Lancet Regional Health-Americas最新文献

{"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 ,&nbsp;Jennifer L. Dodge ,&nbsp;Norah A. Terrault ,&nbsp;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}

{"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 ,&nbsp;Leo A. Celi ,&nbsp;Ben Carter ,&nbsp;Jesse D. Raffa ,&nbsp;Sharon C. O'Donoghue ,&nbsp;Marzyeh Ghassemi ,&nbsp;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 &lt; 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}

{"title":"Single-dose HPV vaccination in the United States — a multi-modeling analysis","authors":"Emily A. Burger ,&nbsp;Jean-François Laprise ,&nbsp;Jennifer C. Spencer ,&nbsp;Stephen Sy ,&nbsp;Mary Caroline Regan ,&nbsp;Melanie Drolet ,&nbsp;Éléonore Chamberland ,&nbsp;Marc Brisson ,&nbsp;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}

{"title":"Authors’ reply to: Todd et al., prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Sarah A. Coggins ,&nbsp;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}

{"title":"Mammography does not fit all: the screening controversy in Brazil","authors":"José Bines ,&nbsp;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}

{"title":"Incidence rates of twelve chronic diseases/conditions in US adults: findings from a population-based study","authors":"Richard L. Nahin ,&nbsp;Termeh Feinberg ,&nbsp;Hanna Grol-Prokopczyk ,&nbsp;Flavia P. Kapos ,&nbsp;Kerri Murray ,&nbsp;Remle Scott ,&nbsp;Anna Zajacova","doi":"10.1016/j.lana.2025.101342","DOIUrl":"10.1016/j.lana.2025.101342","url":null,"abstract":"<div><h3>Background</h3><div>There are no contemporary studies simultaneously examining the incidence of multiple chronic diseases/conditions in US adults. We estimated one-year incidence rates for 12 chronic diseases/conditions with high public burden.</div></div><div><h3>Methods</h3><div>Data were from the nationally representative National Health Interview Survey 2019–2020 Longitudinal Cohort (N = 10,415). We assessed incidence rates for anxiety, arthritis, asthma, cancer, chronic obstructive pulmonary disease (COPD), chronic pain, coronary heart disease (CHD), depression, diabetes, high cholesterol, hypertension, and obesity. We calculated overall and sex-specific age-standardized incidence rates per 1000 person-years (PY) and examined associations with baseline age, sex, race/ethnicity, education, insurance, and smoking status.</div></div><div><h3>Findings</h3><div>In the sample, 51.7% ([95% CI: 50.3–53.1]; N = 5624, representing 129.7 million adults) were female, 20.5% ([95% CI: 20–22.2]; N = 3405, representing 21.1 million adults) were aged 65+ years, 63.2% ([95% CI: 60.9–65.4]; N = 7495, representing 158.5 million adults) were Non-Hispanic White, 16.5% ([95% CI: 14.7–18.4]; N = 1153, representing 41.5 million adults) were Hispanic/Latino, 28.8% ([95% CI: 27.4–30.2]; N = 4228, representing 72.3 million adults) graduated college, and 72.4 ([95% CI: 70.8–73.9]; N = 7287, representing 167.0 million adults) had private health insurance. One-year incidence rates were lowest for diabetes, COPD and CHD: 13.8/1000 PY (95% CI: 10.8–16.8), 14.4/1000 PY (95% CI: 11.8–17.0), and 14.7/1000 PY (95% CI: 12.7–17.0), respectively. The highest rates were observed for high cholesterol and chronic pain, 85.7/1000 PY (95% CI: 79.4–91.9) and 85.3/1000 PY (95% CI: 78.7–92.0), respectively, while all other rates were between these extremes. Females had higher rates of anxiety (69.6 [95% CI: 60.5–75.7] vs 36.4 [95% CI: 29.8–43.1]) and depression (63.7 [95% CI: 55.1–72.3] vs 34.5 [95% CI: 28.4–40.7]), while males had higher rates of hypertension (77.3 [95% CI: 72.3–82.3] vs 56.5 [95% CI: 48.7–64.3]). Incidence-related risk factors differed across diseases/conditions, with age the most consistent predictor.</div></div><div><h3>Interpretation</h3><div>This comprehensive assessment documented striking variation in chronic disease/condition incidence. The findings provide essential evidence for prioritizing and coordinating prevention initiatives across the chronic disease/condition spectrum.</div></div><div><h3>Funding</h3><div><span>US National Institutes of Health</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101342"},"PeriodicalIF":7.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925435","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}

