Multimorbidity, the coexistence of two or more chronic diseases, among cancer patients offers critical insights into shared risk factors, while posing increasing challenges for healthcare systems due to the complexity of care required. Despite its relevance, research in multimorbidity across different age groups is limited in middle income countries.
Methods
We analyzed cancer-related hospitalizations between 2019 and 2023, using a nationwide Diagnosis-Related Groups database covering 68 Chilean health institutions. We examined the distribution of 40 chronic conditions, multimorbidity prevalence, comorbidity profile, and their distribution across age group, sex, and cancer diagnosis.
Findings
We identified 4,722,723 hospitalization events, including 149,270 unique adult patients hospitalized with cancer (mean of 63 ± 15.17 years old). Multimorbidity was present in 47.9% of all cancer-related hospitalizations, increasing steeply with age: 14% in patients aged 18–35, 24.9% in those 36–50, and 55.5% in patients >50 years. Obesity and diabetes were among the most common comorbid conditions across age groups, with significant variations by sex. Notably, obesity was more prevalent in younger patients, particularly those aged 18–35, whereas hypertension showed an inverse profile, increasing markedly with age.
Interpretation
Multimorbidity profile reflect both the clinical complexity of cancer care and potential shared biological and environmental pathways in carcinogenesis. These findings highlight the need to transition from disease-centered to person-centered care models. In Chile, understanding multimorbidity in younger and middle-aged adults may inform precision prevention, integrated service delivery, and equitable planning for both oncologic and non-oncologic care.
Funding
This study was conducted without external funding.
{"title":"Multimorbidity profile among cancer-related hospitalization events in younger and older patients: a large-scale nationwide cross-sectional study","authors":"Yanara A. Bernal , Carla Campaña , Cristobal Sanhueza , Mauricio Apablaza , Ricardo Armisén , Iris Delgado","doi":"10.1016/j.lana.2025.101308","DOIUrl":"10.1016/j.lana.2025.101308","url":null,"abstract":"<div><h3>Background</h3><div>Multimorbidity, the coexistence of two or more chronic diseases, among cancer patients offers critical insights into shared risk factors, while posing increasing challenges for healthcare systems due to the complexity of care required. Despite its relevance, research in multimorbidity across different age groups is limited in middle income countries.</div></div><div><h3>Methods</h3><div>We analyzed cancer-related hospitalizations between 2019 and 2023, using a nationwide Diagnosis-Related Groups database covering 68 Chilean health institutions. We examined the distribution of 40 chronic conditions, multimorbidity prevalence, comorbidity profile, and their distribution across age group, sex, and cancer diagnosis.</div></div><div><h3>Findings</h3><div>We identified 4,722,723 hospitalization events, including 149,270 unique adult patients hospitalized with cancer (mean of 63 ± 15.17 years old). Multimorbidity was present in 47.9% of all cancer-related hospitalizations, increasing steeply with age: 14% in patients aged 18–35, 24.9% in those 36–50, and 55.5% in patients >50 years. Obesity and diabetes were among the most common comorbid conditions across age groups, with significant variations by sex. Notably, obesity was more prevalent in younger patients, particularly those aged 18–35, whereas hypertension showed an inverse profile, increasing markedly with age.</div></div><div><h3>Interpretation</h3><div>Multimorbidity profile reflect both the clinical complexity of cancer care and potential shared biological and environmental pathways in carcinogenesis. These findings highlight the need to transition from disease-centered to person-centered care models. In Chile, understanding multimorbidity in younger and middle-aged adults may inform precision prevention, integrated service delivery, and equitable planning for both oncologic and non-oncologic care.</div></div><div><h3>Funding</h3><div>This study was conducted without external funding.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101308"},"PeriodicalIF":7.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623697","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 : 2025-11-22DOI: 10.1016/j.lana.2025.101312
Patricio Andrés Medel-Jara , Gonzalo Latorre , Eduardo Fuentes-Lopez , Margarita Pizarro , Paola Viviani , Javier Chahuán , Sara Maquilón , Oscar Corsi , Diego Reyes , Alberto Espino , Jose Ignacio Vargas , Ignacio A. Wichmann , Paul Harris , Carolina Serrano , Isabella Buruato , Christopher Sandoval , Nelson M. Varela , Leslie Cerpa , Luis Quiñones , Francis Megraud , Arnoldo Riquelme Perez
Background
Helicobacter pylori eradication reduces the risk of peptic ulcer disease and gastric cancer. In Chile, the effectiveness of standard triple therapy has dropped below 80%. We compared optimized bismuth quadruple therapy: esomeprazole 40 mg three times a day, amoxicillin 1 gr three times a day, metronidazole 500 mg three times a day, and bismuth subsalicylate 369 mg three times a day for 14 days, and standard triple therapy omeprazole 20 mg twice a day, amoxicillin 1 gr twice a day, and clarithromycin 500 mg twice a day for 14 days in a Chilean population.
