Global Health Research and Policy最新文献

Background: Early-life undernutrition, particularly during critical developmental periods, may have lasting impacts on non-communicable diseases (NCDs) in adulthood. The Chinese Great Famine (1959-1961) provides a unique opportunity to evaluate these effects in a large-scale population study. To investigate the impact of early-life undernutrition on adult mortality due to NCDs in individuals exposed to the Chinese Great Famine.

Methods: We analyzed data from a medical insurance database in Hua County, China, including 15,088 individuals born during the famine (1959-1961) and 49,924 individuals deemed unexposed because they were born after the famine (1962-1964), with follow-up from 2012 to 2023. Multivariable Cox regression and competing risks regression were used to assess the association between early-life undernutrition and mortality.

Results: Early-life undernutrition was associated with increased risks of all-cause mortality (HR_adjusted = 1.49, 95% CI 1.37-1.62), cancer mortality (HR_adjusted = 1.41, 95% CI 1.22-1.64), cardiovascular and cerebrovascular diseases mortality (HR_adjusted = 1.51, 95% CI 1.34-1.71), and chronic obstructive pulmonary disease mortality (HR_adjusted = 4.37, 95% CI 2.51-7.61). Subgroup analysis revealed that the exposed group had a higher risk of death from lung, esophageal, gastric, hepato-biliary, and pancreatic cancers, cerebrovascular disease and cardiovascular disease.

Conclusions: This study demonstrates the long-term adverse effects of early-life undernutrition on NCD mortality in adulthood, underscoring the importance of nutritional interventions during critical developmental periods to reduce the burden of NCDs.

Clinical trial registration: Endoscopic Screening for Esophageal Cancer in China (ESECC) randomized controlled trial (Clinical trial: NCT01688908).

Background: Cancer prevention is a critical public health challenge in China, especially among rural residents. This study aimed to examine the mediating role of cancer cognition in the relationship between e-health literacy and cancer prevention consciousness.

Methods: A multi-stage stratified random sampling method was used to recruit 486 rural residents from Shandong Province for a questionnaire survey. Data from 453 valid responses were analyzed using descriptive statistics, univariate and multiple linear regression. Path analysis was used to examine the mediating role of cancer cognition in the relationship between e-health literacy and cancer prevention consciousness.

Results: The mean score of cancer prevention consciousness among rural residents in this study was 7.46 out of a maximum of 10. Regression analysis showed that e-health literacy (β = 0.146, P < 0.001) and cancer cognition (β = 0.150, P < 0.001) influenced cancer prevention consciousness. Gender and the perceived necessity of cancer-related knowledge were also influencing factors (P < 0.001). The direct effect value of e-health literacy on cancer prevention consciousness was 0.155, which accounted for 84.87% of the total effect. The indirect effect value through cancer cognition level is 0.028, accounting for 15.13% of the total effect.

Conclusions: We found an above-average level of cancer prevention consciousness among the rural residents. E-health literacy can enhance the  consciousness among individuals by increasing their cancer cognition. Policymakers should leverage e-health technologies to strengthen residents' capacity to understand cancer-related information, with culturally tailored interventions further supporting effective prevention and global health efforts.

The World Health Organization (WHO) released its first guideline on non-surgical management of chronic primary low back pain (LBP) in adults in 2023. The Guideline signals a timely and important global response to the current and projected burden attributable to LBP, particularly amongst populations made vulnerable, e.g. older people and people in low- and middle-income countries. The Guideline offers recommendations on which interventions for chronic primary LBP should be offered in most contexts, and those interventions that should not be offered as part of routine care. As a WHO technical product, the Guideline can function as a catalyst to commence reorientation of health systems and service delivery towards holistic, integrated, person-centred and high-value LBP care. However, to achieve this vision and Universal Health Coverage that is inclusive of LBP care, transformations are required at point of care (micro-level), within service models and organisations (meso-level) and across health system Building Blocks (macro-level). In this paper, we consider implications of the Guideline for health services and health systems globally. We highlight opportunities and priorities to build capacity across the Building Blocks of health systems and how current global health agendas, such as the WHO 14th General Program of Work, UN Decade of Healthy Ageing 2021-2030, and Rehabilitation 2030 can support implementation of the Guideline's recommendations. Global collaborative and multi-sectoral efforts, supported by countries, health workers, professional/academic societies, health financing agencies, civil society organisations, private sectors, and people with lived experience will be needed to sustainably implement the Guideline's recommendations into health systems globally.

