Pub Date : 2024-12-13DOI: 10.1016/s2468-2667(24)00242-1
Bertina Kreshpaj, Leonie K Elsenburg, Signe Hald Andersen, Tjeerd Rudmer De Vries, Karsten Thielen, Naja Hulvej Rod
Background
Childhood adversities can negatively affect health and social outcomes. We aimed to assess the association between adversity in childhood and use of public services in early adulthood across three systems: health, social welfare, and justice.
Methods
We used Danish nationwide registry data on individuals born between 1980 and 1991 and followed up between 1998 and 2021. We evaluated annual exposure to adversity during childhood (age 0–16 years) across three dimensions—material deprivation, loss or threat of loss within the family, and family dynamics—and used this to divide individuals into five trajectory groups: low adversity, early-life material deprivation, persistent material deprivation, loss or threat of loss, and high adversity. We defined high-intensity users of each public service system as those above the 90th percentile in terms of hospital visits (health system) and weeks of social welfare use (social welfare system), and whether or not they were convicted for a crime (justice system) during early adulthood (age 18–40 years). We analysed the proportion of high-intensity users of each public service system across the childhood adversity trajectory groups. Logistic regression was used to assess whether the risk of becoming a high-intensity user differed by trajectory group relative to the low-adversity group, with adjustment for sex, parental education, parental origin, and maternal age at time of birth.
Findings
Of the 567 035 individuals in the cohort, 273 616 (48·3%) were in the low-adversity group, 128 238 (22·6%) were in the early-life material deprivation group, 100 959 (17·8%) were in the persistent material deprivation group, 43 826 (7·7%) were in the loss or threat of loss group, and 20 396 (3·6%) were in the high-adversity group. Childhood adversity was associated with a markedly higher risk of belonging to the high-intensity user group across all three public service systems. Specifically, low proportions of the low-adversity group became high-intensity users of the health system (19 675 [7·2%]), social welfare system (13 681 [5·0%]), and justice system (38 198 [14·0%]). By comparison, those in the high-adversity group were significantly more likely to become high-intensity users of the health system (4685 [23·0%]; adjusted odds ratio 2·81 [95% CI 2·71–2·93]), social welfare system (8158 [40·0%]; 8·88 [8·50–9·27]), and justice system (8681 [42·6%]; 3·62 [3·50–3·75]).
Interpretation
There were long-term effects of childhood adversities across three public service systems, with an association of high-intensity users among individuals who experienced childhood adversity. Systemic inequalities already present in childhood need to be addressed, with prioritisation of equitable resource allocation for those most in need of assistance.
{"title":"Association between childhood adversity and use of the health, social, and justice systems in Denmark (DANLIFE): a nationwide cohort study","authors":"Bertina Kreshpaj, Leonie K Elsenburg, Signe Hald Andersen, Tjeerd Rudmer De Vries, Karsten Thielen, Naja Hulvej Rod","doi":"10.1016/s2468-2667(24)00242-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00242-1","url":null,"abstract":"<h3>Background</h3>Childhood adversities can negatively affect health and social outcomes. We aimed to assess the association between adversity in childhood and use of public services in early adulthood across three systems: health, social welfare, and justice.<h3>Methods</h3>We used Danish nationwide registry data on individuals born between 1980 and 1991 and followed up between 1998 and 2021. We evaluated annual exposure to adversity during childhood (age 0–16 years) across three dimensions—material deprivation, loss or threat of loss within the family, and family dynamics—and used this to divide individuals into five trajectory groups: low adversity, early-life material deprivation, persistent material deprivation, loss or threat of loss, and high adversity. We defined high-intensity users of each public service system as those above the 90th percentile in terms of hospital visits (health system) and weeks of social welfare use (social welfare system), and whether or not they were convicted for a crime (justice system) during early adulthood (age 18–40 years). We analysed the proportion of high-intensity users of each public service system across the childhood adversity trajectory groups. Logistic regression was used to assess whether the risk of becoming a high-intensity user differed by trajectory group relative to the low-adversity group, with adjustment for sex, parental education, parental origin, and maternal age at time of birth.<h3>Findings</h3>Of the 567 035 individuals in the cohort, 273 616 (48·3%) were in the low-adversity group, 128 238 (22·6%) were in the early-life material deprivation group, 100 959 (17·8%) were in the persistent material deprivation group, 43 826 (7·7%) were in the loss or threat of loss group, and 20 396 (3·6%) were in the high-adversity group. Childhood adversity was associated with a markedly higher risk of belonging to the high-intensity user group across all three public service systems. Specifically, low proportions of the low-adversity group became high-intensity users of the health system (19 675 [7·2%]), social welfare system (13 681 [5·0%]), and justice system (38 198 [14·0%]). By comparison, those in the high-adversity group were significantly more likely to become high-intensity users of the health system (4685 [23·0%]; adjusted odds ratio 2·81 [95% CI 2·71–2·93]), social welfare system (8158 [40·0%]; 8·88 [8·50–9·27]), and justice system (8681 [42·6%]; 3·62 [3·50–3·75]).<h3>Interpretation</h3>There were long-term effects of childhood adversities across three public service systems, with an association of high-intensity users among individuals who experienced childhood adversity. Systemic inequalities already present in childhood need to be addressed, with prioritisation of equitable resource allocation for those most in need of assistance.<h3>Funding</h3>Rockwool Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"21 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820781","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 : 2024-12-12DOI: 10.1016/s2468-2667(24)00270-6
