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Changing patterns of health risk in adolescence: implications for health policy. 青春期健康风险模式的变化:对卫生政策的影响。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 Epub Date: 2024-07-09 DOI: 10.1016/S2468-2667(24)00125-7
Oliver T Mytton, Liam Donaldson, Anne-Lise Goddings, Gabrielle Mathews, Joseph L Ward, Felix Greaves, Russell M Viner

Adolescence is a time of physical, cognitive, social, and emotional development. This period is a very sensitive developmental window; environmental exposures, the development of health behaviours (eg, smoking and physical activity), and illness during adolescence can have implications for lifelong health. In the UK and other high-income countries, the experience of adolescence has changed profoundly over the past 20 years. Smoking, drug use, and alcohol consumption have all been in long-term decline. At the same time, obesity and mental ill health have increased and are now common among adolescents, with new risks (ie, vaping, psychoactive substances, and online harms) emerging. In this Viewpoint, we describe these and related trends in England and the UK. Although previous work has explored these changes in isolation, in this Viewpoint we consider them collectively. We explore what might be driving the changes and consider the implications for practice, policy, and research.

青春期是身体、认知、社交和情感发展的时期。这一时期是非常敏感的发育窗口期;环境暴露、健康行为(如吸烟和体育锻炼)的发展以及青春期的疾病都会对终生健康产生影响。在英国和其他高收入国家,青春期的经历在过去 20 年里发生了深刻的变化。吸烟、吸毒和酗酒现象都在长期下降。与此同时,肥胖症和精神疾病却在增加,现在已成为青少年中的常见病,新的风险(即吸食电子烟、精神活性物质和网络危害)也在出现。在本视点中,我们将介绍英格兰和英国的这些趋势及相关趋势。尽管之前的研究对这些变化进行了单独探讨,但在本观点中,我们将对这些变化进行综合考虑。我们探讨了推动这些变化的原因,并考虑了这些变化对实践、政策和研究的影响。
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引用次数: 0
Correction to Lancet Public Health 2024; 9: e326-38. 柳叶刀公共卫生》2024;9:e326-38 的更正。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 Epub Date: 2024-07-12 DOI: 10.1016/S2468-2667(24)00162-2
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引用次数: 0
Inequalities in epilepsy in the UK: action is needed now. 英国癫痫病的不平等现象:现在就需要采取行动。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00164-6
Angela Hassiotis, Rohit Shankar
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引用次数: 0
The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. 2000-19 年美国按郡、种族和民族划分的肝硬化死亡率负担:健康差异系统分析》(The burden of cirrhosis mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities)。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 Epub Date: 2024-07-14 DOI: 10.1016/S2468-2667(24)00131-2
<p><strong>Background: </strong>Cirrhosis is responsible for substantial health and economic burden in the USA. Reducing this burden requires better understanding of how rates of cirrhosis mortality vary by race and ethnicity and by geographical location. This study describes rates and trends in cirrhosis mortality for five racial and ethnic populations in 3110 US counties from 2000 to 2019.</p><p><strong>Methods: </strong>We estimated cirrhosis mortality rates by county, race and ethnicity, and year (2000-19) using previously validated small-area estimation methods, death registration data from the US National Vital Statistics System, and population data from the US National Center for Health Statistics. Five racial and ethnic populations were considered: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Cirrhosis mortality rate estimates were age-standardised using the age distribution from the 2010 US census as the standard. For each racial and ethnic population, estimates are presented for all counties with a mean annual population greater than 1000.