Methods
Randomized double-blind clinical trial. 127 treatment-naïve individuals with confirmed active H. pylori were recruited. The primary outcome was successful H. pylori eradication, at least 4 weeks post-treatment. We assessed H. pylori resistance to clarithromycin and participants’ CYP2C19 genotype/phenotype. We compared eradication success between the groups using intention-to-treat and per-protocol analyses. The trial adhered to CONSORT guidelines. NTC-Number: NCT05664685 (trial completed).
Findings
127 participants were recruited and randomized (64 standard triple therapy, 63 optimized bismuth quadruple therapy). Men were 44% (56/127), and the mean age was 48 (standard deviation: 14.2) in the sample. Baseline characteristics between the two groups were similar. In intention-to-treat analysis, optimized bismuth quadruple therapy had a significantly higher eradication rate versus standard triple therapy: 95% (60/63) [95% CI 86%–99%] vs. 81% (52/64) [70%–89%], p = 0.033. Adverse events were comparable: optimized bismuth quadruple therapy 67% (42/63) [54%–77%] vs. standard triple therapy 66% (42/64) [53%–76%], p = 1.00. There was no difference in baseline clarithromycin resistance or CYP2C19 polymorphisms.
Interpretation
Optimized bismuth quadruple therapy eradication is higher than standard triple therapy in treatment-naïve individuals with active H. pylori, without difference in adverse events or adherence. Optimized bismuth quadruple therapy is a reliable and safe empiric eradication therapy, especially in areas with high clarithromycin resistance.
Funding
FONDECYT (1230504 AR); ANID-FONDAP (152220002 AR); Horizon 2020 program of European Union (825832 AR); ANID-FONDAP (15130011).
{"title":"Comparison between optimized bismuth quadruple therapy and standard clarithromycin-based triple therapy for first-line Helicobacter pylori eradication: a double-blind randomized controlled trial","authors":"Patricio Andrés Medel-Jara , Gonzalo Latorre , Eduardo Fuentes-Lopez , Margarita Pizarro , Paola Viviani , Javier Chahuán , Sara Maquilón , Oscar Corsi , Diego Reyes , Alberto Espino , Jose Ignacio Vargas , Ignacio A. Wichmann , Paul Harris , Carolina Serrano , Isabella Buruato , Christopher Sandoval , Nelson M. Varela , Leslie Cerpa , Luis Quiñones , Francis Megraud , Arnoldo Riquelme Perez","doi":"10.1016/j.lana.2025.101312","DOIUrl":"10.1016/j.lana.2025.101312","url":null,"abstract":"<div><h3>Background</h3><div><em>Helicobacter pylori</em> eradication reduces the risk of peptic ulcer disease and gastric cancer. In Chile, the effectiveness of standard triple therapy has dropped below 80%. We compared <em>optimized bismuth quadruple therapy</em>: esomeprazole 40 mg three times a day, amoxicillin 1 gr three times a day, metronidazole 500 mg three times a day, and bismuth subsalicylate 369 mg three times a day for 14 days, and standard triple therapy omeprazole 20 mg twice a day, amoxicillin 1 gr twice a day, and clarithromycin 500 mg twice a day for 14 days in a Chilean population.</div></div><div><h3>Methods</h3><div>Randomized double-blind clinical trial. 127 treatment-naïve individuals with confirmed active <em>H. pylori</em> were recruited. The primary outcome was successful <em>H. pylori</em> eradication, at least 4 weeks post-treatment. We assessed <em>H. pylori</em> resistance to clarithromycin and participants’ <em>CYP2C19</em> genotype/phenotype. We compared eradication success between the groups using intention-to-treat and per-protocol analyses. The trial adhered to CONSORT guidelines. NTC-Number: <span><span>NCT05664685</span><svg><path></path></svg></span> (trial completed).</div></div><div><h3>Findings</h3><div>127 participants were recruited and randomized (64 standard triple therapy, 63 optimized bismuth quadruple therapy). Men were 44% (56/127), and the mean age was 48 (standard deviation: 14.2) in the sample. Baseline characteristics between the two groups were similar. In intention-to-treat analysis, optimized bismuth quadruple therapy had a significantly higher eradication rate versus standard triple therapy: 95% (60/63) [95% CI 86%–99%] vs. 81% (52/64) [70%–89%], p = 0.033. Adverse events were comparable: optimized bismuth quadruple therapy 67% (42/63) [54%–77%] vs. standard triple therapy 66% (42/64) [53%–76%], p = 1.00. There was no difference in baseline clarithromycin resistance or <em>CYP2C19</em> polymorphisms.