Pub Date : 2024-10-02DOI: 10.1016/s2468-2667(24)00213-5
Anna Akselsson
No Abstract
无摘要
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Pub Date : 2024-10-02DOI: 10.1016/s2468-2667(24)00188-9
Maryam Shirvanifar, Viktor H Ahlqvist, Michael Lundberg, Kyriaki Kosidou, Ángel Herraiz-Adillo, Daniel Berglind, Cecilia Magnusson, Pontus Henriksson
Background
Whether there are differences in the contribution of overweight and obesity to adverse pregnancy outcomes between migrant and non-migrant women in high-income countries, which might increase health inequalities, remains unclear. Therefore, in this study, we aimed to estimate the contribution (including the proportion and number of attributable cases) of overweight and obesity to a wide range of adverse pregnancy outcomes in Swedish-born and migrant women.
Methods
This population-based cohort study used nationwide population registries in Sweden. All outcomes and covariates were collected from the Medical Birth Register (delivery and maternal characteristics), National Patient Register (inpatient and specialised outpatient care), the Cause of Death Register (all deaths in Sweden), the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (socioeconomic data), and the Total Population Register (maternal birth country data). Women with missing records of BMI at the first antenatal visit, country of birth, or covariates, were excluded from the study. BMI was measured during the first antenatal visit. Maternal country of birth was categorised into Sweden and seven super-regions. The proportion (ie, population attributable fractions [PAFs]) and the number of adverse pregnancy outcomes attributable to overweight and obesity were calculated, adjusting for maternal age, gestational age at first antenatal visit, maternal parity, smoking status, maternal somatic conditions, child's sex, socioeconomic and demographic variables.
Findings
We identified 2 228 416 singleton pregnancies between Jan 1, 2000, and Dec 31, 2020 of 1 245 273 women. 254 778 (11·4%) pregnancies with missing records of BMI at the first antenatal visit, country of birth, or covariates were excluded, which resulted in a final analytical cohort of 1 973 638 pregnancies carried by 1 164 783 women. The overall mean maternal age of the study population was 30·8 years (SD 5·1). As estimated by PAFs, overweight and obesity contributed to a large proportion of adverse pregnancy outcomes: gestational diabetes (52·1% [95% CI 51·0–53·2]), large-for-gestational age (36·9% [36·2–37·6]), pre-eclampsia (26·5% [25·7–27·3]), low Apgar score (14·7% [13·5–15·9]), infant mortality (12·7% [9·8–15·7]), severe maternal morbidity (henceforth referred to as a near-miss event; 8·5% [6·0–11·0]), and preterm birth (5·0% [4·4–5·7]) in the total study population. PAFs varied between maternal birth regions.
Interpretation
Interventions to reduce overweight and obesity have the potential to mitigate the burden of adverse pregnancy outcomes and possibly reduce inequalities in reproductive health. Therefore, public health practice and policy should prioritise efforts to prevent overweight and obesity among women of childbearing age.
