < 0.0001). Asian (aOR 0.84, 95% CI 0.79–0.89) and Hispanic/Latino patients (aOR 0.87, 95% CI 0.83–0.92) had lower odds of restraint than White patients. Propensity score matching between Black and White patients revealed ethnic patterns were highly sensitive to model specification: excluding demographic characteristics revealed significant disparities, which were attenuated when psychiatric diagnoses were also excluded. Matched White patients were not representative of all White ICU patients but rather a subset resembling Black patients on observed characteristics.</div></div><div><h3>Interpretation</h3><div>Restraint practices appear to vary with patient acuity, institutional factors, and communication barriers. The sensitivity of ethnic disparities to psychiatric diagnosis adjustment suggests these diagnoses may function as mediators rather than confounders, potentially reflecting systematic differences in clinical assessment along the causal pathway between ethnicity and restraint decisions. The non-representativeness of matched cohorts underscores that disparities depend on which patient subgroups are compared. Prospective multisite studies with standardized assessment protocols are needed to validate findings, disentangle true clinical variation from systematic bias and provide a more comprehensive understanding of restraint practices across US ICU settings.</div></div><div><h3>Funding</h3><div>No study-specific funding was received.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101374"},"PeriodicalIF":7.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.lana.2025.101361
Emily A. Burger , Jean-François Laprise , Jennifer C. Spencer , Stephen Sy , Mary Caroline Regan , Melanie Drolet , Éléonore Chamberland , Marc Brisson , Jane J. Kim
Background
Evidence supporting the non-inferior efficacy of single-dose human papillomavirus (HPV) vaccination has prompted reconsideration of existing multi-dose HPV vaccination schedules. We evaluated the long-term health impact of adopting single-dose HPV vaccination in the United States to inform policy deliberations.
Methods
We applied two validated individual-based simulation models of HPV transmission and cervical cancer to project the impact of switching from a two-dose to a single-dose HPV vaccination schedule in 2025 in the context of historical HPV vaccination uptake in the United States. Four scenarios were simulated: continuation of two-dose vaccination (or equivalent single-dose efficacy of 98%) and three alternative pessimistic single-dose strategies with lower vaccine efficacy (90%) and/or duration of protection (average of 25 years). Outcomes included age-standardized incidence rates of HPV-16 infection and cervical cancer from years 2005–2099. Additional analyses examined effects under lower vaccination coverage observed in select U.S. regions.
Findings
Maintaining two doses or switching to a non-inferior single-dose HPV vaccination schedule was projected to nearly eliminate HPV-16 infections and reduce cervical cancer incidence by over 90% by the end of the century. Scenarios assuming a lower efficacy or waning protection showed increases in cervical cancer incidence of less than 2 percentage points decades after a switch to single-dose vaccination with no impact on the timeframe to cervical cancer elimination.
Interpretation
Switching to a single-dose HPV vaccination schedule is projected to maintain reductions in cervical cancer, even under pessimistic efficacy and durability assumptions. Continued monitoring of single-dose HPV vaccine efficacy over time remains critical.
Funding
PATH on behalf of the Single-Dose HPV Vaccine Evaluation Consortium; Bill and Melinda Gates Foundation (grant No. OPP48979), and the US National Institutes of Health/National Cancer Institute (Grant Number U01 CA253912).
{"title":"Single-dose HPV vaccination in the United States — a multi-modeling analysis","authors":"Emily A. Burger , Jean-François Laprise , Jennifer C. Spencer , Stephen Sy , Mary Caroline Regan , Melanie Drolet , Éléonore Chamberland , Marc Brisson , Jane J. Kim","doi":"10.1016/j.lana.2025.101361","DOIUrl":"10.1016/j.lana.2025.101361","url":null,"abstract":"<div><h3>Background</h3><div>Evidence supporting the non-inferior efficacy of single-dose human papillomavirus (HPV) vaccination has prompted reconsideration of existing multi-dose HPV vaccination schedules. We evaluated the long-term health impact of adopting single-dose HPV vaccination in the United States to inform policy deliberations.</div></div><div><h3>Methods</h3><div>We applied two validated individual-based simulation models of HPV transmission and cervical cancer to project the impact of switching from a two-dose to a single-dose HPV vaccination schedule in 2025 in the context of historical HPV vaccination uptake in the United States. Four scenarios were simulated: continuation of two-dose vaccination (or equivalent single-dose efficacy of 98%) and three alternative pessimistic single-dose strategies with lower vaccine efficacy (90%) and/or duration of protection (average of 25 years). Outcomes included age-standardized incidence rates of HPV-16 infection and cervical cancer from years 2005–2099. Additional analyses examined effects under lower vaccination coverage observed in select U.S. regions.</div></div><div><h3>Findings</h3><div>Maintaining two doses or switching to a non-inferior single-dose HPV vaccination schedule was projected to nearly eliminate HPV-16 infections and reduce cervical cancer incidence by over 90% by the end of the century. Scenarios assuming a lower efficacy or waning protection showed increases in cervical cancer incidence of less than 2 percentage points decades after a switch to single-dose vaccination with no impact on the timeframe to cervical cancer elimination.</div></div><div><h3>Interpretation</h3><div>Switching to a single-dose HPV vaccination schedule is projected to maintain reductions in cervical cancer, even under pessimistic efficacy and durability assumptions. Continued monitoring of single-dose HPV vaccine efficacy over time remains critical.</div></div><div><h3>Funding</h3><div>PATH on behalf of the <span>Single-Dose HPV Vaccine Evaluation Consortium</span>; <span>Bill and Melinda Gates Foundation</span> (grant No. <span><span>OPP48979</span></span>), and the <span>US National Institutes of Health</span>/<span>National Cancer Institute</span> (Grant Number <span><span>U01 CA253912</span></span>).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101361"},"PeriodicalIF":7.0,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.lana.2025.101369
Sarah A. Coggins , Sagori Mukhopadhyay
{"title":"Authors’ reply to: Todd et al., prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Sarah A. Coggins , Sagori Mukhopadhyay","doi":"10.1016/j.lana.2025.101369","DOIUrl":"10.1016/j.lana.2025.101369","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101369"},"PeriodicalIF":7.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1016/j.lana.2025.101367
José Bines , Fabiola Kestelman
{"title":"Mammography does not fit all: the screening controversy in Brazil","authors":"José Bines , Fabiola Kestelman","doi":"10.1016/j.lana.2025.101367","DOIUrl":"10.1016/j.lana.2025.101367","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101367"},"PeriodicalIF":7.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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