Pub Date : 2026-01-31DOI: 10.1016/j.lanepe.2026.101601
Mark P. Khurana , Mathilde Marie Brünnich Sloth , Neil Scheidwasser , Jacob Curran-Sebastian , Christian Morgenstern , Nicolas Banholzer , David Thein , Laust H. Mortensen , Morten Rasmussen , Pikka Jokelainen , Frederik Trier Møller , Marc Stegger , Tyra G. Krause , Ewan Cameron , David A. Duchêne , Alexandros Katsiferis , Samir Bhatt
Background
Post-acute sequelae of COVID-19 (PASC), or long COVID, are a public health concern. While most recover from SARS-CoV-2 infections within weeks, some experience persistent symptoms. Here, we quantified the association between repeated SARS-CoV-2 infections and the risk of hospital-diagnosed PASC.
Methods
We conducted a nationwide register-based cohort study of all adults in Denmark (≥18 years) with at least one SARS-CoV-2 PCR or antigen test between April 1, 2020, and December 31, 2022. Participants were followed from first test until long COVID diagnosis (ICD-10: B948A), death, emigration, three SARS-CoV-2 infections, or end of study. Risk of long COVID diagnosis was estimated at three timepoints after study entry (180 days, 1 year, 2 years) and the outcomes were assessed during the 180 days after each timepoint. Cause-specific Cox models treated death as a competing risk, with number of infections and vaccination status as time-varying covariates. Absolute risks and differences were estimated using G-computation. Analyses were stratified by sex, income, and vaccination status. Secondary analyses assessed fatigue and headache (ICD-10), excluding individuals with prior diagnoses.
Findings
Of 4,418,544 individuals, 6942 (0.16%) were diagnosed with long COVID. The absolute risk of a diagnosis increased following reinfection (0.73% [95% CI 0.69–0.77] after one infection vs. 1.16% [1.05–1.30] after two infections at 180 days), but differences were small and decreased over time. Risks following reinfection were similar across sex and income strata. Absolute risk decreased with prior vaccinations. Secondary analyses showed no increased risk of fatigue or headache after primary infection. A small increase in fatigue risk was observed after reinfection at 1 year (RD 0.03% [0.01–0.05]), but not for headache.
Interpretation
Reinfection increases long COVID risk; however, the absolute increase after reinfection is smaller than that observed after a primary infection. Vaccination offers substantial protection against long COVID.
Funding
Danish National Research Foundation (DNRF).
COVID-19急性后后遗症（PASC）或长冠状病毒是一个公共卫生问题。虽然大多数人在几周内从SARS-CoV-2感染中康复，但有些人会出现持续的症状。在这里，我们量化了反复感染SARS-CoV-2与医院诊断的PASC风险之间的关系。方法：我们在2020年4月1日至2022年12月31日期间对丹麦所有（≥18岁）至少进行过一次SARS-CoV-2 PCR或抗原检测的成年人进行了一项全国性的基于登记册的队列研究。参与者从第一次测试开始，直到长时间的COVID诊断（ICD-10: B948A）、死亡、移民、三次SARS-CoV-2感染或研究结束。在研究开始后的三个时间点（180天、1年、2年）评估长期COVID诊断的风险，并在每个时间点后的180天内评估结果。病因特异性Cox模型将死亡视为竞争风险，感染数量和疫苗接种状态作为时变协变量。使用g计算估计绝对风险和差异。分析按性别、收入和疫苗接种状况进行分层。二次分析评估疲劳和头痛（ICD-10），排除有既往诊断的个体。在4418544例中，6942例（0.16%）被诊断为长冠状病毒。再次感染后诊断的绝对风险增加（一次感染后0.73% [95% CI 0.69-0.77]， 180天两次感染后1.16%[1.05-1.30]），但差异很小，随着时间的推移而下降。再感染后的风险在性别和收入阶层之间相似。绝对风险降低与先前接种疫苗。二次分析显示，初次感染后疲劳或头痛的风险没有增加。1年后再次感染后，疲劳风险略有增加（RD为0.03%[0.01-0.05]），但头痛风险没有增加。再次感染增加长期COVID风险；然而，再感染后的绝对增加比初次感染后观察到的要小。疫苗接种可有效预防长期COVID。丹麦国家研究基金会（DNRF）。
{"title":"SARS-CoV-2 reinfections and subsequent risk of hospital-diagnosed post-acute sequelae in Denmark (2020–2022): a nationwide cohort study","authors":"Mark P. Khurana , Mathilde Marie Brünnich Sloth , Neil Scheidwasser , Jacob Curran-Sebastian , Christian Morgenstern , Nicolas Banholzer , David Thein , Laust H. Mortensen , Morten Rasmussen , Pikka Jokelainen , Frederik Trier Møller , Marc Stegger , Tyra G. Krause , Ewan Cameron , David A. Duchêne , Alexandros Katsiferis , Samir Bhatt","doi":"10.1016/j.lanepe.2026.101601","DOIUrl":"10.1016/j.lanepe.2026.101601","url":null,"abstract":"<div><h3>Background</h3><div>Post-acute sequelae of COVID-19 (PASC), or long COVID, are a public health concern. While most recover from SARS-CoV-2 infections within weeks, some experience persistent symptoms. Here, we quantified the association between repeated SARS-CoV-2 infections and the risk of hospital-diagnosed PASC.