Luc de Witte, Rosalie van der Vaart
Based on existing cross-sectional studies, case studies, and policy-related reports, experts in the field of assistive technology have long suspected that even in high-income countries such as England not everyone who could benefit from assistive technology has access to it, and that there are inequities in access. However, there was little concrete data on the extent of these gaps. Those data have been provided in the study by Danemayer and colleagues.1 Elegantly using longitudinal data from the English Longitudinal Study of Ageing, the authors show that in a population of 12 080 participants, 2480 (20·5%) had an unmet need for mobility assistive products at baseline and 5102 (42·2%) had an unmet need at least once during the follow-up period, which had a median duration of 4 years. The data further revealed that there are important inequities in access: women, older adults, and people with low education levels, less wealth, or disabilities have higher chances of transitioning from no need to unmet need, with women additionally being less likely than men to transition from unmet need to use. This study is important because it not only provides directions for further research, but it also particularly underscores the need for improving policy and practice. These findings align closely with those from the large, global cross-sectional study into assistive technology needs and access, published by WHO and UNICEF in their Global Report on Assistive Technology.2 In that study, it was estimated that in countries with a very high human development index a median of 20·7% (range 16·5–59·8) of people with a need for assistive technology do not have access to it.
根据现有的横断面研究、案例研究和政策相关报告，辅助技术领域的专家长期以来一直怀疑，即使是在英国这样的高收入国家，也并非每个人都能从辅助技术中受益，而且在获得辅助技术方面存在不公平现象。然而，有关这些差距程度的具体数据却很少。作者利用英国老龄化纵向研究（English Longitudinal Study of Ageing）的纵向数据进行了分析，结果显示，在 12080 名参与者中，有 2480 人（20-5%）在基线时对行动辅助产品的需求未得到满足，有 5102 人（42-2%）在中位数为 4 年的随访期间至少有一次需求未得到满足。数据进一步显示，在获取方面存在着严重的不公平现象：女性、老年人、教育水平低、财富较少或有残疾的人从无需求过渡到未满足需求的几率更高，此外，女性从未满需求过渡到使用的几率也低于男性。这项研究之所以重要，是因为它不仅为进一步的研究提供了方向，还特别强调了改进政策和实践的必要性。这些研究结果与世界卫生组织和联合国儿童基金会在其《全球辅助技术报告》2 中发布的关于辅助技术需求和使用情况的大型全球横断面研究结果非常吻合。据估计，在人类发展指数非常高的国家，有辅助技术需求的人中有 20%-7%（范围为 16-5-59-8）无法使用辅助技术。
{"title":"Inequities in access to assistive technology: a call for action","authors":"Luc de Witte, Rosalie van der Vaart","doi":"10.1016/s2468-2667(24)00270-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00270-6","url":null,"abstract":"Based on existing cross-sectional studies, case studies, and policy-related reports, experts in the field of assistive technology have long suspected that even in high-income countries such as England not everyone who could benefit from assistive technology has access to it, and that there are inequities in access. However, there was little concrete data on the extent of these gaps. Those data have been provided in the study by Danemayer and colleagues.<span><span><sup>1</sup></span></span> Elegantly using longitudinal data from the English Longitudinal Study of Ageing, the authors show that in a population of 12 080 participants, 2480 (20·5%) had an unmet need for mobility assistive products at baseline and 5102 (42·2%) had an unmet need at least once during the follow-up period, which had a median duration of 4 years. The data further revealed that there are important inequities in access: women, older adults, and people with low education levels, less wealth, or disabilities have higher chances of transitioning from no need to unmet need, with women additionally being less likely than men to transition from unmet need to use. This study is important because it not only provides directions for further research, but it also particularly underscores the need for improving policy and practice. These findings align closely with those from the large, global cross-sectional study into assistive technology needs and access, published by WHO and UNICEF in their Global Report on Assistive Technology.<span><span><sup>2</sup></span></span> In that study, it was estimated that in countries with a very high human development index a median of 20·7% (range 16·5–59·8) of people with a need for assistive technology do not have access to it.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"22 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816145","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 : 2024-12-12DOI: 10.1016/s2468-2667(24)00243-3
Jamie Danemayer, Mikaela Bloomberg, Adam Mills, Cathy Holloway, Shereen Hussein
Background
Cross-sectional evidence suggests that access to essential mobility assistive products (MAPs) might be dependent on non-clinical factors. However, MAP use is better understood as a dynamic process wherein individuals pass through different states of MAP need and use. We aimed to test associations of demographic, socioeconomic, and social factors with transitions between MAP need and use states.
