Pub Date : 2024-10-30DOI: 10.1016/s2468-2667(24)00240-8
Maribel Almonte, María de la Luz Hernández, Prajakta Adsul
On average, it takes 15 years from the landmark publication on a cancer control evidence-based intervention to achieve 50% uptake in routine practice.1 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.2 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.3, 4 In line with this evidence, the WHO 2021 and the WHO 2024 guidelines 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.
{"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><sup>1</sup></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><sup>2</sup></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":null,"pages":null},"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}
Pub Date : 2024-10-30DOI: 10.1016/s2468-2667(24)00215-9
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
<h3>Background</h3>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.<h3>Methods</h3>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.<h3>Findings</h3>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] <em>vs</em> –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
背景心力衰竭是一种常见、复杂的疾病，通常与并存的慢性疾病和高死亡率相关。我们旨在评估射血分数降低型心力衰竭（HFrEF）和射血分数保留型心力衰竭（HFpEF）入院患者的流行病学情况，其中包括 COVID-19 大流行期间的情况，而这一流行病的特征在以前并不明确。方法在这项回顾性队列研究中，我们使用了英格兰 5700 万人的全人群电子健康记录，以确定在国民健康服务（NHS）医院住院的任何顾问病例中以心力衰竭为主要诊断入院的患者。我们排除了在初级或中级医疗机构中病史记录不足一年的患者；入院的 NHS 医院中与国家心衰审计（NHFA）相关联的心衰病例不足 10% 的患者；心衰住院时年龄不足 18 岁的患者；以及在心衰住院期间在医院死亡的患者。对于新发心衰患者，我们评估了出院后30天和1年全因和特定病因（心血管、非心血管和心衰相关）急诊再住院率和死亡率，以及指南推荐的药物治疗（GRMT）配药率。随访时间从指数入院开始，直至最早发生相关事件、死亡或数据覆盖结束。我们估算了调整后的危险比（HRs），以比较 HFrEF 和 HFpEF。研究结果在2019年1月1日至2022年12月31日期间，335家英国国家医疗服务系统（NHS）医院共确认了233320名心衰入院指标存活患者，其中101320人（43-4%）为HFrEF，71910人（30-8%）为HFpEF，60090人（25-8%）分类不明。在新发心衰患者中，全因 30 天（2019-22 年为-5-2% [95% CI -7-7 to -2-6]）和 1 年再住院率（-3-9% [-6-6 to -1-2] ）均有所下降。HFpEF（-4-8% [-9-2 to -0-2]）和HFrEF（-6-2% [-10-5 to -1-6] ）患者的30天再住院率下降，但HFpEF患者的1年再住院率并无统计学意义（-2-2% [-6-6 to 2-3] vs HFrEF -5-7% [-10-6 to -0-5]）。出院后 30 天或 1 年的死亡率没有时间趋势。HFpEF患者的全因（HR 1-20 [1-18-1-22]）和特定病因再住院率均高于HFrEF患者。HFpEF 患者出院后 1 年的全因死亡率（HR 1-07 [1-05-1-09]）也较高，这主要是由于非心血管死亡风险过高（HR 1-25 [1-21-1-29]）。同时患有慢性肾病、慢性阻塞性肺病、痴呆症和肝病的患者再次住院率和死亡率最高。慢性肾脏疾病导致 6-5%（5-6-7-4）的 HFrEF 患者在 1 年内再次住院，5-0%（4-1-5-9）的 HFpEF 患者再次住院，是其他并存疾病的两倍。较新的GRMT得到了迅速实施，但同时患有慢性肾脏病的患者中，这些药物的配发率明显降低。通过加强GRMT的实施，可以进一步改善人口健康状况，尤其是合并慢性肾脏病的患者，尽管他们的风险很高，但治疗仍然不足。
{"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":"<h3>Background</h3>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.<h3>Methods</h3>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.<h3>Findings</h3>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] <em>vs</em> –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":null,"pages":null},"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}
Pub Date : 2024-10-30DOI: 10.1016/s2468-2667(24)00229-9
Meng Li, Gregory Y H Lip
Heart failure is a global health burden, with an estimated prevalence of more than 56 million individuals worldwide.1 Notably, heart failure is highly associated with poor quality of life, frequent admissions to hospital, rising health-care costs, and high mortality rates. This complex clinical syndrome poses challenges to therapeutic interventions of heart failure, especially since a higher comorbidity burden leads to greater heart failure hospitalisation and all-cause mortality.2
{"title":"Contemporary heart failure and comorbidity risk management","authors":"Meng Li, Gregory Y H Lip","doi":"10.1016/s2468-2667(24)00229-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00229-9","url":null,"abstract":"Heart failure is a global health burden, with an estimated prevalence of more than 56 million individuals worldwide.<span><span><sup>1</sup></span></span> Notably, heart failure is highly associated with poor quality of life, frequent admissions to hospital, rising health-care costs, and high mortality rates. This complex clinical syndrome poses challenges to therapeutic interventions of heart failure, especially since a higher comorbidity burden leads to greater heart failure hospitalisation and all-cause mortality.<span><span><sup>2</sup></span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556013","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}