{"title":"Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study","authors":"Maryam Shirvanifar, Viktor H Ahlqvist, Michael Lundberg, Kyriaki Kosidou, Ángel Herraiz-Adillo, Daniel Berglind, Cecilia Magnusson, Pontus Henriksson","doi":"10.1016/s2468-2667(24)00188-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00188-9","url":null,"abstract":"<h3>Background</h3>Whether there are differences in the contribution of overweight and obesity to adverse pregnancy outcomes between migrant and non-migrant women in high-income countries, which might increase health inequalities, remains unclear. Therefore, in this study, we aimed to estimate the contribution (including the proportion and number of attributable cases) of overweight and obesity to a wide range of adverse pregnancy outcomes in Swedish-born and migrant women.<h3>Methods</h3>This population-based cohort study used nationwide population registries in Sweden. All outcomes and covariates were collected from the Medical Birth Register (delivery and maternal characteristics), National Patient Register (inpatient and specialised outpatient care), the Cause of Death Register (all deaths in Sweden), the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (socioeconomic data), and the Total Population Register (maternal birth country data). Women with missing records of BMI at the first antenatal visit, country of birth, or covariates, were excluded from the study. BMI was measured during the first antenatal visit. Maternal country of birth was categorised into Sweden and seven super-regions. The proportion (ie, population attributable fractions [PAFs]) and the number of adverse pregnancy outcomes attributable to overweight and obesity were calculated, adjusting for maternal age, gestational age at first antenatal visit, maternal parity, smoking status, maternal somatic conditions, child's sex, socioeconomic and demographic variables.<h3>Findings</h3>We identified 2 228 416 singleton pregnancies between Jan 1, 2000, and Dec 31, 2020 of 1 245 273 women. 254 778 (11·4%) pregnancies with missing records of BMI at the first antenatal visit, country of birth, or covariates were excluded, which resulted in a final analytical cohort of 1 973 638 pregnancies carried by 1 164 783 women. The overall mean maternal age of the study population was 30·8 years (SD 5·1). As estimated by PAFs, overweight and obesity contributed to a large proportion of adverse pregnancy outcomes: gestational diabetes (52·1% [95% CI 51·0–53·2]), large-for-gestational age (36·9% [36·2–37·6]), pre-eclampsia (26·5% [25·7–27·3]), low Apgar score (14·7% [13·5–15·9]), infant mortality (12·7% [9·8–15·7]), severe maternal morbidity (henceforth referred to as a near-miss event; 8·5% [6·0–11·0]), and preterm birth (5·0% [4·4–5·7]) in the total study population. PAFs varied between maternal birth regions.<h3>Interpretation</h3>Interventions to reduce overweight and obesity have the potential to mitigate the burden of adverse pregnancy outcomes and possibly reduce inequalities in reproductive health. Therefore, public health practice and policy should prioritise efforts to prevent overweight and obesity among women of childbearing age.<h3>Funding</h3>Swedish Research Council.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"29 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363251","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 : 2024-10-02DOI: 10.1016/s2468-2667(24)00166-x
<h3>Background</h3>Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies.<h3>Methods</h3>In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework.<h3>Findings</h3>Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·
{"title":"Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s2468-2667(24)00166-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00166-x","url":null,"abstract":"<h3>Background</h3>Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies.<h3>Methods</h3>In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework.<h3>Findings</h3>Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9–29·1) among males and 5·96% (5·76–6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2–26·6) among males, and 30·0% (26·1–32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8–32·4) overall YLLs among males and 22·2 billion (20·1–24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8–74·4) in 2022 to 78·3 years (75·9–80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90–2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1–79·6) among males and 81·0 years (78·5–83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675–808) and 141 million (131–154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"25 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363247","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 : 2024-10-02DOI: 10.1016/s2468-2667(24)00183-x
Sarah E Jackson, Lion Shahab, Harry Tattan-Birch, Jamie Brown
Background
E-cigarettes are increasingly used by smokers and ex-smokers, often to support smoking cessation, but also among those who have never regularly smoked. The aim of our study is to estimate time trends in vaping prevalence among adults who have never regularly smoked and describe the profile of adult never-regular-smokers who vape.
Methods
In this nationally representative, monthly cross-sectional survey in England, 153 073 participants (aged ≥18 years) were recruited from July, 2016, to April, 2024. 94 107 (61·5%) of the 153 073 participants had never regularly smoked. Logistic regression estimated associations between survey wave and current vaping, overall, and by sociodemographic characteristics and alcohol consumption.