Methods
For this multistate modelling study, data were drawn from 13 years (May, 2006, to July, 2019) of the English Longitudinal Study of Ageing, a prospective cohort study. We included respondents aged 50–89 years who participated in at least two waves of data collection. We used multistate models to examine associations of demographic, socioeconomic, and social factors, including age, sex, education, employment, wealth, marital status, and help with activities of daily living (ADL), with transitions between three main states: no need for MAPs, unmet need for MAPs, and use of MAPs.
Findings
We used data collected from 12 080 respondents (6586 women and 5494 men). During follow-up, 5102 (42·2%) of participants had unmet MAP need and 3330 (27·6%) used MAPs. Women were more likely than men to transition from no need to unmet need (hazard ratio [HR] 1·49, 95% CI 1·38–1·60) and less likely to transition from unmet need to use (0·79, 0·72–0·86). We found an increase in risk of transitioning from no need to unmet need for each 1-year increase in age (1·06, 1·06–1·07), for those with low education level (1·34, 1·23–1·45), those with help with ADL (1·32, 1·16–1·49), and who were not employed (1·22, 1·07–1·40) or disabled (3·83, 2·98–4·93). Similarly, we found an increase in risk of transitioning unmet need to use for each 1-year increase in age (1·06, 1·05–1·06), for those with low education level (1·20, 1·10–1·31), and those with help with ADL (1·25, 1·13–1·38). Increasing wealth was associated with a reduced risk of transitioning from no need to unmet need (0·78, 0·74–0·81) and from unmet need to use (0·94, 0·89–0·99). Single people were more likely to transition from unmet need to use than partnered people (HR 1·21, 95% CI 1·10–1·33).
Interpretation
Women might be disproportionately likely to have unmet MAP needs, whereas other demographic, socioeconomic, and social factors are associated with high MAP need overall. Our findings directly support efforts towards expanding access to assistive products and identifying groups that could particularly benefit. As the first study of its kind to our knowledge, replication with other longitudinal datasets is needed.
{"title":"Demographic, socioeconomic, and social barriers to use of mobility assistive products: a multistate analysis of the English Longitudinal Study of Ageing","authors":"Jamie Danemayer, Mikaela Bloomberg, Adam Mills, Cathy Holloway, Shereen Hussein","doi":"10.1016/s2468-2667(24)00243-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00243-3","url":null,"abstract":"<h3>Background</h3>Cross-sectional evidence suggests that access to essential mobility assistive products (MAPs) might be dependent on non-clinical factors. However, MAP use is better understood as a dynamic process wherein individuals pass through different states of MAP need and use. We aimed to test associations of demographic, socioeconomic, and social factors with transitions between MAP need and use states.<h3>Methods</h3>For this multistate modelling study, data were drawn from 13 years (May, 2006, to July, 2019) of the English Longitudinal Study of Ageing, a prospective cohort study. We included respondents aged 50–89 years who participated in at least two waves of data collection. We used multistate models to examine associations of demographic, socioeconomic, and social factors, including age, sex, education, employment, wealth, marital status, and help with activities of daily living (ADL), with transitions between three main states: no need for MAPs, unmet need for MAPs, and use of MAPs.<h3>Findings</h3>We used data collected from 12 080 respondents (6586 women and 5494 men). During follow-up, 5102 (42·2%) of participants had unmet MAP need and 3330 (27·6%) used MAPs. Women were more likely than men to transition from no need to unmet need (hazard ratio [HR] 1·49, 95% CI 1·38–1·60) and less likely to transition from unmet need to use (0·79, 0·72–0·86). We found an increase in risk of transitioning from no need to unmet need for each 1-year increase in age (1·06, 1·06–1·07), for those with low education level (1·34, 1·23–1·45), those with help with ADL (1·32, 1·16–1·49), and who were not employed (1·22, 1·07–1·40) or disabled (3·83, 2·98–4·93). Similarly, we found an increase in risk of transitioning unmet need to use for each 1-year increase in age (1·06, 1·05–1·06), for those with low education level (1·20, 1·10–1·31), and those with help with ADL (1·25, 1·13–1·38). Increasing wealth was associated with a reduced risk of transitioning from no need to unmet need (0·78, 0·74–0·81) and from unmet need to use (0·94, 0·89–0·99). Single people were more likely to transition from unmet need to use than partnered people (HR 1·21, 95% CI 1·10–1·33).<h3>Interpretation</h3>Women might be disproportionately likely to have unmet MAP needs, whereas other demographic, socioeconomic, and social factors are associated with high MAP need overall. Our findings directly support efforts towards expanding access to assistive products and identifying groups that could particularly benefit. As the first study of its kind to our knowledge, replication with other longitudinal datasets is needed.<h3>Funding</h3>UK Aid.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"233 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816146","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 : 2024-12-04DOI: 10.1016/s2468-2667(24)00276-7
This December issue of The Lancet Public Health is our annual themed issue on public health in China. It is dedicated to the 1·4 billion people living in China and to the health-care workers, practitioners, and researchers whose work is featured in this issue and presented at The Lancet-Chinese Academy of Medical Sciences Conference held in Beijing on Nov 21–22. Nowadays, China faces four important challenges: the rise in non-communicable diseases (NCDs), an ageing population, escalating costs, and climate change. A collection of research Articles, Comments, Series, and Reviews presents these challenges, but also discusses opportunities and strategies to tackle these public health issues and narrow inequalities.