</div></div><div><h3>Methods</h3><div>We conducted a nationwide register-based cohort study of all adults in Denmark (≥18 years) with at least one SARS-CoV-2 PCR or antigen test between April 1, 2020, and December 31, 2022. Participants were followed from first test until long COVID diagnosis (ICD-10: B948A), death, emigration, three SARS-CoV-2 infections, or end of study. Risk of long COVID diagnosis was estimated at three timepoints after study entry (180 days, 1 year, 2 years) and the outcomes were assessed during the 180 days after each timepoint. Cause-specific Cox models treated death as a competing risk, with number of infections and vaccination status as time-varying covariates. Absolute risks and differences were estimated using G-computation. Analyses were stratified by sex, income, and vaccination status. Secondary analyses assessed fatigue and headache (ICD-10), excluding individuals with prior diagnoses.</div></div><div><h3>Findings</h3><div>Of 4,418,544 individuals, 6942 (0.16%) were diagnosed with long COVID. The absolute risk of a diagnosis increased following reinfection (0.73% [95% CI 0.69–0.77] after one infection vs. 1.16% [1.05–1.30] after two infections at 180 days), but differences were small and decreased over time. Risks following reinfection were similar across sex and income strata. Absolute risk decreased with prior vaccinations. Secondary analyses showed no increased risk of fatigue or headache after primary infection. A small increase in fatigue risk was observed after reinfection at 1 year (RD 0.03% [0.01–0.05]), but not for headache.</div></div><div><h3>Interpretation</h3><div>Reinfection increases long COVID risk; however, the absolute increase after reinfection is smaller than that observed after a primary infection. Vaccination offers substantial protection against long COVID.</div></div><div><h3>Funding</h3><div><span>Danish National Research Foundation</span> (DNRF).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101601"},"PeriodicalIF":13.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078393","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 : 2026-01-31DOI: 10.1016/j.lanepe.2026.101603
Giuseppina Lo Moro , Fabrizio Bert , Giovanna Elisa Calabrò , Mauro Giovanni Carta , Giulia Cossu , Corrado De Vito , Manuela Martella , Azzurra Massimi , Anna Odone , Paolo Ragusa , Giacomo Pietro Vigezzi , Walter Ricciardi , Roberta Siliquini
Background
Vaccine hesitancy (VH) remains a global threat, exacerbated by socio-political uncertainty. We aimed primarily to estimate VH prevalence in Italy, identifying the most susceptible subgroups, and secondarily to assess whether these patterns varied across VH dimensions.
Methods
Cross-sectional survey (web/telephone) among adults in Italy (September 2024–March 2025). The sample (n = 52,094) was nationally representative by age, gender, education, area, municipality size. The primary outcome was VH (score ≥25, adult Vaccine Hesitancy Scale, aVHS). The secondary outcomes were aVHS subscales “Lack of trust” and “Risk perception”. Post-stratification weighting for age, area, and municipality size was applied.
Findings
VH prevalence was 46.09% (95% CI: 45.65–46.53%). Multivariable models showed several associations with VH, e.g., gender, sexual orientation, ethnicity, health literacy, political and religious orientation, personal experiences, and vaccination support from community figures. Among many subgroups significant after multiple-comparison correction, the strongest differences in VH predicted probability (PP) were estimated among individuals using complementary/alternative medicine (PP = 58.5%), right-aligned (PP = 47.0%) or politically unaffiliated participants (PP = 48.4%), individuals with middle school education (PP = 48.3%), people aged 60–74 (PP = 49.0%), and participants uncertain about healthcare workers' pro-vaccination support (PP = 52.8%). While some groups, e.g., individuals with chronic conditions, inadequate health literacy, or religious participants reported higher perceived risk, others, e.g., non-binary respondents, showed higher lack of trust.
Interpretation
This study highlighted the importance of granular data to inform inclusive strategies. Key figures and politics emerged as relevant, deserving further exploration. Future research should evaluate tailored interventions for identified at-risk groups.
Funding
NextGenerationEU funding within the Italian Ministry of University and Research PNRR Extended Partnership initiative on Emerging Infectious Diseases.