Background: The increasing consumption of fast foods (FFs) and ultra-processed foods (UPFs) worldwide has raised concerns due to their association with carcinogenic compounds and potential links to various cancers. However, this evidence about breast cancer risk remains inconsistent. This study aimed to meta-analyze the association between FFs and UPFs consumption and the risk of breast cancer in females.

Methods: A comprehensive search on online databases was conducted from inception to May 2025, and relevant study data were extracted. The meta-analysis utilized odds ratio (OR) with 95% confidence interval (CI) as effect size measures. Subgroup analyses, heterogeneity assessment, publication bias, and sensitivity analyses were performed to ensure robustness. All statistical analyses were conducted using STATA.

Results: The pooled analysis of 17 observational studies showed a significant association between the highest FFs and UPFs consumption and increased breast cancer risk (OR 1.25, 95% CI [1.09-1.43], p = 0.001). Subgroup analysis revealed a significant positive association between FFs and UPFs consumption and breast cancer risk in case-control studies, but not in cohort studies or menopausal status and a significant association was observed in studies with sample sizes > 1000 and < 1000. Furthermore, the association was significant in Latin America when BMI adjustment was considered for 'yes' and 'no'.

Conclusions: This meta-analysis identified a significant association between the consumption of FFs and UPFs and an increased risk of breast cancer, with high intake linked to a 25% greater risk. These findings suggest that diets high in UPFs may play a role in breast cancer development. As UPF consumption continues to rise, public health strategies and regulatory policies targeting food processing, marketing, labeling, and accessibility are essential for cancer risk reduction and prevention.

Background: Tuberculosis (TB) continues to pose a significant global public health threat, particularly among migrant populations. Screening policies exist in many receiving countries but differ markedly, and there is limited pooled evidence on TB and latent TB infection (LTBI) prevalence among migrants under different screening frameworks. This systematic review and meta-analysis aims to synthesize TB and LTBI prevalence among migrants and compared national screening policies to inform evidence-based public health planning.

Methods: PubMed, Embase, Web of Science and Cochrane Library were searched for studies published 2016-2023. Random-effects models generated pooled prevalence estimates with 95% CIs; subgroup analyses examined differences by screening stage, migrant category, and country-of-origin incidence. Sensitivity analyses tested robustness. Government and health-agency websites were systematically examined and scored to table national TB-screening requirements.

Results: 36 studies (26 TB, 21 LTBI) covering 40,738,331 migrants screened met inclusion criteria. The Pooled TB prevalence was 214.52/100,000 (95% CI 112.18-349.66) and LTBI prevalence 14.9% (95% CI 9.91-20.60). Countries employing both pre-entry screening and subsequent post-entry surveillance achieved the lowest TB prevalence (94.09/100,000). The highest burdens occurred among refugees/asylum seekers (439.25/100,000) and migrants from countries with TB incidence 300-499/100,000 (491.96/100,000). LTBI was most common when identified through post-entry screening (21.90%), those with multiple migrants (18.11%), and among migrants originating from countries with ≥ 500/100,000 TB incidence (30.90%). Policy comparison showed pre-entry screening is almost universal; the United States is the only country mandating systematic LTBI screening. Screening-scope scores were highest in traditional immigrant countries (16-20), intermediate in middle-income destinations such as China and Malaysia (10-14), and lowest in Nordic (4-8).

Conclusions: This study emphasizes the importance of targeted TB screening, especially for migrants from high-prevalence regions and at-risk populations. Comprehensive pre- and post-entry TB screening, along with strengthened latent TB screening and surveillance for diverse migrant populations, is essential. Meanwhile enhanced collaboration to update screening policies are key to achieving the goal of TB eradication and provide practical insights for effective TB control.