</div></div><div><h3>Interpretation</h3><div>Optimized bismuth quadruple therapy eradication is higher than standard triple therapy in treatment-naïve individuals with active <em>H. pylori</em>, without difference in adverse events or adherence. Optimized bismuth quadruple therapy is a reliable and safe empiric eradication therapy, especially in areas with high clarithromycin resistance.</div></div><div><h3>Funding</h3><div><span>FONDECYT</span> (1230504 AR); <span>ANID-FONDAP</span> (152220002 AR); <span>Horizon 2020 program of European Union</span> (825832 AR); <span>ANID-FONDAP</span> (15130011).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101312"},"PeriodicalIF":7.0,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576955","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 : 2025-11-20DOI: 10.1016/j.lana.2025.101313
Pradnyashree Wadivkar , Debbie S. Thompson , Meredith Shamamian , Meredith Hawkins , Michael S. Boyne
Type 5 Diabetes (T5DM) was first identified by Hugh-Jones in Jamaica in 1955 as J-type diabetes. Since then, multiple reports from various countries have supported the idea that T5DM differs from other known forms of diabetes. Common features that distinguish T5DM include a body mass index of <18.5 kg/m2, low hepatic fat mass, low C-peptide concentrations, normal insulin sensitivity, and absence of ketoacidosis. Despite this unique phenotype, T5DM is often missed or misdiagnosed, potentially resulting in underreporting, though the magnitude is unknown. While the majority of Latin America and the Caribbean are experiencing a nutritional transition, chronic undernutrition still exists in some regions facing food insecurity and geopolitical conflicts, thus raising the risk for incident T5DM. This paper aims to highlight the 70-year history of T5DM, which began in the Americas, and proposes refocusing our attention on this underexplored but critical condition, which will probably continue to affect many individuals in the Americas.
{"title":"Type 5 diabetes: a 70-year perspective and its implications for the Americas","authors":"Pradnyashree Wadivkar , Debbie S. Thompson , Meredith Shamamian , Meredith Hawkins , Michael S. Boyne","doi":"10.1016/j.lana.2025.101313","DOIUrl":"10.1016/j.lana.2025.101313","url":null,"abstract":"<div><div>Type 5 Diabetes (T5DM) was first identified by Hugh-Jones in Jamaica in 1955 as J-type diabetes. Since then, multiple reports from various countries have supported the idea that T5DM differs from other known forms of diabetes. Common features that distinguish T5DM include a body mass index of <18.5 kg/m<sup>2</sup>, low hepatic fat mass, low C-peptide concentrations, normal insulin sensitivity, and absence of ketoacidosis. Despite this unique phenotype, T5DM is often missed or misdiagnosed, potentially resulting in underreporting, though the magnitude is unknown. While the majority of Latin America and the Caribbean are experiencing a nutritional transition, chronic undernutrition still exists in some regions facing food insecurity and geopolitical conflicts, thus raising the risk for incident T5DM. This paper aims to highlight the 70-year history of T5DM, which began in the Americas, and proposes refocusing our attention on this underexplored but critical condition, which will probably continue to affect many individuals in the Americas.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101313"},"PeriodicalIF":7.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568648","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 : 2025-11-19DOI: 10.1016/j.lana.2025.101296
Josefina L. Razzini , Daniela Parada , Guillermo Solovey , Gonzalo Guiñazú , Emiliano M. Sosa , Sabrina R. Orta , Sofía Esposto , Gabriela Sanluis Fenelli , Anastasia E. Regalado , Valeria Torre , Micaela Pichinenda , María Fabiana Ossorio , Stella Maris Souto , María Nieves Ojeda , Silvana Lugo , Fernando Ferrero , Fernando P. Polack , Julia Dvorkin , Mauricio T. Caballero , Florencia Cohen
Background
Respiratory syncytial virus (RSV) is a major cause of hospitalizations and mortality in young infants worldwide. The RSVpreF maternal immunization (MI) was recently introduced in Argentina.