{"title":"Prevalence of vaccine hesitancy in Italy: a cross-sectional study","authors":"Giuseppina Lo Moro , Fabrizio Bert , Giovanna Elisa Calabrò , Mauro Giovanni Carta , Giulia Cossu , Corrado De Vito , Manuela Martella , Azzurra Massimi , Anna Odone , Paolo Ragusa , Giacomo Pietro Vigezzi , Walter Ricciardi , Roberta Siliquini","doi":"10.1016/j.lanepe.2026.101603","DOIUrl":"10.1016/j.lanepe.2026.101603","url":null,"abstract":"<div><h3>Background</h3><div>Vaccine hesitancy (VH) remains a global threat, exacerbated by socio-political uncertainty. We aimed primarily to estimate VH prevalence in Italy, identifying the most susceptible subgroups, and secondarily to assess whether these patterns varied across VH dimensions.</div></div><div><h3>Methods</h3><div>Cross-sectional survey (web/telephone) among adults in Italy (September 2024–March 2025). The sample (n = 52,094) was nationally representative by age, gender, education, area, municipality size. The primary outcome was VH (score ≥25, adult Vaccine Hesitancy Scale, aVHS). The secondary outcomes were aVHS subscales “Lack of trust” and “Risk perception”. Post-stratification weighting for age, area, and municipality size was applied.</div></div><div><h3>Findings</h3><div>VH prevalence was 46.09% (95% CI: 45.65–46.53%). Multivariable models showed several associations with VH, e.g., gender, sexual orientation, ethnicity, health literacy, political and religious orientation, personal experiences, and vaccination support from community figures. Among many subgroups significant after multiple-comparison correction, the strongest differences in VH predicted probability (PP) were estimated among individuals using complementary/alternative medicine (PP = 58.5%), right-aligned (PP = 47.0%) or politically unaffiliated participants (PP = 48.4%), individuals with middle school education (PP = 48.3%), people aged 60–74 (PP = 49.0%), and participants uncertain about healthcare workers' pro-vaccination support (PP = 52.8%). While some groups, e.g., individuals with chronic conditions, inadequate health literacy, or religious participants reported higher perceived risk, others, e.g., non-binary respondents, showed higher lack of trust.</div></div><div><h3>Interpretation</h3><div>This study highlighted the importance of granular data to inform inclusive strategies. Key figures and politics emerged as relevant, deserving further exploration. Future research should evaluate tailored interventions for identified at-risk groups.</div></div><div><h3>Funding</h3><div>NextGenerationEU funding within the Italian <span>Ministry of University and Research</span> PNRR Extended Partnership initiative on <span>Emerging Infectious Diseases</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101603"},"PeriodicalIF":13.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078394","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 : 2026-01-29DOI: 10.1016/j.lanepe.2025.101566
Background
Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems.
Methods
This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score.
Findings
A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality.
Interpretation
Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics.
Funding
National Institute for Health and Care Research, United Kingdom.
外科服务部门对COVID-19大流行准备不足，导致选择性活动大面积中断。本研究旨在确定可采取行动的优先事项，以加强外科和医院系统的大流行防范。方法本研究汇集了三项国际前瞻性队列研究的数据，这些研究包括术前7天或术后30天内SARS-CoV-2检测结果阳性的患者。患者被纳入四个大流行时期：第一阶段（2020年1月至5月）、第二阶段（2020年6月至7月）、第三阶段（2020年10月）和第四阶段（2022年12月至3月）。主要结局指标为术后30天死亡率。建立了层次逻辑回归模型，探讨大流行时期（初级分析）和医院层面的防范（二级分析）与术后30天死亡率之间的关系。根据手术准备指数（SPI）评分，将医院准备分为低准备、中等准备和高度准备。来自102个国家1589家医院的31751名患者被纳入研究。从第1期到第4期，年龄≥70岁、ASA等级为3 - 5.30天的患者术后死亡率从第1期（18.4%[1378/7502]）、第2期（9.9%[219/2234]，调整优势比（aOR） 0.65, 95%可信区间（CI） 0.53-0.78）、第3期（10.5% [246/2427],aOR 0.60, 95% CI 0.50-0.71）到第4期（5.8% [1132/ 19588],aOR 0.33, 95% CI 0.30-0.37）下降。在第4期，接种SARS-CoV-2疫苗的患者死亡率低于未接种疫苗的患者（4.9%[603/12,361]对7.4% [529/7178],aOR 0.49, 95% CI 0.42-0.57）。与准备不足的医院（11.2%[1019/9071]）相比，准备适度的医院（9.4% [857/9071],aOR 0.84, 95% CI 0.75 ~ 0.94）和准备充分的医院（5.8% [5.3 /9071],aOR 0.70, 95% CI 0.62 ~ 0.80）的死亡率较低。在COVID-19大流行期间，术后死亡率有所下降，在准备较好的医院中死亡率更低。医院是至关重要的国家基础设施，通过制定正式的大流行计划、建立病人和手术优先次序协议以及围篱手术床来加强医院的防范，将确保在未来大流行期间更安全的手术护理。英国国家卫生和保健研究所。
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Pub Date : 2026-01-29DOI: 10.1016/j.lanepe.2026.101595
Adriana P.C. Hermans , Demetris Avraam , Isabel K. Schuurmans , Ana G. Soares , Marius Lahti-Pulkkinen , Polina Girchenko , Tanja G.M. Vrijkotte , Susanne R. de Rooij , Ahmed Elhakeem , Judith van der Waerden , Barbara Heude , Chloé Vainqueur , Tiffany C. Yang , Rachael W. Cheung , Dan Lewer , Katrine Strandberg-Larsen , Tim Cadman , Maja Popovic , Francesca Candelora , Jari Lahti , Hanan El Marroun
Background
Prenatal maternal depression affects an estimated one in five women, with implications not only for the mother but also for the child, associating negatively with offspring mental health and cognition. This study aimed to investigate multiple outcomes within the same set of participants from multiple cohorts, explore sex-specific differences in associations, and examine of the role of timing of maternal depression.