Pub Date : 2024-10-29DOI: 10.1016/s2468-2667(24)00211-1
Xinli Song, Bin Zhou, Sarah Baird, Chunling Lu, Majid Ezzati, Li Chen, Jieyu Liu, Yi Zhang, Ruolin Wang, Qi Ma, Jianuo Jiang, Yang Qin, Ziqi Dong, Wen Yuan, Tongjun Guo, Zhiying Song, Yunfei Liu, Jiajia Dang, Peijin Hu, Yanhui Dong, Susan M Sawyer
<h3>Background</h3>There are little recent data in China regarding contemporary nutritional inequities among children and adolescents, particularly in relation to urban–rural residence and regional socioeconomic status (SES). We aim to assess inequalities in thinness and obesity in Chinese children and adolescents.<h3>Methods</h3>Weight and height measurements for 1 677 261 children and adolescents aged 7–18 years were obtained from seven cycles of the Chinese National Surveys on Students Constitution and Health (1985, 1995, 2000, 2005, 2010, 2014, and 2019). Sex-specific BMI-for-age Z scores were applied to define thinness (Z scores <–2SD) and obesity (Z scores >+2SD). Urban–rural classification came from the Statistical Urban and Rural Division Code, and gross domestic product (GDP) per capita in the province in which the school was situated was used as a proxy for SES. T1 represented the provinces with the most disadvantaged SES and T3 represented the provinces with the most advantaged SES. General linear regression models assessed correlations between prevalence and GDP per capita, with projections to 2030 derived from best-fitting models.<h3>Findings</h3>The mean prevalence of obesity rose from 0·10% (95% CI 0·09 to 0·11) in 1985 to 8·25% (8·13 to 8·37) in 2019, whereas thinness prevalence decreased from 8·49% (8·41 to 8·58) to 3·37% (3·29 to 3·45). High SES provinces exhibited a significant drop in obesity prevalence from 2014 (8·42% [8·19 to 8·65]) to 2019 (7·73% [7·52 to 7·95]). Nationally, the prevalence of obesity was consistently higher in urban areas than in rural areas for both sexes from 1985 to 2019; however, a greater prevalence of obesity was observed in rural than urban girls residing in T3 regions in 2019 (urban–rural gap: –0·37% [–0·07 to –0·80]). Rural boys had a higher prevalence of thinness than their urban counterparts across all survey waves, with the exceptions of 1985 and 1995. For girls, no significant urban–rural gap in thinness was observed in the most recent survey in 2019 (–0·10% [–0·24 to 0·04]). From 1985 to 2014, boys and girls from high SES regions had a higher risk of obesity and a lower risk of thinness than those from low SES regions. However, in 2019, a nationwide shift occurred, and the T3–T1 difference in obesity approached or went below zero for boys (–0·49% [–1·02 to 0·04]) and girls (–0·68% [–1·00 to –0·35]). T3–T1 differences in thinness also approached zero for boys (–0·46% [–0·77 to –0·14]) and girls (–0·14% [–0·43 to 0·15]). The projected estimates to 2030 for urban–rural obesity gaps (boys: –1·00% [–2·65 to 0·65]; girls: –2·88% [–6·91 to 1·15]) and T3–T1 obesity differences (boys: –8·88% [–13·76 to –4·01]; girls: –8·82% [–12·78 to –4·85]) were both negative, with forecasted estimates for urban–rural gaps and T3–T1 differences in thinness prevalence in 2030 close to zero for both boys and girls.<h3>Interpretation</h3>China's socioeconomic development continues to influence within-country ineq