{"title":"Public health in China: challenges and prospects","authors":"","doi":"10.1016/s2468-2667(24)00276-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00276-7","url":null,"abstract":"This December issue of <em>The Lancet Public Health</em> is our annual themed issue on public health in China. It is dedicated to the 1·4 billion people living in China and to the health-care workers, practitioners, and researchers whose work is featured in this issue and presented at <em>The Lancet</em>-Chinese Academy of Medical Sciences Conference held in Beijing on Nov 21–22. Nowadays, China faces four important challenges: the rise in non-communicable diseases (NCDs), an ageing population, escalating costs, and climate change. A collection of research Articles, Comments, Series, and Reviews presents these challenges, but also discusses opportunities and strategies to tackle these public health issues and narrow inequalities.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"262 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776435","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 : 2024-12-04DOI: 10.1016/s2468-2667(24)00267-6
Chunhua He, Leni Kang, Yuxi Liu, Xue Yu, Qi Li, Juan Liang, Li Dai, Xiaohong Li, Yanping Wang, Jun Zhu, Hanmin Liu
<h3>Background</h3>Sustainable Development Goal (SDG) 3.2 aims to end preventable deaths of newborns and children younger than 5 years. China's progress towards SDG 3.2 has not been evaluated on multiple dimensions. We aimed to assess mortality rates in children younger than 5 years (hereafter referred to as under-5 mortality) and to quantify preventable child mortality and geospatial and temporal trends in child mortality in China from 2016 to 2022.<h3>Methods</h3>In this observational analysis, we used data from the Chinese National Maternal and Child Health Surveillance System (MCHSS) for the period Jan 1, 2016, to Dec 31, 2022 and conducted all-cause mortality and cause-specific mortality analyses for different age groups (age 0–6 days, 7–27 days, 0–27 days, 1–5 months, 6–11 months, 12–23 months, 24–59 months, and birth to 59 months) separately at the national, residential (rural <em>vs</em> urban), and regional (eastern <em>vs</em> central <em>vs</em> western China) levels. All mortality rates were adjusted by age group, type of residency, region, and region-residency strata using a 3-year moving average of the under-reporting rates. National deaths were estimated using the number of livebirths from 2016 to 2022 from the Health Statistics Yearbook of China. Estimated national-level and regional-level mortality rates were weighted by the proportion of the population living in urban and rural areas from the 2010 national census. Optimal survival metrics for neonates and children younger than 5 years were calculated by cause of death in 2020–22 (termed the national optimum), on the basis of the lowest mortality observed among the six region-residency strata.<h3>Findings</h3>In 2022, approximately 65 700 (95% CI 62 700–68 800) children younger than 5 years died in China, with 45·1% (42·7–47·4) of these deaths occurring in the neonatal period (age <28 days). China's under-5 mortality rate decreased from 10·2 deaths (9·9–10·5) per 1000 livebirths in 2016 to 6·8 deaths (6·5–7·2) per 1000 livebirths in 2022; the neonatal mortality rate decreased from 4·9 deaths (4·7–5·1) per 1000 livebirths in 2016 to 3·1 deaths (2·9–3·3) per 1000 livebirths in 2022. The relative risk of death in children younger than 5 years in rural areas compared with urban areas decreased from 2·4 (2·2–2·6) in 2016 to 1·9 (1·7–2·1) in 2022, and in the western region compared with the eastern region decreased from 3·4 (3·0–3·9) in 2016 to 2·3 (1·9–2·8) in 2022. The leading causes of under-5 mortality in 2022 were injuries (23·1% [21·1–25·1] of all-cause deaths), congenital malformations (14·8% [13·1–16·4]), preterm birth complications (14·1% [12·5–15·7]), intrapartum-related events (10·1% [8·7–11·5]), and acute respiratory infections (9·5% [8·2–10·9]). The leading cause of death in the neonatal period was preterm birth complications (12·8% [11·4–14·2] of deaths in children younger than 5 years).<h3>Interpretation</h3>Under-5 mortality in China declined between 2016 and 2022. D