Methods
We performed large-scale individual participant data analyses with a sample size of up to 76,514 participants to investigate prospective associations between prenatal maternal depression and eight offspring behavioural and developmental outcomes, leveraging harmonised data from seven European birth cohorts. Cohort-specific estimates were combined using random-effects meta-analysis. Potential sex differences and the role of pre-pregnancy and postnatal depression in the associations were examined.
Findings
Prenatal maternal depression was associated with higher internalising, externalising, attention deficit hyperactivity disorder, and autism spectrum disorder symptoms (6.61–10.90 increased percentile scores). Associations were similar between males and females, largely independent of pre-pregnancy depression, and partially mediated by postnatal maternal depression. Continuous prenatal depressive symptoms were associated with all eight offspring outcomes.
Interpretation
These findings emphasise the importance of prenatal maternal depression as a key developmental risk factor. Future work should consider how best to support mental health during pregnancy and children exposed to prenatal depression. Our results contribute to the growing evidence underscoring the need for early intervention and tailored support for those experiencing depression during pregnancy.
Funding
HappyMums Project, funded by the European Union (Grant Agreement n.101057390).
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Pub Date : 2026-01-23DOI: 10.1016/j.lanepe.2026.101593
Anna Schranz , Anja Knoche-Becker , Moritz Rosenkranz , Uwe Verthein , Jakob Manthey
Background
In April 2024, Germany legalised adult cannabis possession and cultivation, and in August 2024 established legal THC-limits for driving. This study aimed to examine short-term impacts on (1) cannabis use and (2) driving under the influence of cannabis (DUIC), and (3) investigates the extent of DUIC involving cannabis combined with alcohol or other drugs (DUIC(+)).
Methods
Data came from two cross-sectional population surveys in Germany and Austria (control) before (t0: Nov–Dec 2023) and after legalisation (t1: Nov 2024–Jan 2025). We assessed 12-month cannabis use among adults aged 18–64 (Germany: nt0 = 6670, nt1 = 9692; Austria: nt0 = 2132, nt1 = 2102) and DUIC among at least monthly cannabis users (excluding medical use; Germany: nt0 = 393, nt1 = 589; Austria: nt0 = 86, nt1 = 92) using a difference-in-differences (DiD) approach. For t1, we compared the proportion of DUIC(+) and cannabis-only DUIC(−) episodes among all DUIC episodes by use frequency.
Findings
In Germany, cannabis use rose from 12·1% to 14·4%, but this trend did not significantly differ from Austria (DiD-effect: OR = 1·18, 95% CI 0·95–1·48, p = 0·141, weighted). Among at least monthly users, DUIC decreased slightly from 28·5% to 26·8% (unweighted), with no significant difference compared with Austria (DiD-effect: aOR = 0·68, 95% CI 0·27–1·68, p = 0·408). Results held across sensitivity analyses including additional confounders and negative controls. At t1, DUIC(+) accounted for 21·5% of episodes. DUIC(−) was most common among daily users, DUIC(+) among weekly users.
Interpretation
Eight months after legalisation, no significant short-term effects on cannabis use or DUIC were observed. DUIC(+), associated with higher traffic risk, was most common among weekly users. A comprehensive evaluation of the cannabis reform requires further monitoring of DUIC and traffic data.
Funding
Federal Highway and Transport Research Institute (FE 82.0816/2023).
