Lancet Public Health最新文献

{"title":"Mandatory salt targets: a key policy tool for global salt reduction efforts","authors":"Monique Tan","doi":"10.1016/s2468-2667(24)00227-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00227-5","url":null,"abstract":"Salt is consumed in excess in most countries, with global salt intake averaging at more than double the recommended maximum limit of 5 g per day. By raising blood pressure, excess salt intake is a major risk factor for cardiovascular disease, the leading cause of premature death and ill health worldwide. In 2013, all WHO Member States committed to a 30% reduction in average salt intake by 2025. However, as of 2023, none were on track to achieve it.<span><span>¹</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"15 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workplace mortality risk and social determinants among migrant workers: a systematic review and meta-analysis","authors":"Karen Lau, Robert Aldridge, Marie Norredam, George Frederick Mkoma, Mathura Kugan, Rosita Chia-Yin Lin, Ligia Kiss, Cathy Zimmerman, Sally Hargreaves","doi":"10.1016/s2468-2667(24)00226-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00226-3","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Migrant workers, a population of 170 million, often work in dangerous or unhealthy working environments and are likely to suffer workplace injuries and labour abuses. However, the risk of mortality in migrant workers compared with local workers is unknown. We aim to synthesise global evidence on migrant worker mortality risk and identify social determinants to inform health and safety protections for migrant workers.&lt;h3&gt;Methods&lt;/h3&gt;We conducted a systematic review and meta-analysis of peer-reviewed literature to examine mortality outcomes among migrant workers and associated risk factors. We searched MEDLINE, Embase, PsycINFO, and Ovid Global Health for studies published between Jan 1, 2000, and Jan 17, 2023, reporting quantitative primary research in English. A broad definition of migrant worker was used, including any worker who is foreign-born (ie, international first-generation migrant workers), either in paid employment or self-employment. Internal migrants, second-generation migrants, and foreign health-care workers were excluded. The primary outcome was any reported mortality, including all-cause mortality, cause-specific mortality, suicide, homicide, and fatal occupational injury. We used meta-analysis to compare outcomes between migrant worker and local worker populations, and a random-effects model to calculate pooled estimates. We used narrative synthesis to develop a data-driven conceptual framework capturing the intersectional social determinants of mortality in migrant workers. The study protocol is registered on PROSPERO, CRD42023372893.&lt;h3&gt;Findings&lt;/h3&gt;Of 11 495 identified records, 44 were included in the systematic review, of which 11 studies were pooled in meta-analyses. Data were from 16 countries, most of which were high-income countries, and included 44 338 migrant worker deaths, including migrants from the agriculture, construction, mining, and service industries. Compared with local workers, migrant workers had a higher risk of fatal occupational injury (pooled relative risk 1·71, 95% CI 1·22–2·38; eight studies; &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=99·4%), and a lower risk of all-cause mortality (0·94, 0·88–0·99; three studies, &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt;=90·7%). Migrant workers were more likely to die from external causes of death (such as falls or assaults) than internal causes of death (such as respiratory or digestive diseases) compared with local workers, with migrant workers also more likely to die from work-related homicides, especially in the retail and sex industries, with some evidence of higher suicide rates among female migrant workers compared with female local workers. Influential social determinants for poor fatality outcomes include migration-related factors (such as lower language proficiency, undocumented status, and long duration of stay) and labour-related factors (such as precarious employment, labour migration policies, and economic deregulation policies).&lt;h3&gt;Interpretation&lt;/h3&gt;Migrant workers have a ","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"213 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated health benefits, costs, and cost-effectiveness of implementing WHO's sodium benchmarks for packaged foods in India: a modelling study","authors":"Kathy Trieu, Liping Huang, Leopold N Aminde, Linda Cobiac, Daisy H Coyle, Mary Njeri Wanjau, Sudhir Raj Thout, Bruce Neal, Jason H Y Wu, Lennert Veerman, Matti Marklund, Rachita Gupta","doi":"10.1016/s2468-2667(24)00221-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00221-4","url":null,"abstract":"<h3>Background</h3>Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India.