Methods
This study assessed the impact of RSVpreF MI on RSV-related acute lower respiratory tract infections (ALRTI) hospitalizations through a hospital-based, multicentre, retrospective surveillance cohort study, and measured vaccine effectiveness (VE) using a nested test-negative case–control study. Data of hospitalized infants under 18 months of age was collected and analysed within seven years from three Argentine tertiary hospitals. VE analysis included ALRTI-hospitalized infants who were born between March 1 and November 9, 2024, were under 6 months of age when tested for RSV, and whose mothers were eligible for prenatal RSV immunization. Expected RSV-ALRTI hospitalizations were compared with observed cases using a Poisson model. We estimated the VE of RSVpreF MI against RSV-ALRTI hospitalizations, paediatric intensive care unit (PICU) admissions, and extended hospital stays by comparing these rates in vaccinated and unvaccinated under 3 and 6 months.
Findings
A total of 3373 participants were included in the impact analysis, fromof whom 323 were born during the vaccination period and were eligible for the VE analysis. The VE of RSVpreF MI was 80·8% (95% CI: 62·8–90·5%), and 66·1% (95% CI 30·1–83·8) for infants under 3 and 6 months, respectively, adjusted for age, sex, comorbidities, and epidemiological weeks. VE for PICU admission was 87·2% (95% CI 52·6–97·0) and 88·6% (95% CI 62·3–97·1) for extended hospital stays in infants under 6 months. The vaccine reduced RSV-ALRTI hospitalizations in infants under 6 months by 33·6% (95% CI 29·5–37·2) in 2024 compared to expected cases from previous years. The number needed to immunize to prevent one RSV-related hospitalization was 83·9 (95% CI 65·9–185·4).
Interpretation
RSVpreF MI significantly reduced RSV-ALRTI hospitalizations, averting one-third of such hospitalizations in infants under 6 months. These findings provide valuable evidence for policymakers and health authorities.
{"title":"Impact and effectiveness of RSV maternal immunization on infant hospitalizations in Buenos Aires: a hospital-based, multicentre, retrospective surveillance cohort study","authors":"Josefina L. Razzini , Daniela Parada , Guillermo Solovey , Gonzalo Guiñazú , Emiliano M. Sosa , Sabrina R. Orta , Sofía Esposto , Gabriela Sanluis Fenelli , Anastasia E. Regalado , Valeria Torre , Micaela Pichinenda , María Fabiana Ossorio , Stella Maris Souto , María Nieves Ojeda , Silvana Lugo , Fernando Ferrero , Fernando P. Polack , Julia Dvorkin , Mauricio T. Caballero , Florencia Cohen","doi":"10.1016/j.lana.2025.101296","DOIUrl":"10.1016/j.lana.2025.101296","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory syncytial virus (RSV) is a major cause of hospitalizations and mortality in young infants worldwide. The RSVpreF maternal immunization (MI) was recently introduced in Argentina.</div></div><div><h3>Methods</h3><div>This study assessed the impact of RSVpreF MI on RSV-related acute lower respiratory tract infections (ALRTI) hospitalizations through a hospital-based, multicentre, retrospective surveillance cohort study, and measured vaccine effectiveness (VE) using a nested test-negative case–control study. Data of hospitalized infants under 18 months of age was collected and analysed within seven years from three Argentine tertiary hospitals. VE analysis included ALRTI-hospitalized infants who were born between March 1 and November 9, 2024, were under 6 months of age when tested for RSV, and whose mothers were eligible for prenatal RSV immunization. Expected RSV-ALRTI hospitalizations were compared with observed cases using a Poisson model. We estimated the VE of RSVpreF MI against RSV-ALRTI hospitalizations, paediatric intensive care unit (PICU) admissions, and extended hospital stays by comparing these rates in vaccinated and unvaccinated under 3 and 6 months.