2024年4月，德国将成人大麻持有和种植合法化，并于2024年8月建立了合法的驾驶四氢大麻酚限制。本研究旨在研究对(1)大麻使用和(2)大麻影响下驾驶（DUIC）的短期影响，以及(3)调查涉及大麻与酒精或其他药物混合的DUIC的程度（DUIC(+)）。方法数据来自合法化前（2023年11月- 12月）和合法化后（2024年11月- 2025年1月）在德国和奥地利（对照）进行的两次横断面人口调查。我们使用差异中的差异（DiD）方法评估了18-64岁成年人12个月的大麻使用情况（德国：nt0 = 6670, nt1 = 9692；奥地利：nt0 = 2132, nt1 = 2102）和至少每月大麻使用者（不包括医疗使用；德国：nt0 = 393, nt1 = 589；奥地利：nt0 = 86, nt1 = 92）的DUIC。对于t1，我们按使用频率比较了DUIC（+）和大麻纯DUIC（−）发作在所有DUIC发作中的比例。在德国，大麻使用率从12.1%上升到14.4%，但这一趋势与奥地利没有显著差异（did -effect: OR = 1.18, 95% CI 0.95 - 1.48, p = 0.141，加权）。在至少一个月的使用者中，DUIC从28.5%略微下降到26.8%（未加权），与奥地利相比无显著差异（did效应：aOR = 0.68, 95% CI 0.27 - 1.68, p = 0.408）。包括额外混杂因素和阴性对照在内的敏感性分析结果一致。t1时，DUIC（+）占21.5%。DUIC（−）在每日用户中最常见，DUIC（+）在每周用户中最常见。合法化8个月后，没有观察到对大麻使用或DUIC的显着短期影响。DUIC（+）与更高的流量风险相关，在每周用户中最常见。对大麻改革的全面评估需要进一步监测DUIC和交通数据。联邦公路和运输研究所（FE 82.0816/2023）。
{"title":"Short-term effects of cannabis legalisation in Germany on driving under the influence of cannabis: a difference-in-differences analysis using Austria as a control","authors":"Anna Schranz , Anja Knoche-Becker , Moritz Rosenkranz , Uwe Verthein , Jakob Manthey","doi":"10.1016/j.lanepe.2026.101593","DOIUrl":"10.1016/j.lanepe.2026.101593","url":null,"abstract":"<div><h3>Background</h3><div>In April 2024, Germany legalised adult cannabis possession and cultivation, and in August 2024 established legal THC-limits for driving. This study aimed to examine short-term impacts on (1) cannabis use and (2) driving under the influence of cannabis (DUIC), and (3) investigates the extent of DUIC involving cannabis combined with alcohol or other drugs (DUIC(+)).</div></div><div><h3>Methods</h3><div>Data came from two cross-sectional population surveys in Germany and Austria (control) before (t<sub>0</sub>: Nov–Dec 2023) and after legalisation (t<sub>1</sub>: Nov 2024–Jan 2025). We assessed 12-month cannabis use among adults aged 18–64 (Germany: n<sub>t0</sub> = 6670, n<sub>t1</sub> = 9692; Austria: n<sub>t0</sub> = 2132, n<sub>t1</sub> = 2102) and DUIC among at least monthly cannabis users (excluding medical use; Germany: n<sub>t0</sub> = 393, n<sub>t1</sub> = 589; Austria: n<sub>t0</sub> = 86, n<sub>t1</sub> = 92) using a difference-in-differences (DiD) approach. For t<sub>1</sub>, we compared the proportion of DUIC(+) and cannabis-only DUIC(−) episodes among all DUIC episodes by use frequency.</div></div><div><h3>Findings</h3><div>In Germany, cannabis use rose from 12·1% to 14·4%, but this trend did not significantly differ from Austria (DiD-effect: <em>OR</em> = 1·18, 95% CI 0·95–1·48, <em>p</em> = 0·141, weighted). Among at least monthly users, DUIC decreased slightly from 28·5% to 26·8% (unweighted), with no significant difference compared with Austria (DiD-effect: <em>aOR</em> = 0·68, 95% <em>CI</em> 0·27–1·68, <em>p</em> = 0·408). Results held across sensitivity analyses including additional confounders and negative controls. At t<sub>1</sub>, DUIC(+) accounted for 21·5% of episodes. DUIC(−) was most common among daily users, DUIC(+) among weekly users.</div></div><div><h3>Interpretation</h3><div>Eight months after legalisation, no significant short-term effects on cannabis use or DUIC were observed. DUIC(+), associated with higher traffic risk, was most common among weekly users. A comprehensive evaluation of the cannabis reform requires further monitoring of DUIC and traffic data.</div></div><div><h3>Funding</h3><div><span>Federal Highway</span> and <span>Transport Research Institute</span> (FE 82.0816/2023).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101593"},"PeriodicalIF":13.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023191","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 : 2026-01-23DOI: 10.1016/j.lanepe.2026.101592
Carolina Espina , David Ritchie , Elio Riboli , Hans Kromhout , Silvia Franceschi , Iris Lansdorp-Vogelaar , Theresa M. Marteau , Ioanna Bakogianni , Nadia Vilahur , Catherina J. Alberts , Urska Ivanus , Ariadna Feliu , Erica D'Souza , Hajo Zeeb , Giota Mitrou , Tit Albreht , Joakim Dillner , Jérôme Foucaud , Marta Manczuk , Jose María Martin-Moreno , Joachim Schüz