Findings
Vaping prevalence among never-regular-smokers was relatively stable up to 2021, at an average of 0·5% (95% CI 0·5–0·6) between July, 2016, and December, 2020; it then increased rapidly, reaching 3·5% (2·8–4·4) in April, 2024. This increase was largely driven by young adults (19·0% [13·9–25·4] among individuals aged 18 years) and those with higher alcohol consumption levels (22·1% [11·7–37·8%] among the heaviest drinkers). By contrast, trends among all adults (including current and former smokers) suggested the rise in vaping prevalence plateaued among all ages by early 2023. In 2023–24, 55·6% (48·2–62·8) of never-regular-smokers who vaped reported vaping daily; 81·7% (75·4–86·7) had been vaping for 6 months or more. The most used devices in 2023–24 were disposables (50·2% [42·9–57·5]) and the most commonly used e-liquids contained 20 mg/mL or more nicotine (44·6% [37·4–52·0]).
Interpretation
The number of adults in England who vape but have never regularly smoked rose rapidly between 2021 and 2024, particularly in younger age groups and most of these individuals reported vaping regularly over a sustained period. The public health impacts of this finding will depend on what these people would otherwise be doing: it is likely that some might have smoked if vaping were not an available option (exposing them to more harm), whereas others might not have smoked or vaped.
{"title":"Vaping among adults in England who have never regularly smoked: a population-based study, 2016–24","authors":"Sarah E Jackson, Lion Shahab, Harry Tattan-Birch, Jamie Brown","doi":"10.1016/s2468-2667(24)00183-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00183-x","url":null,"abstract":"<h3>Background</h3>E-cigarettes are increasingly used by smokers and ex-smokers, often to support smoking cessation, but also among those who have never regularly smoked. The aim of our study is to estimate time trends in vaping prevalence among adults who have never regularly smoked and describe the profile of adult never-regular-smokers who vape.<h3>Methods</h3>In this nationally representative, monthly cross-sectional survey in England, 153 073 participants (aged ≥18 years) were recruited from July, 2016, to April, 2024. 94 107 (61·5%) of the 153 073 participants had never regularly smoked. Logistic regression estimated associations between survey wave and current vaping, overall, and by sociodemographic characteristics and alcohol consumption.<h3>Findings</h3>Vaping prevalence among never-regular-smokers was relatively stable up to 2021, at an average of 0·5% (95% CI 0·5–0·6) between July, 2016, and December, 2020; it then increased rapidly, reaching 3·5% (2·8–4·4) in April, 2024. This increase was largely driven by young adults (19·0% [13·9–25·4] among individuals aged 18 years) and those with higher alcohol consumption levels (22·1% [11·7–37·8%] among the heaviest drinkers). By contrast, trends among all adults (including current and former smokers) suggested the rise in vaping prevalence plateaued among all ages by early 2023. In 2023–24, 55·6% (48·2–62·8) of never-regular-smokers who vaped reported vaping daily; 81·7% (75·4–86·7) had been vaping for 6 months or more. The most used devices in 2023–24 were disposables (50·2% [42·9–57·5]) and the most commonly used e-liquids contained 20 mg/mL or more nicotine (44·6% [37·4–52·0]).<h3>Interpretation</h3>The number of adults in England who vape but have never regularly smoked rose rapidly between 2021 and 2024, particularly in younger age groups and most of these individuals reported vaping regularly over a sustained period. The public health impacts of this finding will depend on what these people would otherwise be doing: it is likely that some might have smoked if vaping were not an available option (exposing them to more harm), whereas others might not have smoked or vaped.<h3>Funding</h3>Cancer Research UK.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"23 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363249","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 : 2024-10-02DOI: 10.1016/s2468-2667(24)00185-3
Julia Rey Brandariz, Harriet Rumgay, Olalekan Ayo-Yusuf, Richard Edwards, Farhad Islami, Shiwei Liu, Mónica Pérez-Ríos, Paulo César Rodrigues Pinto Corrêa, Alberto Ruano-Ravina, Isabelle Soerjomataram