{"title":"Changes in the epidemiology of under-5 mortality in China from 2016 to 2022: an observational analysis of population-based surveillance data","authors":"Chunhua He, Leni Kang, Yuxi Liu, Xue Yu, Qi Li, Juan Liang, Li Dai, Xiaohong Li, Yanping Wang, Jun Zhu, Hanmin Liu","doi":"10.1016/s2468-2667(24)00267-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00267-6","url":null,"abstract":"<h3>Background</h3>Sustainable Development Goal (SDG) 3.2 aims to end preventable deaths of newborns and children younger than 5 years. China's progress towards SDG 3.2 has not been evaluated on multiple dimensions. We aimed to assess mortality rates in children younger than 5 years (hereafter referred to as under-5 mortality) and to quantify preventable child mortality and geospatial and temporal trends in child mortality in China from 2016 to 2022.<h3>Methods</h3>In this observational analysis, we used data from the Chinese National Maternal and Child Health Surveillance System (MCHSS) for the period Jan 1, 2016, to Dec 31, 2022 and conducted all-cause mortality and cause-specific mortality analyses for different age groups (age 0–6 days, 7–27 days, 0–27 days, 1–5 months, 6–11 months, 12–23 months, 24–59 months, and birth to 59 months) separately at the national, residential (rural <em>vs</em> urban), and regional (eastern <em>vs</em> central <em>vs</em> western China) levels. All mortality rates were adjusted by age group, type of residency, region, and region-residency strata using a 3-year moving average of the under-reporting rates. National deaths were estimated using the number of livebirths from 2016 to 2022 from the Health Statistics Yearbook of China. Estimated national-level and regional-level mortality rates were weighted by the proportion of the population living in urban and rural areas from the 2010 national census. Optimal survival metrics for neonates and children younger than 5 years were calculated by cause of death in 2020–22 (termed the national optimum), on the basis of the lowest mortality observed among the six region-residency strata.<h3>Findings</h3>In 2022, approximately 65 700 (95% CI 62 700–68 800) children younger than 5 years died in China, with 45·1% (42·7–47·4) of these deaths occurring in the neonatal period (age <28 days). China's under-5 mortality rate decreased from 10·2 deaths (9·9–10·5) per 1000 livebirths in 2016 to 6·8 deaths (6·5–7·2) per 1000 livebirths in 2022; the neonatal mortality rate decreased from 4·9 deaths (4·7–5·1) per 1000 livebirths in 2016 to 3·1 deaths (2·9–3·3) per 1000 livebirths in 2022. The relative risk of death in children younger than 5 years in rural areas compared with urban areas decreased from 2·4 (2·2–2·6) in 2016 to 1·9 (1·7–2·1) in 2022, and in the western region compared with the eastern region decreased from 3·4 (3·0–3·9) in 2016 to 2·3 (1·9–2·8) in 2022. The leading causes of under-5 mortality in 2022 were injuries (23·1% [21·1–25·1] of all-cause deaths), congenital malformations (14·8% [13·1–16·4]), preterm birth complications (14·1% [12·5–15·7]), intrapartum-related events (10·1% [8·7–11·5]), and acute respiratory infections (9·5% [8·2–10·9]). The leading cause of death in the neonatal period was preterm birth complications (12·8% [11·4–14·2] of deaths in children younger than 5 years).<h3>Interpretation</h3>Under-5 mortality in China declined between 2016 and 2022. D","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"19 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776442","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}
Preventive health measures offer superior economic returns compared with the ever-increasing costs of treating established diseases, which place unsustainable pressure on health systems. By reducing the incidence and severity of illness, prevention minimises health-care expenditure and maximises societal welfare by lowering the burden of disease. In China, the principle of making prevention a priority is recognised in the Healthy China 2030 Initiative, which aims to shift the health system's focus towards prevention. However, this goal faces substantial challenges due to structural, legislative, and financial barriers.