Despite the growing cancer burden in the European Union, public awareness of effective prevention is low. In response, Europe's Beating Cancer Plan has supported the development of the 5th edition of the European Code Against Cancer (ECAC5). Using a transparent, stepwise decision-making process, around 80 experts reviewed the latest scientific evidence on cancer prevention and used modern communication strategies to update the previous edition. An innovation in ECAC5 is the inclusion of population-level recommendations, aiming to structurally influence the systems that shape individual choices and improve environmental conditions to which all citizens are involuntarily exposed. ECAC5 includes 14 actionable, evidence-based recommendations for individuals to reduce their cancer risk alongside their respective policy recommendations. All are presented through equity lens, with attention to co-benefits for preventing other non-communicable diseases and tailoring messages to diverse audiences. Clear evidence-based statements on cancer risks factors and effective preventive interventions will empower citizens to make healthier choices, call policymakers to act, foster public support for effective policies, and contribute to more effective cancer prevention.
{"title":"European Code Against Cancer 5th edition: 14 ways you can help prevent cancer","authors":"Carolina Espina , David Ritchie , Elio Riboli , Hans Kromhout , Silvia Franceschi , Iris Lansdorp-Vogelaar , Theresa M. Marteau , Ioanna Bakogianni , Nadia Vilahur , Catherina J. Alberts , Urska Ivanus , Ariadna Feliu , Erica D'Souza , Hajo Zeeb , Giota Mitrou , Tit Albreht , Joakim Dillner , Jérôme Foucaud , Marta Manczuk , Jose María Martin-Moreno , Joachim Schüz","doi":"10.1016/j.lanepe.2026.101592","DOIUrl":"10.1016/j.lanepe.2026.101592","url":null,"abstract":"<div><div>Despite the growing cancer burden in the European Union, public awareness of effective prevention is low. In response, Europe's Beating Cancer Plan has supported the development of the 5th edition of the European Code Against Cancer (ECAC5). Using a transparent, stepwise decision-making process, around 80 experts reviewed the latest scientific evidence on cancer prevention and used modern communication strategies to update the previous edition. An innovation in ECAC5 is the inclusion of population-level recommendations, aiming to structurally influence the systems that shape individual choices and improve environmental conditions to which all citizens are involuntarily exposed. ECAC5 includes 14 actionable, evidence-based recommendations for individuals to reduce their cancer risk alongside their respective policy recommendations. All are presented through equity lens, with attention to co-benefits for preventing other non-communicable diseases and tailoring messages to diverse audiences. Clear evidence-based statements on cancer risks factors and effective preventive interventions will empower citizens to make healthier choices, call policymakers to act, foster public support for effective policies, and contribute to more effective cancer prevention.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101592"},"PeriodicalIF":13.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023193","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 : 2026-01-23DOI: 10.1016/j.lanepe.2026.101589
Markus Frischhut , Barbara Prainsack , Tamara Hervey , Anniek de Ruijter , Tomislav Sokol , Nick Guldemond , Joaquin Cayon-De las Cuevas , André den Exter , Nick Fahy , Guerino Massimo Oscar Fares
{"title":"20 Years of EU health values (2006–2026): four proposals for the future","authors":"Markus Frischhut , Barbara Prainsack , Tamara Hervey , Anniek de Ruijter , Tomislav Sokol , Nick Guldemond , Joaquin Cayon-De las Cuevas , André den Exter , Nick Fahy , Guerino Massimo Oscar Fares","doi":"10.1016/j.lanepe.2026.101589","DOIUrl":"10.1016/j.lanepe.2026.101589","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101589"},"PeriodicalIF":13.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037236","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}
People with diabetes may be more vulnerable to temperature extremes due to impaired thermoregulation and higher prevalence of comorbidities, but evidence is limited. We aimed to compare short-term effects of extreme heat and cold on all-cause emergency hospital admissions in Germany among people with and without diabetes.
Methods
We applied space- and time-stratified conditional quasi-Poisson regression with distributed lag non-linear models (up to 21 days) to estimate short-term effects of daily average temperature. We chose the reference temperature (20 °C) such that it approximates the minimum morbidity temperature in most subgroups. Analyses were stratified by sex, age, and diabetes status using data from all emergency hospital admissions in Germany, 2005–2022 (N = 132,243,083) at the level of 400 administrative districts, enabling an ecological study.
