Lancet Regional Health-Europe最新文献

{"title":"Work ability trajectories and sick leave in individuals with post COVID-19 condition: 3-year follow-up of a population-based cohort","authors":"Tala Ballouz,&nbsp;Philipp Kerksieck,&nbsp;Sarah R. Haile,&nbsp;Holger Dressel,&nbsp;Oliver Hämmig,&nbsp;Georg F. Bauer,&nbsp;Jan S. Fehr,&nbsp;Milo A. Puhan,&nbsp;Dominik Menges","doi":"10.1016/j.lanepe.2025.101536","DOIUrl":"10.1016/j.lanepe.2025.101536","url":null,"abstract":"<div><h3>Background</h3><div>Data on the longer-term impact of post COVID-19 condition (PCC) on work-related functioning is limited, despite evidence on the persistence of PCC for years after infection. This study aimed to describe changes in work ability and sick leave associated with PCC up to three years post-infection.</div></div><div><h3>Methods</h3><div>We used data from 667 working-age individuals within a prospective population-based cohort following individuals infected with SARS-CoV-2 between August 2020 and January 2021. PCC was determined at 12 months and work ability was assessed biannually. The impact of SARS-CoV-2 on participants’ physical and mental work performance and COVID-19 related sick leave were assessed at three years.</div></div><div><h3>Findings</h3><div>Participants with protracted COVID-19 related symptoms at 12 months after infection reported persistently lower work ability scores than those without symptoms, with no evidence of a difference in change over time (−0.12 points per year, 95% CI −0.29 to 0.07). Compared to recovered individuals, work ability scores among those with moderate health impairment improved by +0.72 points per year (95% CI −0.04 to 1.46), while trends were similar among those with mild or severe impairment. A higher proportion of participants with PCC reported worsening in physical and mental performance at work than those without PCC. Among those with PCC, 11.5% (9/78) reported taking COVID-19 related sick leave for one month or more, in contrast to 4.0% (13/327) among those without PCC.</div></div><div><h3>Interpretation</h3><div>The study highlights the prolonged impact of PCC on work-related functioning and underscores the need for targeted occupational, clinical and social measures for those affected.</div></div><div><h3>Funding</h3><div><span>Federal Office of Public Health</span>, <span>Department of Health of the Canton of Zurich</span>, <span>University of Zurich Foundation</span>, Switzerland; <span>Horizon Europe</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101536"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580504","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":"Risk of new HIV diagnosis by intersecting migration, socioeconomic, and mental health vulnerabilities in the Netherlands: a nationwide analysis of the ATHENA cohort and Statistics Netherlands registry data","authors":"Vita W. Jongen ,&nbsp;Anders Boyd ,&nbsp;Patrizia Carrieri ,&nbsp;Nina Schat ,&nbsp;Selwyn H. Lowe ,&nbsp;Rosan van Zoest ,&nbsp;Marit G.A. van Vonderen ,&nbsp;Jolanda Lammers ,&nbsp;Mark Verhagen ,&nbsp;Ard van Sighem ,&nbsp;Marc van der Valk","doi":"10.1016/j.lanepe.2025.101508","DOIUrl":"10.1016/j.lanepe.2025.101508","url":null,"abstract":"<div><h3>Background</h3><div>To further reduce new HIV diagnoses in the Netherlands, individual and structural barriers hindering prevention must be addressed. We aimed to estimate the disproportional burden of new HIV diagnoses and explore how intersecting socio-demographic, socio-economic, and health-related factors jointly influence the risk of a new HIV diagnosis.</div></div><div><h3>Methods</h3><div>We combined data from the ATHENA cohort, an ongoing nationwide HIV cohort, with registry data from Statistics Netherlands. We selected individuals with a new HIV diagnosis between 1 January 2012 and 31 December 2023 and matched them to individuals from the general population. We assessed determinants of a new HIV diagnosis using a multivariable generalized linear model. We used Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify the joint and individual contribution of intersecting variables.