<h3>Methods</h3>We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%.<h3>Findings</h3>In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2–0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0–2·4) million incident cardiovascular disease events, and 0·7 (0·4–1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4–6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2–20·1) million incident cardiovascular disease events, and 4·8 (2·8–6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective.<h3>Interpretation</h3>Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise.<h3>Funding</h3>WHO Country Office India.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"3 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"City mobility patterns during the COVID-19 pandemic: analysis of a global natural experiment","authors":"Ruth F Hunter, Selin Akaraci, Ruoyu Wang, Rodrigo Reis, Pedro C Hallal, Sandy Pentland, Christopher Millett, Leandro Garcia, Jason Thompson, Kerry Nice, Belen Zapata-Diomedi, Esteban Moro","doi":"10.1016/s2468-2667(24)00222-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00222-6","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;During the COVID-19 pandemic, changes were seen in city mobility patterns around the world, including in active transportation (walking, cycling, micromobility, and public transit use), creating a unique opportunity for global public health lessons and action. We aimed to analyse a global natural experiment exploring city mobility patterns during the pandemic and how they related to the implementation of COVID-19-related policies.&lt;h3&gt;Methods&lt;/h3&gt;We obtained data from Apple's Mobility Trends Reports on city mobility indexes for 296 cities from Jan 13, 2020 to Feb 4, 2022. Mobility indexes represented the frequency of Apple Maps queries for driving, walking, and public transit journeys relative to a baseline value of 100 for the pre-pandemic period (defined as Jan 13, 2020). City mobility index trajectories were plotted with stratification by country income level, transportation-related city type, population density, and COVID-19 pandemic severity (SARS-CoV-2 infection rate). We also synthesised global pandemic policies and recovery actions that promoted or restricted city mobility and active transportation (walking, cycling and micromobility, and public transit) using the Shifting Streets dataset. Additionally, a natural experiment on a global scale evaluated the effects of new active transportation policies on walking and public transit use in cities around the world. We used multivariable regression with a difference-in-difference (DID) analysis to explore whether the implementation of walking or public transit promotion policies affected mobility indexes, comparing cities with and without implementation of these policies in the pre-intervention period (Jan 27 to April 12, 2020) and post-intervention period (April 13 to June 28, 2020).&lt;h3&gt;Findings&lt;/h3&gt;Based on city mobility index trajectories, we observed an overall decline in mobility indexes for walking, driving, and public transit at the beginning of the pandemic, but these values began to increase in April, 2020. Cities with lower population densities generally had higher driving and walking indexes than cities with higher population density, while cities with higher population densities had higher public transit indexes. Cities with higher pandemic severity generally had higher driving and walking indexes than cities with lower pandemic severity, while cities with lower pandemic severity had higher public transit indexes than other cities. We identified 587 policies in the dataset that had known implementation dates and were relevant to active transportation, which included 305 policies on walking, 321 on cycling and micromobility, and 143 on public transit, across 230 cities within 33 countries (19 high-income, 11 middle-income, and three low-income countries). In the global natural experiment (including 39 cities), implementation of policy interventions promoting walking was significantly associated with a higher absolute value of the walking index (DID coefficient 20·6","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"7 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus-based cervical screening and long-term cervical cancer risk: a randomised health-care policy trial in Sweden","authors":"Jiangrong Wang, K Miriam Elfström, Joakim Dillner","doi":"10.1016/s2468-2667(24)00218-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00218-4","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Human papillomavirus (HPV)-based cervical screening is a globally recommended public health policy. Randomised clinical trials find superior performance of primary HPV-based screening compared with cytology for preventing cervical cancer. However, additional evidence from real-world public health policies is needed. In preplanned secondary analysis of a randomised health-care policy trial in Sweden we aimed to evaluate which policy provided better protection against invasive cervical cancer, after two full rounds of screening.