Findings
Both heat and cold increased hospital admissions. Heat-related relative risks (RR) were broadly similar between people with and without diabetes. Considering all ages, heat-related RRs (95% confidence interval) were 1.03 (1.03–1.04), 1.07 (1.00–1.13), and 1.02 (1.01–1.03) in males without, with type 1, and with type 2 diabetes. Age-specific RRs for heat and cold were similar between people without and with type 2 diabetes but higher for type 1 diabetes in some subgroups; e.g. cold-related RRs were 1.13 (1.12–1.15) and 1.51 (1.14–2.01) in men aged ≥80 years without and with type 1 diabetes.
Interpretation
Contrary to prior hypotheses, diabetes was not associated with greater vulnerability. This may reflect good healthcare access and increased awareness of heat and cold-related risks among people with diabetes. Nevertheless, given the higher baseline risk of hospital admission in diabetes, similar RR may still translate into larger absolute effects of extreme temperatures. Hence, clinical practice and policies aimed at mitigating temperature-related effects should continue to consider diabetes as a potential vulnerability factor.
{"title":"Air temperature and all-cause emergency hospital admissions in people with and without diabetes in Germany (2005–2022): a time-series analysis","authors":"Thaddäus Tönnies , Marielle Wirth , Katharina Piedboeuf-Potyka , Oliver Kuss","doi":"10.1016/j.lanepe.2026.101591","DOIUrl":"10.1016/j.lanepe.2026.101591","url":null,"abstract":"<div><h3>Background</h3><div>People with diabetes may be more vulnerable to temperature extremes due to impaired thermoregulation and higher prevalence of comorbidities, but evidence is limited. We aimed to compare short-term effects of extreme heat and cold on all-cause emergency hospital admissions in Germany among people with and without diabetes.</div></div><div><h3>Methods</h3><div>We applied space- and time-stratified conditional quasi-Poisson regression with distributed lag non-linear models (up to 21 days) to estimate short-term effects of daily average temperature. We chose the reference temperature (20 °C) such that it approximates the minimum morbidity temperature in most subgroups. Analyses were stratified by sex, age, and diabetes status using data from all emergency hospital admissions in Germany, 2005–2022 (N = 132,243,083) at the level of 400 administrative districts, enabling an ecological study.</div></div><div><h3>Findings</h3><div>Both heat and cold increased hospital admissions. Heat-related relative risks (RR) were broadly similar between people with and without diabetes. Considering all ages, heat-related RRs (95% confidence interval) were 1.03 (1.03–1.04), 1.07 (1.00–1.13), and 1.02 (1.01–1.03) in males without, with type 1, and with type 2 diabetes. Age-specific RRs for heat and cold were similar between people without and with type 2 diabetes but higher for type 1 diabetes in some subgroups; e.g. cold-related RRs were 1.13 (1.12–1.15) and 1.51 (1.14–2.01) in men aged ≥80 years without and with type 1 diabetes.</div></div><div><h3>Interpretation</h3><div>Contrary to prior hypotheses, diabetes was not associated with greater vulnerability. This may reflect good healthcare access and increased awareness of heat and cold-related risks among people with diabetes. Nevertheless, given the higher baseline risk of hospital admission in diabetes, similar RR may still translate into larger absolute effects of extreme temperatures. Hence, clinical practice and policies aimed at mitigating temperature-related effects should continue to consider diabetes as a potential vulnerability factor.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101591"},"PeriodicalIF":13.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023192","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 : 2026-01-22DOI: 10.1016/j.lanepe.2025.101585
Irene López-Sánchez , Anna Palomar-Cros , Ravinder Claire , Laura Pérez-Crespo , Agustina Giuliodori , Ian Koblbauer , Jeremy Dietz , Jamie Elvidge , James Koh , Asieh Golozar , Juan Manuel Ramirez-Anguita , Angela Leis , Miguel-Angel Mayer , Nicola Symmers , Mahéva Vallet , Colin McLean , Peter S. Hall , Mees Mosseveld , Katia Verhamme , Espen Enerly , Danielle Newby
Background
Real-world evidence provides valuable insights into cancer burden, presentation, and care variations. Through a large-scale federated approach, this study aims to explore patient characteristics and overall survival for eight cancers using data from 11 electronic health records and cancer registries from eight European countries, mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM).
Methods
Patients aged 18 years or older with a primary cancer diagnosis between 2000 and 2019 were included. Patients were followed from cancer diagnosis until death, database exit, or study end. Mortality data was sourced from linked national or subnational death registries for most databases. Patient characteristics, including comorbidities, and medication use, were summarised. Age-standardised overall survival (OS) at one, five, and ten years were calculated using the Kaplan–Meier method and stratified by cancer type, age group and sex.