<h3>Background</h3>The tobacco-free generation aims to prevent the sale of tobacco to people born after a specific year. We aimed to estimate the impact of eliminating tobacco smoking on lung-cancer mortality in people born during 2006–10 in 185 countries.<h3>Methods</h3>For this population-based birth-cohort simulation study, we proposed a scenario in which tobacco sales were banned for people born between Jan 1, 2006, and Dec 31, 2010, and in which this intervention was perfectly enforced, quantified until Dec 31, 2095. To predict future lung-cancer mortality rates, we extracted lung-cancer mortality data by sex, 5-year age group, and 5-year calendar period for countries with at least 15 years of data from the WHO Mortality Database. For countries for which mortality data were not available, we extracted data on lung-cancer incidence from the Cancer Incidence in Five Continents. To establish the number of lung-cancer deaths that could be prevented in the birth cohort if tobacco smoking was eliminated, we subtracted reported age-specific rate of deaths in people who had never smoked tobacco (hereafter referred to as never smokers) from a previous study from the expected rate of lung-cancer deaths in our birth cohort and applied this difference to the size of the population. We computed population impact fractions (PIFs), the percentage of lung-cancer deaths that could be prevented, by dividing the number of preventable lung-cancer deaths by the expected lung-cancer deaths in the birth cohort. We also aggregated expected and prevented deaths into the four World Bank income groups (ie, high-income, upper-middle-income, lower-middle-income, and low-income). The primary outcome was the impact on lung-cancer mortality of implementing a tobacco-free generation.<h3>Findings</h3>Our birth cohort included a total population of 650 525 800 people. Globally, we predicted that 2 951 400 lung-cancer deaths could occur in the population born during 2006–10 if lung-cancer rates continue to follow trends observed during the past 15 years. Of these deaths, 1 842 900 (62·4%) were predicted to occur in male individuals and 1 108 500 (37·6%) were expected to occur in female individuals. We estimated that 1 186 500 (40·2%) of 2 951 400 lung-cancer deaths in people born during 2006–10 could be prevented if tobacco elimination (ie, a tobacco-free generation) was achieved. We estimated that more lung-cancer deaths could be prevented in male individuals (844 200 [45·8%] of 1 842 900 deaths) than in female individuals (342 400 [30·9%] of 1 108 500 deaths). In male individuals, central and eastern Europe had the highest PIF (48 900 [74·3%] of 65 800 deaths) whereas in female individuals, western Europe had the highest PIF (56 200 [77·7%] of 72 300 deaths). Middle Africa was the region with the lowest PIF in both male individuals (180 [2·1%] of 8600 deaths) and female individuals (60 [0·9%] of 6400 deaths). In both sexes combined, PIF was 17 400 (13·5%) of 128 900 deaths i
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Pub Date : 2024-10-01Epub Date: 2024-09-26DOI: 10.1016/S2468-2667(24)00181-6
Alexis Robert, Anne M Suffel, Adam J Kucharski
<p><strong>Background: </strong>Among people infected with measles in England between 2010 and 2019, the proportion of cases who had previously received two doses of vaccine has increased, especially among young adults. Possible explanations include rare infections in vaccinated individuals who did not gain immunity upon vaccination, made more common because fewer individuals in the population were born in the endemic era, before vaccination was introduced, and exposed as part of endemic transmission, or the waning of vaccine-induced immunity, which would present new challenges for measles control in near-elimination settings. We aimed to evaluate whether measles dynamics observed in England between 2010 and 2019 were in line with a waning of vaccine-induced immunity.</p><p><strong>Methods: </strong>We used a compartmental mathematical model stratified by age group, region, and vaccine status, fitted to individual-level case data reported in England from 2010 to 2019 and collected by the UK Health Security Agency. The deterministic model was fitted using Monte Carlo Markov Chains under three scenarios: without the waning of vaccine-induced immunity, with waning depending on time since vaccination, and with waning depending on time since vaccination, starting in 2000. We generated stochastic simulations from the fitted parameter sets to evaluate which scenarios could replicate the transmission dynamics observed in vaccinated cases in England.