Archives of Public Health最新文献

Background: Primary percutaneous coronary intervention (pPCI) is the gold standard treatment for acute myocardial infarction (MI). Yet, its implementation across Brazil's diverse regions remains poorly characterized. Although Brazil's public healthcare system (Sistema Único de Saúde [SUS]) serves approximately 72% of Brazil's population, comprehensive analysis of pPCI utilization patterns and outcomes has been limited. This study aimed to evaluate contemporary trends in pPCI utilization, associated costs, and clinical outcomes across Brazil's regions from 2008 to 2023.

Methods: We conducted a retrospective observational study of emergency MI hospitalizations treated with pPCI using Brazil's Unified Health System databases. Population‑adjusted rates of pPCI, inflation‑adjusted standardized costs, in‑hospital mortality, and densities of registered pPCI‑capable facilities were estimated for Brazil and its five regions. Five‑year interval means and cumulative changes were computed. Statistical significance was evaluated with Z‑tests and 95% confidence intervals.

Results: National pPCI hospitalizations increased by 190.94%, with marked regional variation. The South reached 26.22 procedures per 100,000 population in 2023, while the North remained critically low (1.49 per 100,000). After inflation adjustment, standardized costs declined nationally (-36.34% per day; -47.12% per hospitalization), yet population‑adjusted in‑hospital mortality rose by 121.74% over the study period. Across regions, most pPCI‑capable facilities were private rather than public or philanthropic. Disparities were most pronounced between the South and North regions, reflecting broader socioeconomic inequities.

Conclusion: Brazil has substantially increased pPCI utilization, but persistent regional disparities and rising population‑adjusted mortality highlight systemic challenges in timely, high‑quality care. Targeted interventions - standardized protocols, strengthened infrastructure and transfer networks in underserved areas, and focused investment - are needed to improve equity and cardiovascular outcomes nationwide.

Background: Colorectal cancer (CRC) remains a major public health burden in Hong Kong. Although screening programs and lifestyle changes have contributed to recent declines in age-standardized rates, the absolute burden continues to rise due to rapid population aging. A comprehensive understanding of long-term trends and their demographic drivers is essential for future cancer control planning. This study aimed to comprehensively assess long-term CRC incidence trends in Hong Kong and to project the future disease burden.

Methods: We analyzed CRC incidence data from the Hong Kong Cancer Registry (1983-2022). Crude and age-standardized incidence rates were calculated by sex and age group. Temporal patterns were assessed using age-period-cohort models, future incidence was projected using Bayesian APC methods, and decomposition and scenario analyses were conducted to evaluate demographic drivers and potential screening impacts.

Results: From 1983 to 2022, a total of 141,566 CRC cases were registered in Hong Kong. Age-standardized incidence rates stabilized and declined after 2010, whereas crude rates and absolute case numbers continued to increase, driven mainly by population aging. Bayesian projections indicated further declines in incidence rates through 2032, but the absolute burden is expected to remain substantial, with total annual cases exceeding 12,000. Decomposition analysis identified population aging as the dominant contributor to long-term increases in case numbers, and screening scenario analyses suggested that higher uptake could potentially accelerate declines in age-standardized incidence rates under simplified assumptions.

Conclusions: Although age-standardized CRC incidence rates are declining in Hong Kong, the absolute burden is expected to remain high due to population aging. These findings highlight the combined importance of addressing demographic aging and expanding organized screening to reduce future CRC burden.

Background: Global Burden of Disease (GBD) estimates are widely used for international health comparisons, but their validity in high-data settings remains debated. Gastric cancer provides a critical case, given its high incidence in East Asia and the availability of robust national screening and mortality data.

Methods: We compared estimates from the Korean National Burden of Disease (KNBD) study and the GBD for gastric cancer between 2008 and 2018. We additionally examined Japan, another country with nationwide gastric cancer screening and high-quality mortality reporting, to assess whether similar patterns emerged.

Results: KNBD reported declines in years of life lost (YLLs), reflected in the decreasing YLL share of disability-adjusted life years (DALYs), alongside substantial increases in years lived with disability (YLDs), underscoring survivorship-related disability. By contrast, GBD Korea showed a decrease in YLL but virtually no change in YLD. In Japan, where mortality has also declined substantially through national screening programs, GBD nevertheless reported negligible changes in YLL and YLD shares of total DALYs. Although a Japanese national DALY study is not available for direct comparison, these similar patterns across GBD Korea and GBD Japan raise concerns about the capacity of GBD methods to adequately capture survivorship in high-data countries.

Conclusion: Our findings demonstrate that the same disease can generate fundamentally different burden-of-disease narratives depending on the metric framework applied. In Korea, national data highlight survivorship-related disability that is effectively absent in GBD estimates; in Japan, GBD may similarly downplays disability despite declining mortality. Policymakers may consider national burden-of-disease estimates as more appropriate for local planning, while global models could be strengthened by integrating high-quality country-level data to better reflect survivors' burdens.