{"title":"Integrating prevention and treatment: rethinking China's health financing","authors":"Zhicheng Wang, Kit Yee Chan, Qianyi Xia, Jiantuo Yu, Minghui Ren","doi":"10.1016/s2468-2667(24)00247-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00247-0","url":null,"abstract":"Preventive health measures offer superior economic returns compared with the ever-increasing costs of treating established diseases, which place unsustainable pressure on health systems. By reducing the incidence and severity of illness, prevention minimises health-care expenditure and maximises societal welfare by lowering the burden of disease. In China, the principle of making prevention a priority is recognised in the Healthy China 2030 Initiative, which aims to shift the health system's focus towards prevention. However, this goal faces substantial challenges due to structural, legislative, and financial barriers.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"77 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776436","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 : 2024-12-04DOI: 10.1016/s2468-2667(24)00264-0
Xi Xia, Xia Meng, Cong Liu, Yi Guo, Xinyue Li, Yue Niu, Kin Bong Hubert Lam, Neil Wright, Christiana Kartsonaki, Yiping Chen, Ling Yang, Huaidong Du, Canqing Yu, Dianjianyi Sun, Jun Lv, Junshi Chen, Xiaoming Yang, Ruqin Gao, Shaowei Wu, Haidong Kan, Chan Qu
<h3>Background</h3>Little evidence is available on the long-term health effects of nitrogen dioxide (NO<sub>2</sub>) in low-income and middle-income populations. We investigated the associations of long-term NO<sub>2</sub> exposure with the incidence of a wide spectrum of disease outcomes, based on data from the China Kadoorie Biobank.<h3>Methods</h3>This prospective cohort study involved 512 724 Chinese adults aged 30–79 years recruited from ten areas of China during 2004–08. Time-varying Cox regression models yielded adjusted hazard ratios (HRs) for the associations of long-term NO<sub>2</sub> exposure with aggregated disease incidence endpoints classified by 14 ICD-10 chapters, and incidences of 12 specific diseases selected from three key ICD-10 chapters (cardiovascular, respiratory, and musculoskeletal diseases) found to be robustly associated with NO<sub>2</sub> in the analyses of aggregated endpoints. All models were stratified by age-at-risk (in 1-year scale), study area, and sex, and were adjusted for education, household income, smoking status, alcohol intake, cooking fuel type, heating fuel type, self-reported health status, BMI, physical activity level, temperature, and relative humidity.<h3>Findings</h3>The analysis of 512 709 participants (mean baseline age 52·0 years [SD 10·7]; 59·0% female and 41·0% male) included approximately 6·5 million person-years of follow-up. Between 5285 and 144 852 incident events were recorded for each of the 14 aggregated endpoints. Each 10 μg/m<sup>3</sup> higher annual average NO<sub>2</sub> exposure was associated with higher risks of chapter-specific endpoints, especially cardiovascular (n=144 852; HR 1·04 [95% CI 1·02–1·05]), respiratory (n=73 232; 1·03 [1·01–1·05]), musculoskeletal (n=54 409; 1·11 [1·09–1·14]), and mental and behavioural (n=5361; 1·12 [1·05–1·21]) disorders. Further in-depth analyses on specific diseases found significant positive supra-linear associations with hypertensive disease (1·08 [1·05–1·11]), lower respiratory tract infection (1·03 [1·01–1·06]), arthrosis (1·15 [1·09–1·21]), intervertebral disc disorders (1·13 [1·09–1·17]), and spondylopathies (1·05 [1·01–1·10]), and linear associations with ischaemic heart disease (1·03 [1·00–1·05]), ischaemic stroke (1·08 [1·06–1·11]), and asthma (1·15 [1·04–1·27]), whereas intracerebral haemorrhage (1·00 [0·95–1·06]), other cerebrovascular disease (0·98 [0·96–1·01]), acute upper respiratory infection (1·03 [0·96–1·09]), and chronic lower respiratory disease (0·98 [0·95–1·02]) showed no significant association. NO<sub>2</sub> exposure showed robust null association with external causes (n=32 907; 0·98 [0·95–1·02]) as a negative control.<h3>Interpretation</h3>In China, long-term NO<sub>2</sub> exposure was associated with a range of diseases, particularly cardiovascular, respiratory, and musculoskeletal diseases. These associations underscore the pressing need to implement the recently tightened WHO air quality guidelines.<h3>Funding</h3
{"title":"Associations of long-term nitrogen dioxide exposure with a wide spectrum of diseases: a prospective cohort study of 0·5 million Chinese adults","authors":"Xi Xia, Xia Meng, Cong Liu, Yi Guo, Xinyue Li, Yue Niu, Kin Bong Hubert Lam, Neil Wright, Christiana Kartsonaki, Yiping Chen, Ling Yang, Huaidong Du, Canqing Yu, Dianjianyi Sun, Jun Lv, Junshi Chen, Xiaoming Yang, Ruqin Gao, Shaowei Wu, Haidong Kan, Chan Qu","doi":"10.1016/s2468-2667(24)00264-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00264-0","url":null,"abstract":"<h3>Background</h3>Little evidence is available on the long-term health effects of nitrogen dioxide (NO<sub>2</sub>) in low-income and middle-income populations. We investigated the associations of long-term NO<sub>2</sub> exposure with the incidence of a wide spectrum of disease outcomes, based on data from the China Kadoorie Biobank.<h3>Methods</h3>This prospective cohort study involved 512 724 Chinese adults aged 30–79 years recruited from ten areas of China during 2004–08. Time-varying Cox regression models yielded adjusted hazard ratios (HRs) for the associations of long-term NO<sub>2</sub> exposure with aggregated disease incidence endpoints classified by 14 ICD-10 chapters, and incidences of 12 specific diseases selected from three key ICD-10 chapters (cardiovascular, respiratory, and musculoskeletal diseases) found to be robustly associated with NO<sub>2</sub> in the analyses of aggregated endpoints. All models were stratified by age-at-risk (in 1-year scale), study area, and sex, and were adjusted for education, household income, smoking status, alcohol intake, cooking fuel type, heating fuel type, self-reported health status, BMI, physical activity level, temperature, and relative humidity.