</p><p><strong>Findings: </strong>The scenario without waning overestimated the number of one-dose recipients among measles cases, and underestimated the number of two-dose recipients among cases older than 15 years (median 75 cases [95% simulation interval (SI) 44-124] in simulations without waning, 196 [95% SI 122-315] in simulations when waning was included, 188 [95% SI 118-301] in simulations when waning started in 2000, and 202 observed cases). The number of onward transmissions from vaccinated cases was 83% (95% credible interval 72-91%) of the number of transmissions from unvaccinated cases. The estimated waning rate was slow (0·039% per year of age; 95% credible interval 0·034-0·044% per year in the best-fitting scenario with waning starting in 2000), but sufficient to increase measles burden.</p><p><strong>Interpretation: </strong>Measles case dynamics in England are consistent with scenarios assuming the waning of vaccine-induced immunity. Since measles is highly infectious, slow waning leads to a heightened burden in outbreaks, increasing the number of measles cases in people who are both vaccinated and unvaccinated. Our findings show that although the vaccine remains highly protective against measles infections for decades and most transmission is connected to people who are unvaccinated, breakthrough infections are increasingly frequent for individuals aged 15 years and older who have been vaccinated twice.</p><p><strong>Funding: </strong>National Institute for Health and Care Research and Wellcom
{"title":"Long-term waning of vaccine-induced immunity to measles in England: a mathematical modelling study.","authors":"Alexis Robert, Anne M Suffel, Adam J Kucharski","doi":"10.1016/S2468-2667(24)00181-6","DOIUrl":"10.1016/S2468-2667(24)00181-6","url":null,"abstract":"<p><strong>Background: </strong>Among people infected with measles in England between 2010 and 2019, the proportion of cases who had previously received two doses of vaccine has increased, especially among young adults. Possible explanations include rare infections in vaccinated individuals who did not gain immunity upon vaccination, made more common because fewer individuals in the population were born in the endemic era, before vaccination was introduced, and exposed as part of endemic transmission, or the waning of vaccine-induced immunity, which would present new challenges for measles control in near-elimination settings. We aimed to evaluate whether measles dynamics observed in England between 2010 and 2019 were in line with a waning of vaccine-induced immunity.</p><p><strong>Methods: </strong>We used a compartmental mathematical model stratified by age group, region, and vaccine status, fitted to individual-level case data reported in England from 2010 to 2019 and collected by the UK Health Security Agency. The deterministic model was fitted using Monte Carlo Markov Chains under three scenarios: without the waning of vaccine-induced immunity, with waning depending on time since vaccination, and with waning depending on time since vaccination, starting in 2000. We generated stochastic simulations from the fitted parameter sets to evaluate which scenarios could replicate the transmission dynamics observed in vaccinated cases in England.</p><p><strong>Findings: </strong>The scenario without waning overestimated the number of one-dose recipients among measles cases, and underestimated the number of two-dose recipients among cases older than 15 years (median 75 cases [95% simulation interval (SI) 44-124] in simulations without waning, 196 [95% SI 122-315] in simulations when waning was included, 188 [95% SI 118-301] in simulations when waning started in 2000, and 202 observed cases). The number of onward transmissions from vaccinated cases was 83% (95% credible interval 72-91%) of the number of transmissions from unvaccinated cases. The estimated waning rate was slow (0·039% per year of age; 95% credible interval 0·034-0·044% per year in the best-fitting scenario with waning starting in 2000), but sufficient to increase measles burden.