{"title":"Trends and inequalities in thinness and obesity among Chinese children and adolescents: evidence from seven national school surveys between 1985 and 2019","authors":"Xinli Song, Bin Zhou, Sarah Baird, Chunling Lu, Majid Ezzati, Li Chen, Jieyu Liu, Yi Zhang, Ruolin Wang, Qi Ma, Jianuo Jiang, Yang Qin, Ziqi Dong, Wen Yuan, Tongjun Guo, Zhiying Song, Yunfei Liu, Jiajia Dang, Peijin Hu, Yanhui Dong, Susan M Sawyer","doi":"10.1016/s2468-2667(24)00211-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00211-1","url":null,"abstract":"<h3>Background</h3>There are little recent data in China regarding contemporary nutritional inequities among children and adolescents, particularly in relation to urban–rural residence and regional socioeconomic status (SES). We aim to assess inequalities in thinness and obesity in Chinese children and adolescents.<h3>Methods</h3>Weight and height measurements for 1 677 261 children and adolescents aged 7–18 years were obtained from seven cycles of the Chinese National Surveys on Students Constitution and Health (1985, 1995, 2000, 2005, 2010, 2014, and 2019). Sex-specific BMI-for-age Z scores were applied to define thinness (Z scores <–2SD) and obesity (Z scores >+2SD). Urban–rural classification came from the Statistical Urban and Rural Division Code, and gross domestic product (GDP) per capita in the province in which the school was situated was used as a proxy for SES. T1 represented the provinces with the most disadvantaged SES and T3 represented the provinces with the most advantaged SES. General linear regression models assessed correlations between prevalence and GDP per capita, with projections to 2030 derived from best-fitting models.<h3>Findings</h3>The mean prevalence of obesity rose from 0·10% (95% CI 0·09 to 0·11) in 1985 to 8·25% (8·13 to 8·37) in 2019, whereas thinness prevalence decreased from 8·49% (8·41 to 8·58) to 3·37% (3·29 to 3·45). High SES provinces exhibited a significant drop in obesity prevalence from 2014 (8·42% [8·19 to 8·65]) to 2019 (7·73% [7·52 to 7·95]). Nationally, the prevalence of obesity was consistently higher in urban areas than in rural areas for both sexes from 1985 to 2019; however, a greater prevalence of obesity was observed in rural than urban girls residing in T3 regions in 2019 (urban–rural gap: –0·37% [–0·07 to –0·80]). Rural boys had a higher prevalence of thinness than their urban counterparts across all survey waves, with the exceptions of 1985 and 1995. For girls, no significant urban–rural gap in thinness was observed in the most recent survey in 2019 (–0·10% [–0·24 to 0·04]). From 1985 to 2014, boys and girls from high SES regions had a higher risk of obesity and a lower risk of thinness than those from low SES regions. However, in 2019, a nationwide shift occurred, and the T3–T1 difference in obesity approached or went below zero for boys (–0·49% [–1·02 to 0·04]) and girls (–0·68% [–1·00 to –0·35]). T3–T1 differences in thinness also approached zero for boys (–0·46% [–0·77 to –0·14]) and girls (–0·14% [–0·43 to 0·15]). The projected estimates to 2030 for urban–rural obesity gaps (boys: –1·00% [–2·65 to 0·65]; girls: –2·88% [–6·91 to 1·15]) and T3–T1 obesity differences (boys: –8·88% [–13·76 to –4·01]; girls: –8·82% [–12·78 to –4·85]) were both negative, with forecasted estimates for urban–rural gaps and T3–T1 differences in thinness prevalence in 2030 close to zero for both boys and girls.<h3>Interpretation</h3>China's socioeconomic development continues to influence within-country ineq","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142519989","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}
Pub Date : 2024-10-24DOI: 10.1016/s2468-2667(24)00167-1
Heather Wardle, Louisa Degenhardt, Virve Marionneau, Gerda Reith, Charles Livingstone, Malcolm Sparrow, Lucy T Tran, Blair Biggar, Christopher Bunn, Michael Farrell, Viktorija Kesaite, Vladimir Poznyak, Jianchao Quan, Jürgen Rehm, Angela Rintoul, Manoj Sharma, Jeremy Shiffman, Kristiana Siste, Daria Ukhova, Rachel Volberg, Shekhar Saxena
The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US$700 billion by 2028. Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalisation, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Gambling, in some form at least, is now legally permitted in more than 80% of countries worldwide. Online gambling, given its borderless accessibility, is available everywhere via the internet.