&lt;h3&gt;Methods&lt;/h3&gt;The organised cervical screening programme in the capital region of Sweden invited all women aged 30–64 years and eligible for screening to a randomised health-care policy trial of HPV-based versus cytology-based screening. During 2014–16, 395 725 eligible women were randomly assigned (non-concealed) to either policy and the invasive cervical cancer incidences over 8 years of follow-up were compared. Intention-to-screen analyses included all invited women and per-protocol analyses the women that attended baseline screening according to protocol. This trial is registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT01511328&lt;/span&gt;&lt;svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"&gt;&lt;path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;.&lt;h3&gt;Findings&lt;/h3&gt;Women invited to HPV-based cervical screening had a 17% lower invasive cervical cancer risk compared with women invited to cytology (hazard ratio [HR] 0·83, 95% CI 0·70–0·98). Women participating in HPV-based screening had a 28% lower invasive cervical cancer risk compared with women participating with cytology (HR 0·72, 95% CI 0·54–0·95). Adverse events were a higher number of referrals to colposcopy with biopsy in the HPV policy (15 832 [7·5%] of 212 199 in intention to screen analyses and 9968 [9·0%] of 110 176 per protocol at baseline) than in the cytology policy (12 650 [6·9%] of 183 120 in intention to screen analyses, and 7179 [7·9%] of 90 821 per protocol at baseline). Women who were HPV-negative at baseline had invasive cervical cancer risks of 1·3 (95% CI 0·6–2·4) per 100 000 person-years, whereas the risk for women with normal cytology was 9·1 (6·7–11·8) per 100 000 person-years. HPV-positive women with negative cytology triage had invasive cervical cancer risks of 79·2 per 100 000 person-years and HPV 16 or HPV 18-positive women with negative cytology triage had risks of 318·2 per 100 000 person-years.&lt;h3&gt;Interpretation&lt;/h3&gt;This randomised policy trial found HPV-based screening to be superior for preventing invasive cervical cancer in the real-world setting. A single baseline HPV-negative test was associated with a very ","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"131 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated health effect, cost, and cost-effectiveness of mandating sodium benchmarks in Australia's packaged foods: a modelling study","authors":"Matti Marklund, Kathy Trieu, Leopold N Aminde, Linda Cobiac, Daisy H Coyle, Liping Huang, Bruce Neal, Lennert Veerman, Jason H Y Wu","doi":"10.1016/s2468-2667(24)00219-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00219-6","url":null,"abstract":"<h3>Background</h3>Excess dietary sodium is a leading cause of death and disability globally. Because packaged foods are a major source of sodium in many countries, including Australia, mandatory limits for sodium might improve population health. We aimed to estimate the long-term health and economic effect of mandating such thresholds in Australia.<h3>Methods</h3>We used a multiple cohort, proportional, multistate, life table model to simulate the effect of mandating either the WHO global sodium benchmarks or the currently non-mandatory Australian Healthy Food Partnership (HFP) sodium targets. We compared maintaining the current sodium intake status quo with intervention scenarios, using nationally representative data on dietary intake, sodium in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study. The effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted annually at 3%.<h3>Findings</h3>Compared with the status quo intervention, mandating the WHO benchmarks could be cost saving over the first 10 years (AUD$223 [95% uncertainty interval 82–433] million saved), with 2743 (1677–3976) cardiovascular disease deaths and 43 971 (26 892–63 748) incident cardiovascular disease events averted, and 11 174 (6800–16 205) HALYs gained. Over the population's lifetime, the intervention was cost effective (100·0% probability). Mandating the HFP sodium targets was also estimated to be cost effective (100·0% probability), but with 29% of the health benefits compared with the WHO benchmarks.<h3>Interpretation</h3>Our modelling study supports mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Although making Australia's voluntary reformulation targets mandatory might save thousands of lives, mandating the WHO global benchmarks could yield substantially greater health gains.<h3>Funding</h3>None.