</div></div><div><h3>Findings</h3><div>A total of 3373 participants were included in the impact analysis, fromof whom 323 were born during the vaccination period and were eligible for the VE analysis. The VE of RSVpreF MI was 80·8% (95% CI: 62·8–90·5%), and 66·1% (95% CI 30·1–83·8) for infants under 3 and 6 months, respectively, adjusted for age, sex, comorbidities, and epidemiological weeks. VE for PICU admission was 87·2% (95% CI 52·6–97·0) and 88·6% (95% CI 62·3–97·1) for extended hospital stays in infants under 6 months. The vaccine reduced RSV-ALRTI hospitalizations in infants under 6 months by 33·6% (95% CI 29·5–37·2) in 2024 compared to expected cases from previous years. The number needed to immunize to prevent one RSV-related hospitalization was 83·9 (95% CI 65·9–185·4).</div></div><div><h3>Interpretation</h3><div>RSVpreF MI significantly reduced RSV-ALRTI hospitalizations, averting one-third of such hospitalizations in infants under 6 months. These findings provide valuable evidence for policymakers and health authorities.</div></div><div><h3>Funding</h3><div>Gates Foundation and Thrasher Research Fund.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101296"},"PeriodicalIF":7.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568649","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 : 2025-11-15DOI: 10.1016/j.lana.2025.101298
Andrea L. Wirtz , Elizabeth Humes , Tonia C. Poteat , Keri N. Althoff , Kenneth H. Mayer , Erin E. Cooney , Meg Stevenson , Ceza Pontes , Asa E. Radix , Andrew J. Wawrzyniak , Sari L. Reisner
Background
Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States.
Methods
From March 2018–August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24–48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18–24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals.
Findings
Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0–132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7–95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03–1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04–1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01–1·02), psychological distress (aRR:1·08, 95% CI:1·00–1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01–1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence.
Interpretation
GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts.
{"title":"Age-disparate experiences and incidence of gender-based violence victimization of transgender women: findings from a cohort study in eastern and southern United States","authors":"Andrea L. Wirtz , Elizabeth Humes , Tonia C. Poteat , Keri N. Althoff , Kenneth H. Mayer , Erin E. Cooney , Meg Stevenson , Ceza Pontes , Asa E. Radix , Andrew J. Wawrzyniak , Sari L. Reisner","doi":"10.1016/j.lana.2025.101298","DOIUrl":"10.1016/j.lana.2025.101298","url":null,"abstract":"<div><h3>Background</h3><div>Gender-based violence (GBV) is a threat to health and human rights and experiences may vary with age. We estimated the incidence and correlates of GBV in transgender women in the United States.</div></div><div><h3>Methods</h3><div>From March 2018–August 2020, we enrolled a cohort (N = 1312) of transgender women without HIV in eastern and southern US. Participants were followed for 24–48 months via site-based and digital modes. We measured lifetime and recent (past 3 or 6 months) psychological, physical, and sexual GBV over follow-up. We calculated frequencies and incidence rates (IR) of each form of violence, stratified by age at enrollment (18–24 vs. ≥ 25 years). We used modified Poisson regression models to identify predictors of incident GBV and calculate adjusted relative risk (aRR) and 95% confidence intervals.</div></div><div><h3>Findings</h3><div>Participants were a mean age of 31years (standard deviation: 11) and 60% identified as White race (793/1312), 15% as Black (196/1312), and 19% as Hispanic/Latine (242/1312). At baseline, 88% (1140/1312) reported any lifetime GBV and 42% (546/1312) recent GBV. Psychological violence was most common (39% [507/1312] recent, 85% [1101/1312] lifetime), followed by physical (12% [151/1312] recent, 65% [843/1312] lifetime) and sexual (7% [94/1312] recent, 43% [557/1312] lifetime). Perpetrators were most frequently family members, partners, and strangers. Incidence of GBV was higher among young adults (IR = 119·4/100 person-years, 95% CI = 107·0–132·9) compared to adults (IR = 88·5/100 person-years, 95% CI = 81·7–95·6). Among young adults, online versus site-based participants had elevated GBV risk (aRR = 1·14, 95% CI = 1·03–1·26). Among adults, food insecurity (aRR:1·13, 95% CI:1·04–1·23), higher discrimination scores (aRR:1·01, 95% CI: 1·01–1·02), psychological distress (aRR:1·08, 95% CI:1·00–1·17), and drug use disorder symptoms (aRR:1·09, 95 CI:1·01–1·18) were associated with increased GBV risk. Other predictors were observed in age-specific models for incident psychological, physical, and sexual violence.