{"title":"The Lancet Public Health Commission on gambling","authors":"Heather Wardle, Louisa Degenhardt, Virve Marionneau, Gerda Reith, Charles Livingstone, Malcolm Sparrow, Lucy T Tran, Blair Biggar, Christopher Bunn, Michael Farrell, Viktorija Kesaite, Vladimir Poznyak, Jianchao Quan, Jürgen Rehm, Angela Rintoul, Manoj Sharma, Jeremy Shiffman, Kristiana Siste, Daria Ukhova, Rachel Volberg, Shekhar Saxena","doi":"10.1016/s2468-2667(24)00167-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00167-1","url":null,"abstract":"The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US$700 billion by 2028. Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalisation, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Gambling, in some form at least, is now legally permitted in more than 80% of countries worldwide. Online gambling, given its borderless accessibility, is available everywhere via the internet.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489152","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}
Pub Date : 2024-10-24DOI: 10.1016/s2468-2667(24)00248-2
Today, we publish the Lancet Public Health Commission on gambling—an inquiry and response to a neglected, understudied, and expanding public health threat. Gambling is not a simple leisure activity; it is a health-harming addictive behaviour. The harms associated with gambling are wide-ranging, not only affecting an individual's health and wellbeing, but also their wealth and relationships, affecting families and communities with potential lifelong consequences, and deepening health and societal inequalities. By assessing the barriers to preventing gambling-related health harms, the Commission unveils and deciphers the intersections between the social, commercial, legal, and political determinants of health.
{"title":"Time for a public health response to gambling","authors":"","doi":"10.1016/s2468-2667(24)00248-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00248-2","url":null,"abstract":"Today, we publish the <span><span><em>Lancet Public Health</em> Commission on gambling</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>—an inquiry and response to a neglected, understudied, and expanding public health threat. Gambling is not a simple leisure activity; it is a health-harming addictive behaviour. The harms associated with gambling are wide-ranging, not only affecting an individual's health and wellbeing, but also their wealth and relationships, affecting families and communities with potential lifelong consequences, and deepening health and societal inequalities. By assessing the barriers to preventing gambling-related health harms, the Commission unveils and deciphers the intersections between the social, commercial, legal, and political determinants of health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489145","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}
Pub Date : 2024-10-18DOI: 10.1016/s2468-2667(24)00223-8
Nigar Nargis, J Lee Westmaas, Eva Orr, Mohammed M Alqahtani, Parichoy Pal Choudhury, Farhad Islami, Ahmedin Jemal
Cannabis in the USA is transitioning from a nationwide illegal status to liberalisation for medicinal or recreational use across different jurisdictions. As the acceptability and accessibility of cannabis continue to grow, updated knowledge on the cancer risk from recreational cannabis use is necessary to inform recommendations by public health organisations, policy makers, and clinical practitioners. We reviewed the evidence to date. Our umbrella review of current global epidemiological evidence reveals that links between cannabis exposure and cancer risk are more suggestive than conclusive. The cancer type most closely linked to cannabis use is non-seminoma testicular cancer. However, evidence is emerging of an increased risk of other types of cancer (eg, lung squamous cell carcinoma, head and neck squamous cell carcinoma, and oral, breast, liver, cervical, laryngeal, pancreatic, thyroid, and childhood cancer), underscoring the potential importance of incorporating prevention and cessation of cannabis use in cancer prevention efforts. Our review also identified the need for replication of previous studies for additional epidemiological investigations that use rigorous study designs, and data collection protocols free from the biases of major confounders, misclassification, and measurement error in assessing cannabis exposure. Research on the long-term health and economic consequences of all cannabis products (both medical and recreational) are also needed. Currently, the insufficient evidence on the health risks of cannabis use reduces the ability of policy makers, health-care professionals, and individuals to make informed decisions about cannabis use and could expose the public to a potentially serious health risk.