</div></div><div><h3>Findings</h3><div>6055 men and 1020 women were newly diagnosed with HIV. Having a migration background and a low to middle income or income below the poverty line was associated with a higher risk of a new HIV diagnosis for both men (low to middle: adjusted odd ratio (aOR) = 1.24, 95% confidence interval (CI) = 1.17–1.31; below the poverty line: aOR = 1.75, 95% CI = 1.62–1.89) and women (low to middle: aOR = 2.49, 95% CI = 2.05–3.01; below the poverty line: aOR = 4.71, 95% CI = 3.80–5.83). Use of mental health care (aOR = 1.14, 95% CI = 1.01–1.27) or antidepressants (aOR = 1.66, 95% CI = 1.50–1.84) also increased the risk among men; while receiving social welfare (aOR = 1.39, 95% CI = 1.15–1.67) and use of antipsychotic medication (aOR = 1.66, 95% CI = 1.21–2.28) increased the risk among women. Of all intersections identified in MAIHDA, men with a first-generation migration background, income below the poverty line, and who used antidepressants had the highest predicted probability of an HIV diagnosis (0.036%, 95% confidence interval (CI) = 0.025–0.052). Women with a first-generation background, income below the poverty line, who received social welfare, and who used antipsychotic medication had the highest predicted risk (0.019%, 95% CI = 0.011–0.035).</div></div><div><h3>Interpretation</h3><div>A disproportionally higher burden of a new HIV diagnosis was observed for individuals with a migration background and economic and mental health vulnerabilities. HIV prevention and testing need to be reinforced in these groups.</div></div><div><h3>Funding</h3><div><span>Dutch Ministry of Health, Welfare and Sport</span>; <span>TKI Health Holland</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101508"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736732","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":"European Medicines Agency approvals of new medicines in September and October 2025","authors":"Bruno Sepodes ,&nbsp;Juan Garcia Burgos ,&nbsp;Steffen Thirstrup","doi":"10.1016/j.lanepe.2025.101542","DOIUrl":"10.1016/j.lanepe.2025.101542","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101542"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571262","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":"Current perspectives on psychedelic treatments in Europe","authors":"Santiago Madero ,&nbsp;Oscar Soto-Angona ,&nbsp;Genis Ona ,&nbsp;Jose Sanchez-Moreno ,&nbsp;Eduard Vieta","doi":"10.1016/j.lanepe.2025.101537","DOIUrl":"10.1016/j.lanepe.2025.101537","url":null,"abstract":"<div><div>In this viewpoint, we explore the evolving landscape of psychedelic-assisted therapy in Europe, focusing on clinical, regulatory, and therapeutic developments. While access remains limited, recent initiatives in Switzerland, Germany, and the Czech Republic illustrate growing momentum toward regulated use. We examine the debate surrounding psychedelics as pharmacological agents versus psychotherapeutic catalysts and argue for an integrative framework that considers neurobiological mechanisms, subjective experience, and contextual factors. We focus on how their effects, particularly those involving neuroplasticity and critical periods, may interact with psychotherapeutic processes. We highlight the importance of context and psychological support in shaping outcomes and discuss the challenges of implementing scalable care models. Regulatory fragmentation and methodological complexities continue to hinder progress, but publicly funded trials such as EPIsoDE and PsyPal offer promising examples of ethical and effective approaches. In our view, the future of psychedelic therapy lies not in simplifying its complexity, but in embracing it.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101537"},"PeriodicalIF":13.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580505","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":"Strengthening antimicrobial resistance governance in Europe: a coordinated one health approach","authors":"Benjamin Davido ,&nbsp;Sofia Ny ,&nbsp;Corine van Lingen ,&nbsp;Christine Årdal ,&nbsp;Laura Alonso Irujo ,&nbsp;Sofia Linnros ,&nbsp;Lucie Collineau ,&nbsp;Nerea Gonzalez Hernandez ,&nbsp;Marta Gutierrez Rubio ,&nbsp;Giel van de Laar ,&nbsp;Lida Politi ,&nbsp;Brian Kristensen ,&nbsp;Ana Álvarez-Fernández ,&nbsp;Yohann Lacotte ,&nbsp;Agathe Claude ,&nbsp;Marie-Cécile Ploy","doi":"10.1016/j.lanepe.2025.101540","DOIUrl":"10.1016/j.lanepe.2025.101540","url":null,"abstract":"<div><div>Antimicrobial resistance (AMR) causes over 35,000 deaths annually in the EU/EEA and is projected to result in 1.91 million global deaths each year by 2050. The second Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI-2), uniting 128 partners from 30 countries, represents a coordinated EU/EEA effort to curb AMR through a One Health approach. Although nearly all EU/EEA countries have an AMR National Action Plan, our initial assessment revealed that implementation remains constrained by limited resources, weak intersectoral coordination and fragmented leadership. EU-JAMRAI-2 addresses these challenges by promoting harmonized surveillance, strengthening infection prevention and control, applying behaviorally tailored stewardship interventions, ensuring sustainable access to essential antibiotics, and raising awareness among priority target audiences. By analyzing policy gaps and operational barriers, this paper underscores the need for stronger accountability and political commitment to translate strategies into sustainable action. Strengthening AMR governance through a unified European approach is essential to achieve effective, lasting progress against this silent pandemic.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101540"},"PeriodicalIF":13.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797111","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":"Cost-effectiveness of pramipexole augmentation for acute phase and maintenance therapy of treatment-resistant depression compared to placebo augmentation: economic evaluation of the PAX-D randomised controlled trial","authors":"Agata Łaszewska ,&nbsp;Timea Helter ,&nbsp;Ashley Baldwin ,&nbsp;Anthony J. Cleare ,&nbsp;Philip J. Cowen ,&nbsp;Jonathan Evans ,&nbsp;Quentin J.M. Huys ,&nbsp;Micheal Kurkar ,&nbsp;Alexander C. Lewis ,&nbsp;Neil Nixon ,&nbsp;Abhinav Rastogi ,&nbsp;Stuart Watson ,&nbsp;John R. Geddes ,&nbsp;Michael Browning ,&nbsp;Judit Simon","doi":"10.1016/j.lanepe.2025.101533","DOIUrl":"10.1016/j.lanepe.2025.101533","url":null,"abstract":"<div><h3>Background</h3><div>Pramipexole augmentation of antidepressant treatment for treatment-resistant depression (TRD) has been shown to improve symptom burden over 12 weeks but with some adverse effects compared to placebo augmentation. We aimed to evaluate the cost-effectiveness of pramipexole augmentation for TRD.</div></div><div><h3>Methods</h3><div>We conducted an economic evaluation as part of the PAX-D trial over 12 and 48 weeks. Two costing perspectives, National Health Service and Personal Social Services (NHS + PSS) and societal, were adopted. The primary outcome was quality-adjusted life year (QALY) based on the EQ-5D-5L. Secondary outcomes included year of full capability (YFC) based on the ICECAP-A, and capability-weighted life year (CWLY) based on the OxCAP-MH. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes and cost-effectiveness acceptability curves were reported alongside sensitivity analyses. The trial was registered with ISCTRN (ISRCTN84666271) and EudraCT (2019-001023-13) and is complete.</div></div><div><h3>Findings</h3><div>From the NHS + PSS perspective, mean incremental cost of pramipexole was £60 (95% CI: −£55, £176) over 12 weeks and £811 (95% CI: £110, £1513) over 48 weeks. The difference in QALY gained was 0.012 (95% CI: 0.003, 0.021) over 12 weeks and 0.090 (95% CI: 0.036, 0.144) over 48 weeks, equivalent to 4 (95% CI: 1, 8) and 33 (95% CI: 13, 52) days in perfect health. The ICER was £5069/QALY (95% CI: −£3642, £35,608) over 12 weeks and £9007/QALY (95% CI: £2,219, £27,258) over 48 weeks, representing over 90% probability of cost-effectiveness at £20,000/QALY threshold. From the societal perspective, pramipexole was on average cost saving and more effective over 48 weeks. Alternative analyses provided consistent conclusions.</div></div><div><h3>Interpretation</h3><div>Pramipexole augmentation for TRD has demonstrated both clinical and cost-effectiveness. Further trials, directly comparing pramipexole to other augmentation strategies, will be useful in determining the position of this repurposed medication in the treatment pathway of depression.</div></div><div><h3>Funding</h3><div><span>National Institute for Health and Care Research</span>, <span>Efficacy and Mechanism Evaluation Programme</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101533"},"PeriodicalIF":13.