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":"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":"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":"1 1","pages":""},"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":"95 1","pages":""},"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":"31 1","pages":""},"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":"232 1","pages":""},"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":"2 1","pages":""},"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":"24 1","pages":""},"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":"17 1","pages":""},"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}
Pub Date : 2024-10-15DOI: 10.1016/s2468-2667(24)00154-3
Wenyao Peng, Siqi Lin, Bowang Chen, Xueke Bai, Chaoqun Wu, Xiaoyan Zhang, Yang Yang, Jianlan Cui, Wei Xu, Lijuan Song, Hao Yang, Wenyan He, Yan Zhang, Xi Li, Jiapeng Lu
Background
Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality.
Methods
In this nationwide cohort study, residents aged 35–75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper–Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators.
Findings
Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18–5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07–1·16), cardiovascular disease (1·38, 1·29–1·48), and respiratory disease (1·44, 1·22–1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution.
Interpretation
There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity.
Funding
The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China.
Translation
For the Chinese translation of the abstract see Supplementary Materials section.
{"title":"Area-level socioeconomic inequalities in mortality in China: a nationwide cohort study based on the ChinaHEART project","authors":"Wenyao Peng, Siqi Lin, Bowang Chen, Xueke Bai, Chaoqun Wu, Xiaoyan Zhang, Yang Yang, Jianlan Cui, Wei Xu, Lijuan Song, Hao Yang, Wenyan He, Yan Zhang, Xi Li, Jiapeng Lu","doi":"10.1016/s2468-2667(24)00154-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00154-3","url":null,"abstract":"<h3>Background</h3>Socioeconomic status is a key social determinant of health. Compared with individual-level socioeconomic status, the association between area-level socioeconomic status and mortality has not been well investigated in China. We aimed to assess associations between area-level socioeconomic status and all-cause mortality and cause-specific mortality in China, as well as the interplay of area-level and individual-level socioeconomic status on mortality.<h3>Methods</h3>In this nationwide cohort study, residents aged 35–75 years from 453 districts and counties were included in the China Health Evaluation and Risk Reduction Through Nationwide Teamwork (ChinaHEART) Study. The composite value of area-level socioeconomic status was generated from national census data and categorised into tertiles. Mortality rates and their 95% CIs were calculated using the Clopper–Pearson method. Cox frailty models were fitted to calculate adjusted hazard ratios and 95% CIs for area-level socioeconomic status with the risk of all-cause mortality and cause-specific mortality and their disparities across different population. We also assessed the roles of multiple individual factors as potential mediators.<h3>Findings</h3>Between December, 2015, and December, 2022, 1 119 027 participants were included, for whom the mean age was 56·1 (SD 9·9) years and 672 385 (60·1%) were female. 24 426 (5·24 [95% CI 5·18–5·31] per 1000 person-years) deaths occurred during the median 4·5-year follow-up. Compared with high area-level socioeconomic status, low area-level socioeconomic status was significantly associated with an increased risk of all-cause (hazard ratio 1·11, 95% CI 1·07–1·16), cardiovascular disease (1·38, 1·29–1·48), and respiratory disease (1·44, 1·22–1·71) mortality. The stronger associations were observed in people older than 60 years, females, and participants with lower individual-level socioeconomic status. The individual-level socioeconomic, behavioural, and metabolic factors mediated 39·5% of the association between area-level socioeconomic status and mortality, of which individual-level socioeconomic status made the largest contribution.<h3>Interpretation</h3>There are substantial area-level socioeconomic status-related inequalities in mortality in China. Individual-level socioeconomic, behavioural, and metabolic factors had mediating effects. Actions to improve area-level circumstances and individual factors are needed to improve health equity.<h3>Funding</h3>The Chinese Academy of Medical Sciences Innovation Fund for Medical Science, the National High Level Hospital Clinical Research Funding, the Ministry of Finance of China, and the National Health Commission of China.<h3>Translation</h3>For the Chinese translation of the abstract see Supplementary Materials section.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"88 4 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439557","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 : 2024-10-05DOI: 10.1016/s2468-2667(24)00128-2
Anna Vera Jørring Pallesen, Jochen O Mierau, Frederik Kølby Christensen, Laust Hvas Mortensen