{"title":"Cancer risk and legalisation of access to cannabis in the USA: overview of the evidence","authors":"Nigar Nargis, J Lee Westmaas, Eva Orr, Mohammed M Alqahtani, Parichoy Pal Choudhury, Farhad Islami, Ahmedin Jemal","doi":"10.1016/s2468-2667(24)00223-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00223-8","url":null,"abstract":"Cannabis in the USA is transitioning from a nationwide illegal status to liberalisation for medicinal or recreational use across different jurisdictions. As the acceptability and accessibility of cannabis continue to grow, updated knowledge on the cancer risk from recreational cannabis use is necessary to inform recommendations by public health organisations, policy makers, and clinical practitioners. We reviewed the evidence to date. Our umbrella review of current global epidemiological evidence reveals that links between cannabis exposure and cancer risk are more suggestive than conclusive. The cancer type most closely linked to cannabis use is non-seminoma testicular cancer. However, evidence is emerging of an increased risk of other types of cancer (eg, lung squamous cell carcinoma, head and neck squamous cell carcinoma, and oral, breast, liver, cervical, laryngeal, pancreatic, thyroid, and childhood cancer), underscoring the potential importance of incorporating prevention and cessation of cannabis use in cancer prevention efforts. Our review also identified the need for replication of previous studies for additional epidemiological investigations that use rigorous study designs, and data collection protocols free from the biases of major confounders, misclassification, and measurement error in assessing cannabis exposure. Research on the long-term health and economic consequences of all cannabis products (both medical and recreational) are also needed. Currently, the insufficient evidence on the health risks of cannabis use reduces the ability of policy makers, health-care professionals, and individuals to make informed decisions about cannabis use and could expose the public to a potentially serious health risk.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449248","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}
Pub Date : 2024-10-15DOI: 10.1016/s2468-2667(24)00244-5
Sophie Howard
Rosanna Maletta (Department of Psychology, University of Liverpool, Liverpool, UK) presented a study to understand how discrimination could affect mental health. Indeed, repeated discrimination could result in a build-up of resilience, or a cumulative negative effect could develop. Data from the UK Household Longitudinal Study waves 2015–20 were used. In the cohort of 3863 people, 24% of participants reported discrimination at one timepoint, and 16% reported more than one occurrence. Those who had experienced discrimination had worse mental health outcomes than those who had not, and was worse for those with more than one occurrence. Those more at risk of mental health problems from discrimination exposure were more likely to be female, young adults, in the lowest income group, or have had baseline mental health problems. These findings suggest that interventions to tackle discrimination and support for those affected should be prioritised.
{"title":"68th Society for Social Medicine & Population Health Annual Scientific meeting","authors":"Sophie Howard","doi":"10.1016/s2468-2667(24)00244-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00244-5","url":null,"abstract":"Rosanna Maletta (Department of Psychology, University of Liverpool, Liverpool, UK) presented a study to understand how discrimination could affect mental health. Indeed, repeated discrimination could result in a build-up of resilience, or a cumulative negative effect could develop. Data from the UK Household Longitudinal Study waves 2015–20 were used. In the cohort of 3863 people, 24% of participants reported discrimination at one timepoint, and 16% reported more than one occurrence. Those who had experienced discrimination had worse mental health outcomes than those who had not, and was worse for those with more than one occurrence. Those more at risk of mental health problems from discrimination exposure were more likely to be female, young adults, in the lowest income group, or have had baseline mental health problems. These findings suggest that interventions to tackle discrimination and support for those affected should be prioritised.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439508","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}
Pub Date : 2024-10-15DOI: 10.1016/s2468-2667(24)00224-x
Alvaro Schwalb, Lara Goscé, Rein M G J Houben
Understanding structural determinants is crucial in addressing tuberculosis, as these factors define the context in which the disease impacts populations. Incarceration has, in recent years, emerged as a major driver for tuberculosis in Latin America.1, 2 Although tuberculosis notification rates among the general population have remained stable, rates among people deprived of liberty have rapidly escalated in the region,2 yet these account for only half of the actual burden.3 However, focusing solely on tuberculosis among incarcerated individuals does not fully capture the broader impact of incarceration on the tuberculosis epidemic in Latin America.