</p><p><strong>Interpretation: </strong>Measles case dynamics in England are consistent with scenarios assuming the waning of vaccine-induced immunity. Since measles is highly infectious, slow waning leads to a heightened burden in outbreaks, increasing the number of measles cases in people who are both vaccinated and unvaccinated. Our findings show that although the vaccine remains highly protective against measles infections for decades and most transmission is connected to people who are unvaccinated, breakthrough infections are increasingly frequent for individuals aged 15 years and older who have been vaccinated twice.</p><p><strong>Funding: </strong>National Institute for Health and Care Research and Wellcom","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e766-e775"},"PeriodicalIF":25.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333102","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 : 2024-10-01Epub Date: 2024-08-29DOI: 10.1016/S2468-2667(24)00212-3
{"title":"Correction to Lancet Public Health 2024; 9: e443-60.","authors":"","doi":"10.1016/S2468-2667(24)00212-3","DOIUrl":"10.1016/S2468-2667(24)00212-3","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":" ","pages":"e718"},"PeriodicalIF":25.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115131","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 : 2024-09-16DOI: 10.1016/s2468-2667(24)00225-1
Mark Robinson,Jaithri Ananthapavan
{"title":"The Sheffield model's influence in informing alcohol control policy.","authors":"Mark Robinson,Jaithri Ananthapavan","doi":"10.1016/s2468-2667(24)00225-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00225-1","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"21 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273505","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 : 2024-09-16DOI: 10.1016/s2468-2667(24)00191-9
Damon Morris,Colin Angus,Duncan Gillespie,Abigail K Stevely,Robert Pryce,Luke Wilson,Madeleine Henney,Petra S Meier,John Holmes,Alan Brennan
BACKGROUNDIncreasing the amount of alcohol taxation is among the most effective measures for addressing the rising global burden of alcohol harm. However, less is known about the effect of changing alcohol tax structures. Substantial reforms to UK alcohol taxation structures enacted in August, 2023, mean that all alcohol is taxed based on its ethanol content, beers and ciders sold in on-trade premises (eg, public houses) are taxed at a reduced rate (hereafter called draught relief), and beer and particularly cider remain taxed at lower rates than other alcohol of equivalent strength. We aimed to model the effect of these reforms on alcohol consumption and health and economic outcomes, and the effects of hypothetical alternative scenarios.METHODSThe Sheffield Tobacco and Alcohol Policy Model was used to estimate policy effects on alcohol consumption. The model is an individual-based microsimulation that uses data from the Health Survey for England, Living Costs and Food Survey, Hospital Episode Statistics, and the Office for National Statistics. Spending and revenues to retailers and the Government were estimated cumulatively for a 5-year period post-intervention. Policy effects on all-cause deaths, years of life lost, hospital admissions, and admissions costs were estimated cumulatively for a 20-year period post-intervention.FINDINGSThe reform was estimated to decrease mean weekly alcohol consumption per drinker by less than 0·05 (-0·34%) units (1 unit=8 g/10 mL ethanol), and prevent 2307 deaths and 11 510 hospital admissions during 20 years compared with no policy change. Removing draught relief was estimated to prevent 1441 further deaths and 14 247 further admissions. Hypothetical scenarios showed that removing draught relief would only slightly improve public health outcomes, and increasing tax rates for beer and ciders to match other drinks of equivalent strength would reduce consumption by a further 2·5 units per week (-17%) and deaths by approximately 74 465.INTERPRETATIONAlcohol tax structures based on alcohol strength enable tax policy to improve public health in a targeted way. However, the UK reforms are unlikely to substantially improve health outcomes as they do not raise taxes overall. Raising tax rates for the lowest taxed beer and ciders, which are favoured by those who consume harmful amounts of alcohol, could achieve substantially greater public health benefits and reduce health inequalities.FUNDINGNational Institute for Health and Care Research and UK Prevention Research Partnership.