Findings
There were 1,796,278 eligible cancer patients included with most diagnoses in individuals aged 60–79 years. Top comorbidities and medications were relatively consistent across databases, with certain variations observed by cancer type, possibly indicative of early cancer signs and risk factors. For instance, anaemia was frequent in colorectal (9% [HUS]–23% [IMASIS]; 791/8395–730/3141 individuals) and stomach cancers (10% [HUS]–34% [IMASIS]; 130/1277–225/670), while chronic obstructive pulmonary disease (18% [SIDIAP]–34% [HUVM], 5310/29,009–1039/3063) and pneumonia (5% [CPRD GOLD]–33% [UTARTU], 1904/34,990–1001/3063) were common in lung cancer patients. Breast and prostate cancers had the highest one, five and ten-year overall survival, with 5-year OS ranging from 76% [ECi]–85% [IMASIS] and 75% [HUVM]–83% [SIDIAP], respectively. Pancreatic cancer showed the lowest survival ranging from 3% [NCR]–25% [IMASIS] 5-year OS. Variations in cancer survival estimates were observed across data sources and countries.
Interpretation
Federated analysis of diverse European real-world databases, standardised to OMOP-CDM, offer a valuable benchmark for future cancer research, particularly in understanding prodromes and risk factors, often recorded in routinely collected healthcare data prior to cancer onset.
Funding
The European Health Data & Evidence Network has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806968. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations partners.
{"title":"Comorbidities, medication use, and overall survival in eight cancers: a multinational cohort study of 1.7 million patients across Europe","authors":"Irene López-Sánchez , Anna Palomar-Cros , Ravinder Claire , Laura Pérez-Crespo , Agustina Giuliodori , Ian Koblbauer , Jeremy Dietz , Jamie Elvidge , James Koh , Asieh Golozar , Juan Manuel Ramirez-Anguita , Angela Leis , Miguel-Angel Mayer , Nicola Symmers , Mahéva Vallet , Colin McLean , Peter S. Hall , Mees Mosseveld , Katia Verhamme , Espen Enerly , Danielle Newby","doi":"10.1016/j.lanepe.2025.101585","DOIUrl":"10.1016/j.lanepe.2025.101585","url":null,"abstract":"<div><h3>Background</h3><div>Real-world evidence provides valuable insights into cancer burden, presentation, and care variations. Through a large-scale federated approach, this study aims to explore patient characteristics and overall survival for eight cancers using data from 11 electronic health records and cancer registries from eight European countries, mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM).</div></div><div><h3>Methods</h3><div>Patients aged 18 years or older with a primary cancer diagnosis between 2000 and 2019 were included. Patients were followed from cancer diagnosis until death, database exit, or study end. Mortality data was sourced from linked national or subnational death registries for most databases. Patient characteristics, including comorbidities, and medication use, were summarised. Age-standardised overall survival (OS) at one, five, and ten years were calculated using the Kaplan–Meier method and stratified by cancer type, age group and sex.</div></div><div><h3>Findings</h3><div>There were 1,796,278 eligible cancer patients included with most diagnoses in individuals aged 60–79 years. Top comorbidities and medications were relatively consistent across databases, with certain variations observed by cancer type, possibly indicative of early cancer signs and risk factors. For instance, anaemia was frequent in colorectal (9% [HUS]–23% [IMASIS]; 791/8395–730/3141 individuals) and stomach cancers (10% [HUS]–34% [IMASIS]; 130/1277–225/670), while chronic obstructive pulmonary disease (18% [SIDIAP]–34% [HUVM], 5310/29,009–1039/3063) and pneumonia (5% [CPRD GOLD]–33% [UTARTU], 1904/34,990–1001/3063) were common in lung cancer patients. Breast and prostate cancers had the highest one, five and ten-year overall survival, with 5-year OS ranging from 76% [ECi]–85% [IMASIS] and 75% [HUVM]–83% [SIDIAP], respectively. Pancreatic cancer showed the lowest survival ranging from 3% [NCR]–25% [IMASIS] 5-year OS. Variations in cancer survival estimates were observed across data sources and countries.</div></div><div><h3>Interpretation</h3><div>Federated analysis of diverse European real-world databases, standardised to OMOP-CDM, offer a valuable benchmark for future cancer research, particularly in understanding prodromes and risk factors, often recorded in routinely collected healthcare data prior to cancer onset.</div></div><div><h3>Funding</h3><div>The <span>European Health Data & Evidence Network</span> has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806968. The JU receives support from the <span>European Union’s Horizon 2020</span> research and innovation programme and the European Federation of Pharmaceutical Industries and Associations partners.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101585"},"PeriodicalIF":13.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023190","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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