<h3>Background</h3>Educational attainment and income are often, but not always, associated with disease incidence. Existing research typically examines single diseases, resulting in disparate analyses with little comparability. In this study, we aimed to assess educational and income inequalities across diseases in Denmark.<h3>Methods</h3>This register-based study included all Danish residents aged at least 30 years between Jan 1, 2013, and Dec 31, 2022, who were born after 1920, and with known educational attainment and income. We used a disease-wide approach to assess associations between education and income and the incidence of 751 diagnostic codes determined upon hospital admission. We estimated age-standardised incidence rates and incidence rate ratios (IRRs) using Poisson regression, adjusted for birth cohort and stratified by sex. Participants were followed up until time of diagnosis, death, emigration, or until Dec 31, 2022.<h3>Findings</h3>4 541 309 individuals aged 30 years and older were registered as living in Denmark between Jan 1, 2013, and Dec 31, 2022. 121 083 were excluded due to limited or missing information about educational attainment. 4 420 226 individuals were included in the analysis of educational inequalities (2 232 200 [50%] were female and 2 188 026 [50%] were male). 23 708 were excluded due to absence of income information, and 4 396 518 were included in the analysis of income inequalities (2 223 217 (51%) were female and 2 173 301 (49%) were male). Socioeconomic differences in incidence rates were observed across all disease groups; incidence rates of most diseases decreased with higher educational attainment and income. The magnitude of the socioeconomic inequalities varied substantially. Among non-communicable diseases, the strongest positive association with regard to education was observed in chronic obstructive pulmonary disease for female individuals (low education <em>vs</em> high education, IRR 2·7 [95% CI 2·4–3·0]) and schizophrenia for male inividuals (low education <em>vs</em> high education, IRR 4·4 [2·2–8·8]), and the strongest negative association was in melanoma and other skin cancers for females (low education <em>vs</em> high education, IRR 0·7 [0·7–0·8]) and melanoma and skin cancers for males (low education <em>vs</em> high education, 0·7 [0·6–0·8]). With regard to income, for females, the strongest positive association was observed in schizophrenia (quartile 1 [Q1] <em>vs</em> quartile 4 [Q4], IRR 10·1 [6·1–17·2]), whereas the strongest negative association was in melanoma and other skin cancers (Q1 <em>vs</em> Q4, IRR 0·5 [0·5–0·6]). For males, the strongest positive assocation was schizophrenia (Q1 <em>vs</em> Q4, IRR 18·4 [95% CI 8·5–39·9]) and the strongest negative association was also melanoma and other skin cancers (Q1 <em>vs</em> Q4, IRR 0·5 [0·5–0·6]). The most prevalent disease category, other digestive diseases, was also strongly positively associated with education (low education <em>
{"title":"Educational and income inequalities across diseases in Denmark: a register-based cohort study","authors":"Anna Vera Jørring Pallesen, Jochen O Mierau, Frederik Kølby Christensen, Laust Hvas Mortensen","doi":"10.1016/s2468-2667(24)00128-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00128-2","url":null,"abstract":"<h3>Background</h3>Educational attainment and income are often, but not always, associated with disease incidence. Existing research typically examines single diseases, resulting in disparate analyses with little comparability. In this study, we aimed to assess educational and income inequalities across diseases in Denmark.<h3>Methods</h3>This register-based study included all Danish residents aged at least 30 years between Jan 1, 2013, and Dec 31, 2022, who were born after 1920, and with known educational attainment and income. We used a disease-wide approach to assess associations between education and income and the incidence of 751 diagnostic codes determined upon hospital admission. We estimated age-standardised incidence rates and incidence rate ratios (IRRs) using Poisson regression, adjusted for birth cohort and stratified by sex. Participants were followed up until time of diagnosis, death, emigration, or until Dec 31, 2022.<h3>Findings</h3>4 541 309 individuals aged 30 years and older were registered as living in Denmark between Jan 1, 2013, and Dec 31, 2022. 121 083 were excluded due to limited or missing information about educational attainment. 4 420 226 individuals were included in the analysis of educational inequalities (2 232 200 [50%] were female and 2 188 026 [50%] were male). 23 708 were excluded due to absence of income information, and 4 396 518 were included in the analysis of income inequalities (2 223 217 (51%) were female and 2 173 301 (49%) were male). Socioeconomic differences in incidence rates were observed across all disease groups; incidence rates of most diseases decreased with higher educational attainment and income. The magnitude of the socioeconomic inequalities varied substantially. Among non-communicable diseases, the strongest positive association with regard to education was observed in chronic obstructive pulmonary disease for female individuals (low education <em>vs</em> high education, IRR 2·7 [95% CI 2·4–3·0]) and schizophrenia for male inividuals (low education <em>vs</em> high education, IRR 4·4 [2·2–8·8]), and the strongest negative association was in melanoma and other skin cancers for females (low education <em>vs</em> high education, IRR 0·7 [0·7–0·8]) and melanoma and skin cancers for males (low education <em>vs</em> high education, 0·7 [0·6–0·8]). With regard to income, for females, the strongest positive association was observed in schizophrenia (quartile 1 [Q1] <em>vs</em> quartile 4 [Q4], IRR 10·1 [6·1–17·2]), whereas the strongest negative association was in melanoma and other skin cancers (Q1 <em>vs</em> Q4, IRR 0·5 [0·5–0·6]). For males, the strongest positive assocation was schizophrenia (Q1 <em>vs</em> Q4, IRR 18·4 [95% CI 8·5–39·9]) and the strongest negative association was also melanoma and other skin cancers (Q1 <em>vs</em> Q4, IRR 0·5 [0·5–0·6]). The most prevalent disease category, other digestive diseases, was also strongly positively associated with education (low education <em>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"43 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377489","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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