{"title":"Prenatal and intrapartum antibiotic exposure and childhood infections: considerations and complexities","authors":"Isobel M.F. Todd ,&nbsp;David P. Burgner ,&nbsp;Maria C. Magnus ,&nbsp;Lars Henning Pedersen ,&nbsp;Jessica E. Miller","doi":"10.1016/j.lana.2025.101368","DOIUrl":"10.1016/j.lana.2025.101368","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101368"},"PeriodicalIF":7.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925433","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}

{"title":"Impact and scope of Mexican clinical practice guideline for adult overweight and obesity on weight stigma","authors":"Emma Chávez-Manzanera ,&nbsp;Verónica Vázquez-Velázquez","doi":"10.1016/j.lana.2025.101366","DOIUrl":"10.1016/j.lana.2025.101366","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101366"},"PeriodicalIF":7.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927694","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}

{"title":"An undeniable public health urgency, but an incomplete response: centering racial and ethnic equity in Canada's “Strategic approaches to reducing the substance use-related burden of disease”","authors":"Jude Mary Cénat ,&nbsp;Idrissa Beogo ,&nbsp;Monnica Williams ,&nbsp;Smita Pakhale","doi":"10.1016/j.lana.2025.101370","DOIUrl":"10.1016/j.lana.2025.101370","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"55 ","pages":"Article 101370"},"PeriodicalIF":7.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927696","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}

{"title":"US emergency department visits by women due to assault (2018–2021): a retrospective cross-sectional analysis","authors":"Summer Chavez ,&nbsp;Irma Ugalde ,&nbsp;Michael Ulrich ,&nbsp;Omolola Adepoju ,&nbsp;Tonghui Xu ,&nbsp;Winston Liaw","doi":"10.1016/j.lana.2025.101343","DOIUrl":"10.1016/j.lana.2025.101343","url":null,"abstract":"<div><h3>Background</h3><div>Domestic violence has played a key role in linking firearms and homicide amongst female individuals. Combined with the increase of reports of violence against women during the COVID-19 pandemic, a rise in emergency department (ED) visits may be witnessed. Our aim was to estimate the changes in prevalence and risk factors associated with assault and firearm-related emergency department (ED) visits by female patients following the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We performed a retrospective cross-sectional study of female patients presenting to EDs due to assault from the National Emergency Department Sample (NEDS) from 2018 to 2021. Independent variables included age, race, mortality, ED disposition, primary payer, location, mean total ED chargers, quartile ZIP income, and mechanism and intent of injury. The adjusted association between independent variables and ED visits among patients injured by firearms compared to those injured by other assaults was examined.</div></div><div><h3>Findings</h3><div>The analytic sample represented an estimated 1,575,543 ED weighted records of female assault cases out of a total weighted sample of 537,133,200 observations (0.29%). While year-over-year ED encounters decreased, firearm injuries and the proportion of patients admitted and dying in the hospital increased. Female patients who were injured by firearms had 89 times higher risk of dying in the ED (RR = 88.82; 95% CI 6 = 72.38–97.06) compared to female patients injured by non-firearm injury mechanisms. Racial disparities were prevalent, with Native American women experiencing the greatest risk of being assaulted (RR = 2.81; 95% CI 2.67–2.97). Victims of firearm related assaults had nearly 4.12 times the risk of identifying as Black compared with those assaulted without firearms (95% CI 3.75–4.52). Female patients seeking care for assault had higher risk of being uninsured (95% CI 2.70–2.77).</div></div><div><h3>Interpretation</h3><div>While year-over-year ED encounters due to assault decreased, lockdowns and restrictions associated with the observed COVID-19 pandemic may not fully reflect changes in abuse rates in this time period. The strong connection between firearm presence and female homicide and continuations of assault and firearm-related ED visits among vulnerable demographic groups highlights the need for effective strategies to reduce violence.</div></div><div><h3>Funding</h3><div>Unfunded.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"54 ","pages":"Article 101343"},"PeriodicalIF":7.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925434","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}