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"87 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"50 years of comprehensive state-wide data on pregnancy termination in South Australia: a retrospective, population-based, cohort study","authors":"Laura J Slade, Jennie Louise, Katina D’Onise, Jodie M Dodd","doi":"10.1016/s2468-2667(24)00214-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00214-7","url":null,"abstract":"<h3>Background</h3>Termination of pregnancy is a common procedure, accessed globally, irrespective of logistical and legal barriers. We aimed to document changes in procedural characteristics and demographic factors over time in South Australia, as well as to examine how key sociodemographic variables affect gestational age at pregnancy termination.<h3>Methods</h3>South Australian legislation has required mandatory collection of data related to pregnancy termination since 1970. We conducted a retrospective population-based cohort study of all pregnancy terminations in the state from 1970 to 2020. The primary outcome was gestational age at termination of pregnancy. Linear regression was used to examine socioeconomic characteristics that could confer disadvantage in access to pregnancy termination, with postcodes coded according to the 2016 Australian Statistical Geographical Classification–Remote Area system and the Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD) from the Australian Bureau of Statistics 2018.<h3>Findings</h3>Between Jan 1, 1970, and Dec 31, 2020, 225 440 pregnancy terminations were performed at a median of 8 weeks’ gestation (IQR 7–10). Most pregnant individuals (median age 24 years [IQR 20–31]) resided in urban areas (n=166 311 [77·9%]) and received surgical pregnancy termination (n=287 345 [78·4%]). Major complication rates remained low over time; however, major complications occurred more frequently at higher gestational ages. Gestational age at pregnancy termination decreased over time (from 9 weeks [IQR 8–11] in years 1970–75 to 7 weeks [6–9] in years 2016–20) and was strongly correlated with being a teenager (ie, aged &lt;20 years), rurality, and IRSAD score, with individuals at greater levels of socioeconomic disadvantage undergoing pregnancy termination at consistently higher gestational ages.<h3>Interpretation</h3>Over time, there have been many changes in the demographics of women and the method used for pregnancy termination. Even in a high-income country with legal and publicly funded access to pregnancy termination, there are significant differences in the gestational age at which pregnancy termination occurs, which vary with socioeconomic disadvantage. Understanding changes in the demographics of those undergoing this procedure and the influence of various indicators of socioeconomic disadvantage is vital for optimal service provision.<h3>Funding</h3>None.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"16 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation efforts to support transition to HPV-based cervical cancer screening","authors":"Maribel Almonte, María de la Luz Hernández, Prajakta Adsul","doi":"10.1016/s2468-2667(24)00240-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00240-8","url":null,"abstract":"On average, it takes 15 years from the landmark publication on a cancer control evidence-based intervention to achieve 50% uptake in routine practice.<span><span>¹</span></span> In fact, nearly 20 years have passed since the first observational studies showed that human papillomavirus (HPV) DNA testing had substantially higher sensitivity for detecting cervical precancer and cancer compared with cervical cytology.<span><span>²</span></span> Since then, the performance of HPV testing in primary cervical screening has been evaluated globally, and several large randomised controlled trials have shown that a negative HPV test provides long-term protection against invasive cervical cancer.<span><span>3</span></span>, <span><span>4</span></span> In line with this evidence, the <span><span>WHO 2021 and the WHO 2024 guidelines</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> recommend the use of HPV testing over cervical cytology or visual inspection of the cervix (VIA) in primary screening to prevent cervical cancer following simple algorithms for either screen-and-treat, or screen, triage (using cytology, dual-stain [p16/Ki67] cytology, VIA, or colposcopy), and treat. Despite the evidence and recommendations supporting HPV detection as primary screening test, it has not yet led to widespread transition from cytology-based to HPV-based cervical screening.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"32 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol and mortality in Mexico: prospective study of 150 000 adults","authors":"Eirini Trichia, Jesus Alegre-Díaz, Diego Aguilar-Ramirez, Raúl Ramirez-Reyes, Adrián Garcilazo-Ávila, Carlos González-Carballo, Fiona Bragg, Louisa Gnatiuc Friedrichs, William G Herrington, Lisa Holland, Jason Torres, Rachel Wade, Rory Collins, Richard Peto, Jaime Berumen, Roberto Tapia-Conyer, Pablo Kuri-Morales, Jonathan R Emberson","doi":"10.1016/s2468-2667(24)00228-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00228-7","url":null,"abstract":"<h3>Background</h3>Alcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico.<h3>Methods</h3>The Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into &lt;70, ≥70 to &lt;140, ≥140 to &lt;210, and ≥210 g/week]) to mortality at ages 35–74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming &gt;5 [men] or &gt;4 [women] drinks on a single occasion) and type of preferred drink were also examined.<h3>Findings</h3>Among 138 413 participants aged 35–74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35–74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30–1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39–3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36–4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06–1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67–2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed.<h3>Interpretation</h3>In this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality.<h3>Funding</h3>Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council.<h3>Translation</h3>For the Spanish translation of the abstract see Supplementary Materials section.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"195 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary epidemiology of hospitalised heart failure with reduced versus preserved ejection fraction in England: a retrospective, cohort study of whole-population electronic health records","authors":"Robert A Fletcher, Patrick Rockenschaub, Brendon L Neuen, Isabel Johanna Walter, Nathalie Conrad, Mehrdad A Mizani, Thomas Bolton, Claire A Lawson, Christopher Tomlinson, Stelios Boulitsakis Logothetis, Carmen Petitjean, Luigi Filippo Brizzi, Stephen Kaptoge, Elena Raffetti, Patrick A Calvert, Emanuele Di Angelantonio, Amitava Banerjee, Mamas A Mamas, Iain Squire, Spiros Denaxas, Angela M Wood","doi":"10.1016/s2468-2667(24)00215-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00215-9","url":null,"abstract":"&lt;h3&gt;Background&lt;/h3&gt;Heart failure is common, complex, and often associated with coexisting chronic medical conditions and a high mortality. We aimed to assess the epidemiology of people admitted to hospital with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), including the period covering the COVID-19 pandemic, which was previously not well characterised.&lt;h3&gt;Methods&lt;/h3&gt;In this retrospective, cohort study, we used whole-population electronic health records with 57 million individuals in England to identify patients hospitalised with heart failure as the primary diagnosis in any consultant episode of an in-patient admission to a National Health Service (NHS) hospital. We excluded individuals with less than 1 year of medical history records in primary or secondary care; admissions to NHS hospitals for which less than 10% of heart failure cases were linkable to the National Heart Failure Audit (NHFA); individuals younger than 18 years at the time of the heart failure hospitalisation; and patients who died in hospital during the index heart failure admission. For patients with new onset heart failure, we assessed incidence rates of 30-day and 1-year all-cause and cause-specific (cardiovascular, non-cardiovascular, and heart failure-related) emergency rehospitalisation and mortality after discharge, and dispensed guideline-recommended medical therapy (GRMT). Follow-up occurred from the index admission to the earliest occurrence of the event of interest, death, or end of data coverage. We estimated adjusted hazard ratios (HRs) to compare HFrEF with HFpEF. We computed population-attributable fractions to quantify the percentage of outcomes attributable to coexisting chronic medical conditions.&lt;h3&gt;Findings&lt;/h3&gt;Among 233 320 patients identified who survived the index heart failure admission across 335 NHS hospitals between Jan 1, 2019, and Dec 31, 2022, 101 320 (43·4%) had HFrEF, 71 910 (30·8%) had HFpEF, and 60 090 (25·8%) had an unknown classification. In patients with new onset heart failure, there were reductions in all-cause 30-day (–5·2% [95% CI –7·7 to –2·6] in 2019–22) and 1-year rehospitalisation rates (–3·9% [–6·6 to –1·2]). Declining 30-day rehospitalisation rates affected patients with HFpEF (–4·8% [–9·2 to –0·2]) and HFrEF (–6·2% [–10·5 to –1·6]), although 1-year rates were not statistically significant for patients with HFpEF (–2·2% [–6·6 to 2·3] &lt;em&gt;vs&lt;/em&gt; –5·7% [–10·6 to –0·5] for HFrEF). There were no temporal trends in incidence rates of 30-day or 1-year mortality after discharge. The rates of all-cause (HR 1·20 [1·18–1·22]) and cause-specific rehospitalisation were uniformly higher in those with HFpEF than those with HFrEF. Patients with HFpEF also had higher rates of 1-year all-cause mortality after discharge (HR 1·07 [1·05–1·09]), driven by excess risk of non-cardiovascular death (HR 1·25 [1·21–1·29]). Rates of rehospitalisation and mortality were highest in patients wit","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"20 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}