Background: Sub-Saharan Africa has faced profound healthcare challenges, including severe shortages of professionals and infrastructural deficits. Despite significant international aid, the full impact of Chinese Medical Teams (CMTs) in addressing these issues had remained underexplored. This scoping review aimed to synthesise existing literature on the role of CMTs in Africa, identifying key drivers, barriers, and gaps in research that could enhance the effectiveness of these programmes.

Methods: A comprehensive search was conducted across major English and Chinese databases up to February 2023, following the Arksey and O'Malley framework and adhering to the PRISMA-ScR checklist. Studies providing qualitative or quantitative insights into the modality, effectiveness, and challenges of CMTs were included. Thematic analysis, supported by NVivo 11 software, was used to synthesise the findings.

Results: The review included 20 English articles and 27 Chinese articles from 2009 to 2022, highlighting CMTs' significant role in improving healthcare through direct medical assistance, training of local healthcare workers, and infrastructure development. Key drivers of CMT initiatives included diplomatic goals, economic cooperation, and humanitarian efforts. Conversely, operational challenges such as cultural differences, language barriers, and infrastructural inadequacies were prominent.

Conclusions: CMTs have effectively addressed healthcare disparities in Africa through a distinctive, government-led, and non-conditional programme. Their flexible, long-term engagement has strengthened healthcare systems across underserved regions, offering a model for sustainable global health aid. However, challenges such as cultural barriers and logistical constraints suggest a need for improved cultural competency and flexible staffing. Further empirical research, particularly involving African researchers, is essential to fully understand CMTs' long-term impact and refine strategies for future international health initiatives that align with local needs.

Background: Although liver cancer has varied causes, its evolving epidemiology and causal drivers remain underexplored. This study quantifies the trends and drivers of liver cancer burden attributable to specific causes from 1990 to 2021.

Methods: Using data from the Global Burden of Disease Study, we extracted prevalence, mortality, and disability-adjusted life years (DALYs) associated with specific causes of liver cancer. We assessed spatio-temporal trends across the sociodemographic index (SDI) and quantified the contributions of epidemiological shifts, population growth, and ageing to DALYs.

Results: In 2021, liver cancer accounted for 0.74 million cases, 0.48 million deaths, and 12.89 million DALYs globally. Average annual percentage changes (AAPCs) in prevalence, mortality, and DALY rates from 1990 to 2021 were 1.17%, 1.04%, and 0.48%, respectively. HBV, HCV, and alcohol use were major contributors to DALYs, accounting for 1.92 million (36.00%), 1.53 million (28.62%), and 1.27 million (23.88%) of the increase, respectively. High-income North America and Western Europe experienced rapid growth in liver cancer prevalence from 1990 to 2021, while High-income North America and Southern Latin America had rapid growth in mortality. Global DALY increases were mainly driven by population growth (3.91 million, 73.29%) and population ageing (3.03 million, 56.86%).

Conclusions: The study revealed that hepatitis B, hepatitis C, and alcohol consumption were the primary contributors to the increasing DALYs from liver cancer, with population growth and ageing as key drivers of these changes. These findings underscore the importance of considering the major factors and demographic dynamics in addressing the burden of liver cancer when formulating prevention and intervention strategies.

Background: Given the increasing aging global population and advancements in dementia action plans, the latest disparities in the dementia burden may evolve. This study aimed to analyze and compare temporal trends at regional, national, and sociodemographic levels to provide evidence for public health planning and resource prioritization.

Methods: The age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were derived from the Global Burden of Disease 2021 study. Estimated annual percentage changes (EAPCs) were calculated to quantify their temporal trends. Correlations between EAPC and the human resources for health (HRH) were assessed using Pearson correlation analysis.