</div></div><div><h3>Interpretation</h3><div>GBV is exceptionally high among US transgender women. Survivor services, protective policies, and interventions must explicitly address transgender women's needs, including age-specific GBV contexts.</div></div><div><h3>Funding</h3><div>NIH.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101298"},"PeriodicalIF":7.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576956","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 : 2025-11-14DOI: 10.1016/j.lana.2025.101301
Merike Blofield , Andrea L. Wirtz , Magaly Pedraza , Rafael Olarte , Doris Parada
Background
Syphilis incidence is increasing globally; however, cost and time are significant barriers to treatment completion rates among vulnerable populations, including displaced populations and host communities. To inform public health strategies, we aimed to test whether conditional cash transfers (CCT) increased completion of syphilis treatment among a community sample in a border city of Colombia.
Methods
We embedded a quasi-experimental trial of a CCT intervention in a community sexual health program serving participants aged 14 years and older in low-income settlements around Cúcuta, Colombia in 2023. The program included workshops and syphilis screening. Individuals with laboratory-confirmed syphilis were eligible for inclusion in the trial. Both control and CCT arms provided syphilis diagnostics, counseling and free treatment. CCT consisted of cash payments of USD$12.69 for completion of each of two follow-up treatments. We used generalized linear models to estimate the effect of CCT on treatment completion, defined as three doses of penicillin.
Findings
Of 1751 workshop participants, 114 had laboratory-confirmed syphilis and were enrolled in the trial. Participants were 56% female (64/114) and 44% male (50/114), with 6 participants (5.3%) identifying as transgender, regardless of sex at birth. Participants included 47% Venezuelan migrants staying in Cúcuta (53/114), 26% Colombian returnees (30/114), and 19% Colombians from the host community (22/114). Data on ethnicity was not collected. Median age was 34.5 years (IQR: 25.0–46.0). More than three-quarters (78%, 39/50) of CCT participants completed the three-dose treatment regimen compared to 45% (29/64) of control participants, a risk difference of 33% (p < 0.001). In adjusted models, CCT-assigned participants had a 36% higher treatment completion rate compared to control-assigned participants (adjusted risk difference: aRD: 0.36, 95% CI: 0.19–0.53).
{"title":"Conditional cash transfer interventions to support syphilis treatment in vulnerable populations: a quasi-experimental study among displaced and host communities in a border city of Colombia","authors":"Merike Blofield , Andrea L. Wirtz , Magaly Pedraza , Rafael Olarte , Doris Parada","doi":"10.1016/j.lana.2025.101301","DOIUrl":"10.1016/j.lana.2025.101301","url":null,"abstract":"<div><h3>Background</h3><div>Syphilis incidence is increasing globally; however, cost and time are significant barriers to treatment completion rates among vulnerable populations, including displaced populations and host communities. To inform public health strategies, we aimed to test whether conditional cash transfers (CCT) increased completion of syphilis treatment among a community sample in a border city of Colombia.</div></div><div><h3>Methods</h3><div>We embedded a quasi-experimental trial of a CCT intervention in a community sexual health program serving participants aged 14 years and older in low-income settlements around Cúcuta, Colombia in 2023. The program included workshops and syphilis screening. Individuals with laboratory-confirmed syphilis were eligible for inclusion in the trial. Both control and CCT arms provided syphilis diagnostics, counseling and free treatment. CCT consisted of cash payments of USD$12.69 for completion of each of two follow-up treatments. We used generalized linear models to estimate the effect of CCT on treatment completion, defined as three doses of penicillin.