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580503","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":"Announcing the Lancet Migration European Hub and the Lancet Regional Health-Europe Commission on climate change, migration, displacement and health","authors":"Bernadette N. Kumar ,&nbsp;Anand S. Bhopal ,&nbsp;Sylvia Garry ,&nbsp;Rosemary James ,&nbsp;Ozge Karadag ,&nbsp;Miriam Orcutt ,&nbsp;Shilpa Rao ,&nbsp;Shervin Shahnavaz ,&nbsp;Santino Severoni ,&nbsp;Amirhossein Takian ,&nbsp;Pooja Jha ,&nbsp;Karl Blanchet","doi":"10.1016/j.lanepe.2025.101532","DOIUrl":"10.1016/j.lanepe.2025.101532","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"59 ","pages":"Article 101532"},"PeriodicalIF":13.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579111","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":"Diagnostic algorithms for tuberculosis in Europe: insights from the European Reference Laboratory Network for Tuberculosis (ERLTB-Net)","authors":"Francesca Saluzzo ,&nbsp;Andrea Maurizio Cabibbe ,&nbsp;Richard Anthony ,&nbsp;Alexandra Aubry ,&nbsp;Francis Drobniewski ,&nbsp;Yen Holicka ,&nbsp;Troels Lillebaek ,&nbsp;Rita Macedo ,&nbsp;Mikael Mansjö ,&nbsp;Viktoria Szél ,&nbsp;Ljiljana Žmak ,&nbsp;Daniela M. Cirillo ,&nbsp;Ramona Groenheit","doi":"10.1016/j.lanepe.2025.101516","DOIUrl":"10.1016/j.lanepe.2025.101516","url":null,"abstract":"<div><div>The reported poor treatment outcomes for extensively drug-resistant tuberculosis (TB) in the European region highlight the urgent need for effective and context-appropriate diagnostic strategies. While the World Health Organisation (WHO) provides model algorithms, these require adaptation to the European Union/European Economic Area (EU/EEA) context, a setting with low TB incidence but high resources. This viewpoint from the European Reference Laboratory Network for TB (ERLTB-Net) proposes a tailored diagnostic algorithm that prioritises the universal use of WHO-recommended molecular rapid diagnostic tests, systematic culture, and whole genome sequencing (WGS). This approach integrates phenotypic drug susceptibility testing strategically and outlines the possible role of targeted next-generation sequencing (tNGS) in the EU/EEA setting. The algorithm also addresses the importance of diagnostic harmonisation, cross-border collaboration, and sustained investment in sequencing capacity. By aligning diagnostic practices with the regional epidemiology and laboratory infrastructure, this stepwise, resource-sensitive approach aims to strengthen TB control, improve treatment outcomes, and guide public health action in the EU/EEA.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101516"},"PeriodicalIF":13.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529368","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":"Outcomes of adults with community-acquired bacterial meningitis in the Netherlands: a prospective nationwide cohort study","authors":"Evelien H.G.M. Drost,&nbsp;Eva N. Schepers,&nbsp;Nora Chekrouni,&nbsp;Thijs M. van Soest,&nbsp;Diederik L.H. Koelman,&nbsp;Merijn W. Bijlsma,&nbsp;Matthijs C. Brouwer,&nbsp;Diederik van de Beek","doi":"10.1016/j.lanepe.2025.101529","DOIUrl":"10.1016/j.lanepe.2025.101529","url":null,"abstract":"<div><h3>Background</h3><div>Bacterial meningitis is associated with high rates of unfavourable outcome. We conducted a nationwide prospective study in the Netherlands to evaluate outcome in adults with bacterial meningitis, focusing on pathogen-specific differences, risk factors for unfavourable outcomes, and neurological sequelae.</div></div><div><h3>Methods</h3><div>Adult patients with community-acquired bacterial meningitis confirmed by lumbar puncture were identified through the database of the Netherlands Reference Laboratory for Bacterial Meningitis and prospectively included. Neurological examinations were performed on admission and discharge by the treating physician, and outcome was assessed using the Glasgow Outcome Scale, with scores of 1–4 classified as unfavourable. Logistic regression was used to evaluate the association between potential predictors and outcome.