{"title":"Estimating the effect of transitioning to a strength-based alcohol tax system on alcohol consumption and health outcomes: a modelling study of tax reform in England.","authors":"Damon Morris,Colin Angus,Duncan Gillespie,Abigail K Stevely,Robert Pryce,Luke Wilson,Madeleine Henney,Petra S Meier,John Holmes,Alan Brennan","doi":"10.1016/s2468-2667(24)00191-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00191-9","url":null,"abstract":"BACKGROUNDIncreasing the amount of alcohol taxation is among the most effective measures for addressing the rising global burden of alcohol harm. However, less is known about the effect of changing alcohol tax structures. Substantial reforms to UK alcohol taxation structures enacted in August, 2023, mean that all alcohol is taxed based on its ethanol content, beers and ciders sold in on-trade premises (eg, public houses) are taxed at a reduced rate (hereafter called draught relief), and beer and particularly cider remain taxed at lower rates than other alcohol of equivalent strength. We aimed to model the effect of these reforms on alcohol consumption and health and economic outcomes, and the effects of hypothetical alternative scenarios.METHODSThe Sheffield Tobacco and Alcohol Policy Model was used to estimate policy effects on alcohol consumption. The model is an individual-based microsimulation that uses data from the Health Survey for England, Living Costs and Food Survey, Hospital Episode Statistics, and the Office for National Statistics. Spending and revenues to retailers and the Government were estimated cumulatively for a 5-year period post-intervention. Policy effects on all-cause deaths, years of life lost, hospital admissions, and admissions costs were estimated cumulatively for a 20-year period post-intervention.FINDINGSThe reform was estimated to decrease mean weekly alcohol consumption per drinker by less than 0·05 (-0·34%) units (1 unit=8 g/10 mL ethanol), and prevent 2307 deaths and 11 510 hospital admissions during 20 years compared with no policy change. Removing draught relief was estimated to prevent 1441 further deaths and 14 247 further admissions. Hypothetical scenarios showed that removing draught relief would only slightly improve public health outcomes, and increasing tax rates for beer and ciders to match other drinks of equivalent strength would reduce consumption by a further 2·5 units per week (-17%) and deaths by approximately 74 465.INTERPRETATIONAlcohol tax structures based on alcohol strength enable tax policy to improve public health in a targeted way. However, the UK reforms are unlikely to substantially improve health outcomes as they do not raise taxes overall. Raising tax rates for the lowest taxed beer and ciders, which are favoured by those who consume harmful amounts of alcohol, could achieve substantially greater public health benefits and reduce health inequalities.FUNDINGNational Institute for Health and Care Research and UK Prevention Research Partnership.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"46 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273524","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 : 2024-09-09DOI: 10.1016/s2468-2667(24)00157-9
Keith Hawton,Duleeka Knipe,Jane Pirkis
One of the most effective public health measures to prevent suicide is the restriction of access to means used in suicidal acts. This approach can be especially effective if a method is common and readily accessible. Suicide methods vary widely, and there have been several examples where means restriction has been applied, often with considerable success. Factors contributing to availability of suicide methods can include access to physical means as well as cognitive awareness of methods. In this paper, which is the second in a Series on a public health approach to suicide prevention, we focus primarily on examples of restricting access to physical means of suicide, such as pesticides, firearms, and medication. We also discuss restricting the cognitive availability of means through attention to media and other representations of suicide methods. There are challenges associated with restricting access to means, including resistance to measures required to change the availability of some methods (which might, in part, be commercially determined) and method substitution, whereby one suicide method is replaced by another. Nevertheless, means restriction must be an integral part of all national and local suicide prevention strategies.
{"title":"Restriction of access to means used for suicide.","authors":"Keith Hawton,Duleeka Knipe,Jane Pirkis","doi":"10.1016/s2468-2667(24)00157-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00157-9","url":null,"abstract":"One of the most effective public health measures to prevent suicide is the restriction of access to means used in suicidal acts. This approach can be especially effective if a method is common and readily accessible. Suicide methods vary widely, and there have been several examples where means restriction has been applied, often with considerable success. Factors contributing to availability of suicide methods can include access to physical means as well as cognitive awareness of methods. In this paper, which is the second in a Series on a public health approach to suicide prevention, we focus primarily on examples of restricting access to physical means of suicide, such as pesticides, firearms, and medication. We also discuss restricting the cognitive availability of means through attention to media and other representations of suicide methods. There are challenges associated with restricting access to means, including resistance to measures required to change the availability of some methods (which might, in part, be commercially determined) and method substitution, whereby one suicide method is replaced by another. Nevertheless, means restriction must be an integral part of all national and local suicide prevention strategies.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"27 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231387","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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