Results: Although the ASPR and ASIR remained stable or decreased globally, they both greatly increased in East Asia (ASPR: EAPC = 0.43; 95% CI 0.35, 0.51; ASIR: EAPC = 0.40; 95% CI 0.33, 0.47). For early-onset dementia, the ASPR (range of EAPC = 0.03-0.17) and ASIR (range of EAPC = 0.05-0.19) in the 45 to 59 years age group increased in North Africa and Middle East, particularly among females (ASPR: range of EAPC = 0.08-0.21; ASIR: range of EAPC = 0.09-0.2). Although the ASMR and ASDR both decreased globally and in high socio-demographic index region, they both increased greatly in South Asia (ASMR: EAPC = 0.7; 95% CI 0.66, 0.75; ASDR: EAPC = 0.40; 95% CI 0.37, 0.43). For early-onset dementia, the ASMR (range of EAPC = 0.43-0.78) and ASDR (range of EAPC = 0.19-0.33) in the 40 to 59 years age group had increased in Central Sub-Saharan Africa, particularly among females (ASMR: range of EAPC = 0.5-0.86; ASDR: range of EAPC = 0.19-0.4). Negative correlations were observed between the EAPC in ASPR, ASIR, ASMR and ASDR with various types of HRH at the national level.

Conclusions: Although there has been progresses in controlling the global trends of dementia incidence, prevalence, and mortality, significant regional and national inequalities remain evident. More importantly, the early-onset dementia burden is increasing significantly among females in the African region, underscoring the critical need for healthcare systems that address dementia across the early midlife span.

Background: As a newly emerging collaborative platform to boost regional growth and prosperity, the Belt and Road Initiative (BRI) has great potential to promote global health development. However, the overall health status of BRI countries remains unclear. We analyzed the health patterns and its geographical distribution in 149 BRI countries from 1990 to 2021.

Methods: Using the Global Burden of Disease 2021 (GBD 2021) online database, we examined time trends, country and income variations in death rate and disability-adjusted life years (DALY) rate, and compared the trends and projected 2030 values for ten key health-related Sustainable Development Goals (SDGs) indicators among the 149 BRI countries.

Results: The number of deaths and DALYs of BRI countries represented 62.9-66.0% of global deaths and 64.8-66.8% of global DALYs between 1990 and 2021, and both the overall age-standardized death rate and DALY rate continued to be higher in BRI countries than in non-BRI countries throughout the time period studied. Great variations existed across the 149 BRI countries for both level of and changes in age-standardized death rate and DALY rate. The 2030 targets for six health-related SDGs indicators will not be reached in over 70% of BRI countries according to the previous changing speed trajectory.

Conclusions: Our findings demonstrate that BRI countries face a heavy burden of disease that varies across countries, although health outcomes have improved since 1990. Progress toward 2030 targets for six key health-related SDGs indicators in most BRI countries was slow. These findings support calls for more health collaborations, aid programs, and other health service to reduce health disparities across the BRI countries.

Background: In an aging society, herpes zoster (HZ) increases the health burden on infected patients. While quantitative studies point to a lack of willingness to accept the HZ vaccine in China, there is limited number of studies with in-depth qualitative analysis on HZ vaccination intention. This study undertakes a qualitive study method to identify the barriers and facilitators behind urban residents' HZ vaccination intention in three China cities, and contributes towards some targeted vaccination promotion suggestions to China and other LMICs with similar low coverage of HZ vaccination.

Methods: We conducted 12 focus group discussions in three cities of China. In each discussion we recruited 3 to 6 participants aged 20 and older to catch the views on the HZ vaccine from residents with a wider age range. Participants were recruited by purposive sampling techniques. Guided by the health belief model, thematic analysis was used to group participants' HZ vaccine attitudes and to identify the barriers and facilitators to HZ vaccination.

Results: The attitude of 59 participants participating in the focus group discussions showed a low-level acceptability of the HZ vaccine with only 27.1% (16/59) displaying a willingness to HZ vaccine uptake. The barriers to HZ vaccination included limited or incorrect conception on HZ prevalence, risk factors, susceptibility, symptoms, prevention and treatment methods, and the high cost of the HZ vaccine. Perceived vulnerability to HZ, fear of HZ pain and individuals' financial capacity were the strongest facilitators to HZ vaccination. In addition, it was found that advocacy of HZ vaccination by health professionals or government financial subsidies to HZ vaccination, could attenuate the above barriers to HZ vaccine uptake.

Conclusions: Our study revealed a series of barriers and facilitators of HZ vaccination intention. We recommend HZ education and advocacy by health workers and government health officials to address the limited HZ knowledge and HZ misconceptions, and the government (or health insurance providers) to pay or subsidize the high costs of HZ vaccination to increase the HZ vaccination rate.