</div></div><div><h3>Findings</h3><div>Between January 1, 2006 and January 1, 2024, 2974 patients were included. <em>Streptococcus pneumoniae</em> was the most common pathogen (2029/2974; 68%), followed by <em>Neisseria meningitidis</em> (329/2974; 11%), <em>Listeria monocytogenes</em> (182/2974; 6%), <em>Haemophilus influenzae</em> (119/2974; 4%) and <em>Streptococcus pyogenes</em> (83/2974; 3%). Overall mortality was 17% (516/2974) and remained stable over 18 years (odds ratio per admission year 0·99 [95% CI 0·97–1·01]). Mortality was highest for <em>L</em>. <em>monocytogenes</em> (58/182; 32%), <em>S</em>. <em>pyogenes</em> (16/83; 19%), and <em>S</em>. <em>pneumoniae</em> (365/2029; 18%). Unfavourable outcome occurred in 1161/2974 patients (39%; 95% CI 37–41), and key predictors included advanced age, prolonged symptom duration, systemic or cerebral compromise, low CSF white-cell counts, and absence of adjunctive dexamethasone. Among survivors, neurological sequelae occurred in 1146/2088 patients (55%), including hearing impairment (692/2197; 31%) and cognitive impairment (481/2108; 23%), with highest rates following <em>S</em>. <em>pneumoniae</em> (881/1419; 62%), and <em>S</em>. <em>pyogenes</em> (44/59; 75%).</div></div><div><h3>Interpretation</h3><div>Mortality and morbidity from bacterial meningitis remain high, especially in <em>L</em>. <em>monocytogenes</em>, <em>S</em>. <em>pyogenes</em>, and <em>S</em>. <em>pneumoniae</em> infections. These findings highlight an urgent need for enhanced vaccination strategies, timely recognition, and improved therapies.</div></div><div><h3>Funding</h3><div>Netherlands Organization for Health Research and Development (ZonMW).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"61 ","pages":"Article 101529"},"PeriodicalIF":13.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499912","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":"Cancer diagnoses, referrals, and survival in people with a learning disability in the UK: a population-based, matched cohort study","authors":"Oliver John Kennedy ,&nbsp;Umesh Chauhan ,&nbsp;Louise Gorman ,&nbsp;Paul Lorigan ,&nbsp;Samuel Merriel ,&nbsp;Tjeerd Van Staa ,&nbsp;Alison Wright ,&nbsp;Darren Mark Ashcroft","doi":"10.1016/j.lanepe.2025.101519","DOIUrl":"10.1016/j.lanepe.2025.101519","url":null,"abstract":"<div><h3>Background</h3><div>People with a learning disability (LD, also known as intellectual disability) face poorer health outcomes, yet the burden of cancer in this population is poorly understood. This study investigated cancer-related outcomes in people with a LD compared to the general population.</div></div><div><h3>Methods</h3><div>A matched cohort study was conducted using linked primary care, hospital, mortality, and cancer registry data from Clinical Practice Research Datalink (CPRD) Aurum. In total, 180,911 individuals with a LD were matched with 3,405,467 controls. Outcomes included urgent suspected cancer (USC) referrals, cancer diagnoses, treatment within six months, and overall survival (OS) post-diagnosis.</div></div><div><h3>Findings</h3><div>Individuals with a LD had fewer USC referrals within 28 days of possible cancer symptoms (adjusted risk ratio [aRR] 0.52, 95% confidence interval [CI] 0.49–0.55). LD was associated with several cancers, including sarcoma (adjusted hazard ratio [aHR] 1.98, 1.65–2.39), central nervous system (aHR 3.42, 2.99–3.90), testicular (aHR 2.06, 1.61–2.62), and uterine cancers (aHR 1.69, 1.40–2.05) as well as cancer before age 50 years (aHR 1.74, 1.63–1.86). Absolute incidence was lower in individuals with a LD compared to without (3396 [1.9%] vs 67,506 [2.0%]) due to increased all-cause mortality (aHR 3.19, 3.12–3.27). LD was associated with fewer diagnoses via USC referrals (aRR 0.81, 0.76–0.86), fewer treatments within six months (aRR 0.83, 0.80–0.85) and shorter OS (median 4.4 years, 95% CI 3.9–5.1 vs 9.1 years, 8.8–9.5; aHR 1.73, 1.65–1.83). Melanoma, breast, and prostate cancers were less common but had up to a fourfold increased risk of death after diagnosis in individuals with a LD.</div></div><div><h3>Interpretation</h3><div>Individuals with a LD have higher cancer risk, more diagnoses outside USC pathways, fewer treatments, and poorer prognosis. Fewer diagnoses of some cancers, alongside worse outcomes, may indicate under-investigation. As premature all-cause mortality improves, cancer burden in this population may rise disproportionately.</div></div><div><h3>Funding</h3><div><span>NIHR</span> Greater Manchester Patient Safety Research Collaboration (NIHR204295).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"60 ","pages":"Article 101519"},"PeriodicalIF":13.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790206","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}