<h3>Findings</h3>The analysis of 512 709 participants (mean baseline age 52·0 years [SD 10·7]; 59·0% female and 41·0% male) included approximately 6·5 million person-years of follow-up. Between 5285 and 144 852 incident events were recorded for each of the 14 aggregated endpoints. Each 10 μg/m<sup>3</sup> higher annual average NO<sub>2</sub> exposure was associated with higher risks of chapter-specific endpoints, especially cardiovascular (n=144 852; HR 1·04 [95% CI 1·02–1·05]), respiratory (n=73 232; 1·03 [1·01–1·05]), musculoskeletal (n=54 409; 1·11 [1·09–1·14]), and mental and behavioural (n=5361; 1·12 [1·05–1·21]) disorders. Further in-depth analyses on specific diseases found significant positive supra-linear associations with hypertensive disease (1·08 [1·05–1·11]), lower respiratory tract infection (1·03 [1·01–1·06]), arthrosis (1·15 [1·09–1·21]), intervertebral disc disorders (1·13 [1·09–1·17]), and spondylopathies (1·05 [1·01–1·10]), and linear associations with ischaemic heart disease (1·03 [1·00–1·05]), ischaemic stroke (1·08 [1·06–1·11]), and asthma (1·15 [1·04–1·27]), whereas intracerebral haemorrhage (1·00 [0·95–1·06]), other cerebrovascular disease (0·98 [0·96–1·01]), acute upper respiratory infection (1·03 [0·96–1·09]), and chronic lower respiratory disease (0·98 [0·95–1·02]) showed no significant association. NO<sub>2</sub> exposure showed robust null association with external causes (n=32 907; 0·98 [0·95–1·02]) as a negative control.<h3>Interpretation</h3>In China, long-term NO<sub>2</sub> exposure was associated with a range of diseases, particularly cardiovascular, respiratory, and musculoskeletal diseases. These associations underscore the pressing need to implement the recently tightened WHO air quality guidelines.<h3>Funding</h3","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"155 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776452","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 : 2024-12-04DOI: 10.1016/s2468-2667(24)00249-4
Hao Fong Sit, Wen Chen, Dan Wu, Yangmu Huang, Dong (Roman) Xu, Brian J Hall
Mental health is an important public health issue in China, compounded by a shortage in psychiatric services. Against this backdrop, digital technologies could offer solutions. Digital mental health interventions use technologies, such as smartphone applications, to improve mental health outcomes. Although there has been a drastic increase in mental health mobile apps available in recent years, current evidence-based digital interventions for mental health are scarce and seldom evaluated for effectiveness and implementation in China. In this Viewpoint, we review digital mental health interventions in China and propose a framework that could guide the development of culturally sensitive digital mental health innovations, with the adoption of co-creation and community engagement strategies. We also provide recommendations to address issues related to usage, interventions, and implementation to improve health equity and implementation of digital mental health interventions in the Chinese context.
{"title":"Digital mental health: a potential opportunity to improve health equity in China","authors":"Hao Fong Sit, Wen Chen, Dan Wu, Yangmu Huang, Dong (Roman) Xu, Brian J Hall","doi":"10.1016/s2468-2667(24)00249-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00249-4","url":null,"abstract":"Mental health is an important public health issue in China, compounded by a shortage in psychiatric services. Against this backdrop, digital technologies could offer solutions. Digital mental health interventions use technologies, such as smartphone applications, to improve mental health outcomes. Although there has been a drastic increase in mental health mobile apps available in recent years, current evidence-based digital interventions for mental health are scarce and seldom evaluated for effectiveness and implementation in China. In this Viewpoint, we review digital mental health interventions in China and propose a framework that could guide the development of culturally sensitive digital mental health innovations, with the adoption of co-creation and community engagement strategies. We also provide recommendations to address issues related to usage, interventions, and implementation to improve health equity and implementation of digital mental health interventions in the Chinese context.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"2 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776443","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 : 2024-12-03DOI: 10.1016/s2468-2667(24)00266-4
Yi Yang, Peter Summers, Zoe Aitken, Anne Kavanagh, George Disney
Background
Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia.
Methods
In this nationwide, data linkage study we used Census mortality linked data (2011–20) to construct a cohort of Australians aged 0–74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability.
Findings
15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043–2091) more deaths in males and 1697 (1677–1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449–476) for males and 368 (356–379) for females for cancer, and 471 (95% CI 459–483) for males and 333 (324–342) for females for cardiovascular disease. Less common causes among people without disability—neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases—are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31–10·02) for males and 11·61 (11·13–12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages.