</div></div><div><h3>Findings</h3><div>Of 1751 workshop participants, 114 had laboratory-confirmed syphilis and were enrolled in the trial. Participants were 56% female (64/114) and 44% male (50/114), with 6 participants (5.3%) identifying as transgender, regardless of sex at birth. Participants included 47% Venezuelan migrants staying in Cúcuta (53/114), 26% Colombian returnees (30/114), and 19% Colombians from the host community (22/114). Data on ethnicity was not collected. Median age was 34.5 years (IQR: 25.0–46.0). More than three-quarters (78%, 39/50) of CCT participants completed the three-dose treatment regimen compared to 45% (29/64) of control participants, a risk difference of 33% (p < 0.001). In adjusted models, CCT-assigned participants had a 36% higher treatment completion rate compared to control-assigned participants (adjusted risk difference: aRD: 0.36, 95% CI: 0.19–0.53).</div></div><div><h3>Interpretation</h3><div>Conditional cash transfers might enhance syphilis treatment adherence among populations facing socioeconomic challenges.</div></div><div><h3>Funding</h3><div><span>German Development Cooperation Agency</span>, <span>Deutsche Gesellschaft für Internationale Zusammenarbeit</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101301"},"PeriodicalIF":7.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526894","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 : 2025-11-14DOI: 10.1016/j.lana.2025.101300
Andrés F. Cardona , Natalia Sánchez , Liliana Gutiérrez-Babativ , Leonardo Rojas , Jairo Zuluaga , Stella Martínez , Lucia Viola , Carlos Carvajal , Juliana Bogoya , Laura Prieto-Pinto , Daniel Samacá-Samacá , Antonio Robles , Joshua Kock , Claudio Martín , Luis Corrales , Luis E. Raez , Vladmir Cordeiro de Lima , Suraj Samtani , Oscar Arrieta
{"title":"Corrigendum to “Clinical and economic impact of the availability of innovative therapies for advanced lung cancer in men in Latin America: a population-based secondary data study”- the Lancet Regional Health—Americas 2025; Volume 49: 101172; DOI: 10.1016/j.lana.2025.101172","authors":"Andrés F. Cardona , Natalia Sánchez , Liliana Gutiérrez-Babativ , Leonardo Rojas , Jairo Zuluaga , Stella Martínez , Lucia Viola , Carlos Carvajal , Juliana Bogoya , Laura Prieto-Pinto , Daniel Samacá-Samacá , Antonio Robles , Joshua Kock , Claudio Martín , Luis Corrales , Luis E. Raez , Vladmir Cordeiro de Lima , Suraj Samtani , Oscar Arrieta","doi":"10.1016/j.lana.2025.101300","DOIUrl":"10.1016/j.lana.2025.101300","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101300"},"PeriodicalIF":7.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520198","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 : 2025-11-13DOI: 10.1016/j.lana.2025.101299
Sarah E. Anthony , Manali A. Phadke , Richard B. Lipton , Daniel G. Rogers , Lisa A. Brenner , John P. Ney , Hamada H. Altalib , X. Michelle Androulakis , Amy S. Grinberg , Melissa Skanderson , Hung-Mo Lin , Joel D. Scholten , Brenda T. Fenton , Elizabeth K. Seng , Jason J. Sico
Background
Post-traumatic headache (PTH) is a common sequela of traumatic brain injury (TBI). Although there is a known association between TBI and suicide risk in veterans, the association between PTH and suicide-related outcomes in veterans with TBI is relatively unknown. We aimed to evaluate the association between PTH and suicide-related outcomes in veterans compared to matched controls diagnosed with TBI but no history of headaches.
Methods
This retrospective cohort study was conducted with Veterans Health Administration and Department of Defense electronic health record data from fiscal years 2008 through 2020. Veterans with PTH were matched to a control group who had TBI and no headache disorders. Relative risk was estimated using propensity score-weighted log-binomial models that evaluated differences in suicidal ideation, suicide attempts, and suicide death.