{"title":"Tuberculosis and incarceration: uncovering the broader picture","authors":"Alvaro Schwalb, Lara Goscé, Rein M G J Houben","doi":"10.1016/s2468-2667(24)00224-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00224-x","url":null,"abstract":"Understanding structural determinants is crucial in addressing tuberculosis, as these factors define the context in which the disease impacts populations. Incarceration has, in recent years, emerged as a major driver for tuberculosis in Latin America.<span><span>1</span></span>, <span><span>2</span></span> Although tuberculosis notification rates among the general population have remained stable, rates among people deprived of liberty have rapidly escalated in the region,<span><span><sup>2</sup></span></span> yet these account for only half of the actual burden.<span><span><sup>3</sup></span></span> However, focusing solely on tuberculosis among incarcerated individuals does not fully capture the broader impact of incarceration on the tuberculosis epidemic in Latin America.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439509","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}
Pub Date : 2024-10-15DOI: 10.1016/s2468-2667(24)00192-0
Yiran E Liu, Yasmine Mabene, Sergio Camelo, Zulma Vanessa Rueda, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Moises A Huaman, Tatiana Avalos-Cruz, Valentina A Alarcón, Lawrence M Ladutke, Marcelo Bergman, Ted Cohen, Jeremy D Goldhaber-Fiebert, Julio Croda, Jason R Andrews
Background
Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. We aimed to quantify the impact of historical and future incarceration policies on the tuberculosis epidemic, accounting for effects in and beyond prisons.
Methods
In this modelling study, we calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. The model was fit independently for each country to incarceration and tuberculosis data from 1990 to 2023 (specific dates were country dependent). The model does not include HIV, drug resistance, gender or sex, or age structure. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the effect of alternative incarceration policies on future population tuberculosis incidence.
Findings
Population tuberculosis incidence in 2019 was 29·4% (95% uncertainty interval [UI] 23·9–36·8) higher than expected without the rise in incarceration since 1990, corresponding to 34 393 (28 295–42 579) excess incident cases across countries. The incarceration tPAF in 2019 was 27·2% (20·9–35·8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared with a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico.
Interpretation
The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognised to date. International health agencies, ministries of justice, and national tuberculosis programmes should collaborate to address this health crisis with comprehensive strategies, including decarceration.
{"title":"Mass incarceration as a driver of the tuberculosis epidemic in Latin America and projected effects of policy alternatives: a mathematical modelling study","authors":"Yiran E Liu, Yasmine Mabene, Sergio Camelo, Zulma Vanessa Rueda, Daniele Maria Pelissari, Fernanda Dockhorn Costa Johansen, Moises A Huaman, Tatiana Avalos-Cruz, Valentina A Alarcón, Lawrence M Ladutke, Marcelo Bergman, Ted Cohen, Jeremy D Goldhaber-Fiebert, Julio Croda, Jason R Andrews","doi":"10.1016/s2468-2667(24)00192-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00192-0","url":null,"abstract":"<h3>Background</h3>Tuberculosis incidence is increasing in Latin America, where the incarcerated population has nearly quadrupled since 1990. We aimed to quantify the impact of historical and future incarceration policies on the tuberculosis epidemic, accounting for effects in and beyond prisons.<h3>Methods</h3>In this modelling study, we calibrated dynamic compartmental transmission models to historical and contemporary data from Argentina, Brazil, Colombia, El Salvador, Mexico, and Peru, which comprise approximately 80% of the region's incarcerated population and tuberculosis burden. The model was fit independently for each country to incarceration and tuberculosis data from 1990 to 2023 (specific dates were country dependent). The model does not include HIV, drug resistance, gender or sex, or age structure. Using historical counterfactual scenarios, we estimated the transmission population attributable fraction (tPAF) for incarceration and the excess population-level burden attributable to increasing incarceration prevalence since 1990. We additionally projected the effect of alternative incarceration policies on future population tuberculosis incidence.<h3>Findings</h3>Population tuberculosis incidence in 2019 was 29·4% (95% uncertainty interval [UI] 23·9–36·8) higher than expected without the rise in incarceration since 1990, corresponding to 34 393 (28 295–42 579) excess incident cases across countries. The incarceration tPAF in 2019 was 27·2% (20·9–35·8), exceeding estimates for other risk factors like HIV, alcohol use disorder, and undernutrition. Compared with a scenario where incarceration rates remain stable at current levels, a gradual 50% reduction in prison admissions and duration of incarceration by 2034 would reduce population tuberculosis incidence by over 10% in all countries except Mexico.<h3>Interpretation</h3>The historical rise in incarceration in Latin America has resulted in a large excess tuberculosis burden that has been under-recognised to date. International health agencies, ministries of justice, and national tuberculosis programmes should collaborate to address this health crisis with comprehensive strategies, including decarceration.<h3>Funding</h3>National Institutes of Health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":50.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439507","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}
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