Interpretation
People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary.
Funding
The University of Melbourne.
背景没有关于死亡率不平等的高质量统计数据，制定政策以改善残疾人的健康是具有挑战性的。我们的目标是量化澳大利亚残疾人所经历的死亡率不平等。方法在这项全国性的数据关联研究中，我们使用人口普查死亡率相关数据（2011-20）构建了一个0-74岁的澳大利亚队列。残疾被衡量为在核心日常活动中需要帮助或监督。我们估计了年龄标准化死亡率和特定年龄死亡率，以及残疾人和非残疾人之间的绝对死亡率和相对死亡率不平等。研究结果：15 216 195人参与了这项研究，其中女性7 763 047人，男性7 453 148人。在参与者中，258109名（3.5%）男性和228658名（2.9%）女性报告了残疾，在133840359人年的随访期间，有46990人死亡。每10万人年，残疾男性死亡人数比无残疾男性多2067人（95% CI 2043-2091），残疾女性死亡人数比无残疾女性多1697人（1677-1718）（分别高出3.69倍和4.64倍）。癌症和心血管疾病的绝对不平等程度最高，男性癌症发病率差异为462 (95% CI 449-476)，女性癌症发病率差异为368(356-379)，男性心血管疾病发病率差异为471 (95% CI 459-483)，女性心血管疾病发病率差异为333（324-342）。在非残疾人中不太常见的病因——神经系统疾病、慢性肺病、内分泌疾病和消化系统疾病——在残疾人中相对常见，这导致了较高的相对死亡率不平等。最大的相对不平等来自神经系统疾病，男性的比率为9.66 (95% CI为9.31 - 10.02)，女性为11.61（11.13 - 12.10）。相对和绝对的不平等在意外伤害和自杀死亡率方面也很重要。残疾人群按年龄划分的死亡率一直较高。造成绝对不平等的主要因素从年轻人的神经系统疾病转向老年人的癌症、心血管疾病和慢性肺病。残疾人经历了巨大的死亡率不平等。确定导致这些不平等的可干预因素应成为优先事项。可能有必要进行有针对性的干预和政策改革，为残疾人创造一个更具包容性的社会和保健环境。资助墨尔本大学。
{"title":"All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study in Australia","authors":"Yi Yang, Peter Summers, Zoe Aitken, Anne Kavanagh, George Disney","doi":"10.1016/s2468-2667(24)00266-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00266-4","url":null,"abstract":"<h3>Background</h3>Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia.<h3>Methods</h3>In this nationwide, data linkage study we used Census mortality linked data (2011–20) to construct a cohort of Australians aged 0–74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability.<h3>Findings</h3>15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043–2091) more deaths in males and 1697 (1677–1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449–476) for males and 368 (356–379) for females for cancer, and 471 (95% CI 459–483) for males and 333 (324–342) for females for cardiovascular disease. Less common causes among people without disability—neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases—are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31–10·02) for males and 11·61 (11·13–12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages.<h3>Interpretation</h3>People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary.<h3>Funding</h3>The University of Melbourne.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"4 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759983","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 : 2024-12-03DOI: 10.1016/s2468-2667(24)00274-3
Hannah Kuper, Sara Rotenberg
There are about 1·3 billion people with disability globally, and their higher mortality rates mean that they are dying about 14 years earlier than people without disability.1, 2 In this issue of The Lancet Public Health, Yi Yang and colleagues’ study3 adds to this literature. Using large-scale longitudinal data from 15 million Australians, they showed that people with disability have high inequalities—whether measured on an absolute or relative scale and across different causes of death. Overall, mortality rates were about 3·7-times higher for men with disability and about 4·6-times higher for women with disability than their non-disabled peers. This Article3 adds to the growing, unequivocal evidence on the relationship between mortality and disability. It also highlights three key questions that need to be addressed before public health actors start to take this issue seriously.
{"title":"Closing the mortality gap for people with disabilities","authors":"Hannah Kuper, Sara Rotenberg","doi":"10.1016/s2468-2667(24)00274-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00274-3","url":null,"abstract":"There are about 1·3 billion people with disability globally, and their higher mortality rates mean that they are dying about 14 years earlier than people without disability.<span><span>1</span></span>, <span><span>2</span></span> In this issue of <em>The Lancet Public Health</em>, Yi Yang and colleagues’ study<span><span><sup>3</sup></span></span> adds to this literature. Using large-scale longitudinal data from 15 million Australians, they showed that people with disability have high inequalities—whether measured on an absolute or relative scale and across different causes of death. Overall, mortality rates were about 3·7-times higher for men with disability and about 4·6-times higher for women with disability than their non-disabled peers. This Article<span><span><sup>3</sup></span></span> adds to the growing, unequivocal evidence on the relationship between mortality and disability. It also highlights three key questions that need to be addressed before public health actors start to take this issue seriously.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"153 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760267","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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