Findings
Of the 95,224 veterans included in the total sample, 85,730 were male (90.0%) and 9,949 were female (10.0%). The average age of the sample was 45.9 years (SD = 16.6). 73,500 (77.2%) were White, Non-Hispanic, 17,256 (18.1%) were Black, Non-Hispanic, and 4,468 (4.7%) were classified as other or mixed race. Of the 47,612 veterans diagnosed with PTH, 4,618 (9.7%) reported suicidal ideation or suicide attempts compared to 3,162 (6.6%) in the control group. Veterans with PTH had increased risk of suicidal ideation (RR, 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83) compared to matched controls. Using inverse probability weighting to adjust for confounding, these results remained significant. When adjusting for potential confounders, as well as prior suicidal ideation or suicide attempts, there was no significant difference in risk of suicide death in veterans with PTH (RR, 0.83; 95% CI, 0.67–1.02) compared to those with TBI without headache.
Interpretation
Veterans with PTH have an increased risk of suicidal ideation and suicide attempts compared to veterans with TBI and without headache. There was no difference in suicide mortality between the two groups. Clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities that contribute to increased risk.
Funding
This study was supported by the United States Department of Veterans Affairs special purpose medical service funding (SP80DPE.1-0160).
{"title":"Suicide-related outcomes in veterans with post-traumatic headache: a retrospective cohort study","authors":"Sarah E. Anthony , Manali A. Phadke , Richard B. Lipton , Daniel G. Rogers , Lisa A. Brenner , John P. Ney , Hamada H. Altalib , X. Michelle Androulakis , Amy S. Grinberg , Melissa Skanderson , Hung-Mo Lin , Joel D. Scholten , Brenda T. Fenton , Elizabeth K. Seng , Jason J. Sico","doi":"10.1016/j.lana.2025.101299","DOIUrl":"10.1016/j.lana.2025.101299","url":null,"abstract":"<div><h3>Background</h3><div>Post-traumatic headache (PTH) is a common sequela of traumatic brain injury (TBI). Although there is a known association between TBI and suicide risk in veterans, the association between PTH and suicide-related outcomes in veterans with TBI is relatively unknown. We aimed to evaluate the association between PTH and suicide-related outcomes in veterans compared to matched controls diagnosed with TBI but no history of headaches.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted with Veterans Health Administration and Department of Defense electronic health record data from fiscal years 2008 through 2020. Veterans with PTH were matched to a control group who had TBI and no headache disorders. Relative risk was estimated using propensity score-weighted log-binomial models that evaluated differences in suicidal ideation, suicide attempts, and suicide death.</div></div><div><h3>Findings</h3><div>Of the 95,224 veterans included in the total sample, 85,730 were male (90.0%) and 9,949 were female (10.0%). The average age of the sample was 45.9 years (SD = 16.6). 73,500 (77.2%) were White, Non-Hispanic, 17,256 (18.1%) were Black, Non-Hispanic, and 4,468 (4.7%) were classified as other or mixed race. Of the 47,612 veterans diagnosed with PTH, 4,618 (9.7%) reported suicidal ideation or suicide attempts compared to 3,162 (6.6%) in the control group. Veterans with PTH had increased risk of suicidal ideation (RR, 1.45; 95% CI, 1.39–1.51) and suicide attempts (RR, 1.66; 95% CI, 1.50–1.83) compared to matched controls. Using inverse probability weighting to adjust for confounding, these results remained significant. When adjusting for potential confounders, as well as prior suicidal ideation or suicide attempts, there was no significant difference in risk of suicide death in veterans with PTH (RR, 0.83; 95% CI, 0.67–1.02) compared to those with TBI without headache.</div></div><div><h3>Interpretation</h3><div>Veterans with PTH have an increased risk of suicidal ideation and suicide attempts compared to veterans with TBI and without headache. There was no difference in suicide mortality between the two groups. Clinicians should be aware of heightened suicide risk among veterans with PTH and be especially diligent in terms of screening for suicide risk and related medical and mental health comorbidities that contribute to increased risk.</div></div><div><h3>Funding</h3><div>This study was supported by the United States <span>Department of Veterans Affairs</span> special purpose medical service funding (SP80DPE.1-0160).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101299"},"PeriodicalIF":7.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526893","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":"Reconceptualizing access: advancing pharmaceutical equity for health system resilience in Central and South America","authors":"Esteban Zavaleta-Monestel, Sebastián Arguedas-Chacón","doi":"10.1016/j.lana.2025.101302","DOIUrl":"10.1016/j.lana.2025.101302","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"53 ","pages":"Article 101302"},"PeriodicalIF":7.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145526892","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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