</p><p><strong>Findings: </strong>From 2000 to 2019, national-level age-standardised cirrhosis mortality rates decreased in the Asian (23·8% [95% uncertainty interval 19·6-27·8], from 9·4 deaths per 100 000 population [8·9-9·9] to 7·1 per 100 000 [6·8-7·5]), Black (22·8% [20·6-24·8], from 19·8 per 100 000 [19·4-20·3] to 15·3 per 100 000 [15·0-15·6]), and Latino (15·3% [13·3-17·3], from 26·3 per 100 000 [25·6-27·0] to 22·3 per 100 000 [21·8-22·8]) populations and increased in the AIAN (39·3% [32·3-46·4], from 45·6 per 100 000 [40·6-50·6] to 63·5 per 100 000 [57·2-70·2] in 2000 and 2019, respectively) and White (25·8% [24·2-27·3], from 14·7 deaths per 100 000 [14·6-14·9] to 18·5 per 100 000 [18·4-18·7]) populations. In all years, cirrhosis mortality rates were lowest among the Asian population, highest among the AIAN population, and higher in males than females for each racial and ethnic population. The degree of heterogeneity in county-level cirrhosis mortality rates varied by racial and ethnic population, with the narrowest IQR in the Asian population (median 8·0 deaths per 100 000, IQR 6·4-10·4) and the widest in the AIAN population (55·1, 30·3-78·8). Cirrhosis mortality increased over the study period in almost all counties for the White (2957 [96·9%] of 3051 counties) and AIAN (421 [88·8%] of 474) populations, but in a smaller proportion of counties for the Asian, Black, and Latino populations. For all racial and ethnic populations, cirrhosis mortality rates increased in more counties between 2000 and 2015 than between 2015 and 2019.</p><p><strong>Interpretation: </strong>Cirrhosis mortality increased nationally and in many counties from 2000 to 2019. Although the magnitude of racial and ethnic disparities decreased in some places, disparities nonetheless persisted, and mortality remained high in many locations and communi
背景:肝硬化在美国造成了巨大的健康和经济负担。要减轻这一负担,就必须更好地了解不同种族和族裔以及不同地理位置的肝硬化死亡率有何差异。本研究描述了 2000 年至 2019 年期间美国 3110 个县中五个种族和民族人群的肝硬化死亡率及其变化趋势:我们使用先前验证过的小区域估算方法、美国国家生命统计系统的死亡登记数据以及美国国家卫生统计中心的人口数据,按县、种族和族裔以及年份(2000-19 年)估算了肝硬化死亡率。我们考虑了五个种族和民族的人群:美国印第安人或阿拉斯加原住民 (AIAN)、亚洲人或太平洋岛民 (Asian)、黑人、拉丁裔或西班牙裔 (Latino) 以及白人。肝硬化死亡率估计值以 2010 年美国人口普查的年龄分布为标准进行了年龄标准化。对于每个种族和民族的人口,估算值针对年平均人口大于 1000 人的所有县:从 2000 年到 2019 年,亚裔(23-8% [95% 不确定区间 19-6-27-8],从每 10 万人 9-4 例死亡 [8-9-9-9] 降至每 10 万人 7-1 例死亡 [6-8-7-5])、黑人(22-8% [20-6-24-8],从每 10 万人 19-8 例死亡 [19-4-20-3] 降至每 10 万人 15-3 例死亡 [15-0-15-6])和拉丁裔(15-3% [13-3-17-3]、从每 10 万人 26-3 例[25-6-27-0]降至每 10 万人 22-3 例[21-8-22-8]),而在 2000 年和 2019 年,亚裔美国人(39-3% [32-3-46-4],分别从每 10 万人 45-6 例[40-6-50-6]增至每 10 万人 63-5 例[57-2-70-2])和白人(25-8% [24-2-27-3],从每 10 万人 14-7 例[14-6-14-9]增至每 10 万人 18-5 例[18-4-18-7])中,肝硬化死亡率有所上升。在所有年份中,亚裔人口的肝硬化死亡率最低,亚裔美国人的肝硬化死亡率最高,在每个种族和族裔人口中,男性的肝硬化死亡率均高于女性。县级肝硬化死亡率的异质性程度因种族和族裔人口而异,亚裔人口的 IQR 最窄(中位数为每 10 万人中有 8-0 例死亡,IQR 为 6-4-10-4),亚裔美国人的 IQR 最宽(55-1,30-3-78-8)。在研究期间,几乎所有县的白人(3051 个县中的 2957 个[96-9%])和亚裔美国人(474 个县中的 421 个[88-8%])的肝硬化死亡率都有所上升,但亚裔、黑人和拉丁裔人口的肝硬化死亡率上升的县比例较小。就所有种族和族裔人口而言,2000 年至 2015 年期间肝硬化死亡率上升的县比 2015 年至 2019 年期间上升的县要多:从 2000 年到 2019 年,全国和许多县的肝硬化死亡率都有所上升。虽然一些地方的种族和民族差异有所减少,但差异依然存在,许多地方和社区的死亡率仍然很高。我们的研究结果表明,有必要在国家和地方层面实施有针对性的、因地制宜的计划和政策,以减轻肝硬化的负担:美国国立卫生研究院(院内研究计划、国立少数民族健康和健康差异研究所、国立心肺血液研究所、院内研究计划、国立癌症研究所、国立老龄化研究所、国立关节炎、肌肉骨骼和皮肤病研究所、疾病预防办公室以及行为和社会科学研究办公室)。
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引用次数: 0
Correction to Lancet Public Health 2024; 9: e432-42. Lancet Public Health 2024; 9: e432-42.
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 Epub Date: 2024-07-17 DOI: 10.1016/S2468-2667(24)00165-8
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引用次数: 0
A missed opportunity to tackle health inequity in the USA? 美国错失解决健康不公平问题的良机?
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00168-3
The Lancet Public Health
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引用次数: 0
Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data. 美国 1920 至 1990 年间出生的成年人患癌率的差异:基于人口的癌症登记数据分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00156-7
Hyuna Sung, Chenxi Jiang, Priti Bandi, Adair Minihan, Miranda Fidler-Benaoudia, Farhad Islami, Rebecca L Siegel, Ahmedin Jemal
<p><strong>Background: </strong>Trends in cancer incidence in recent birth cohorts largely reflect changes in exposures during early life and foreshadow the future disease burden. Herein, we examined cancer incidence and mortality trends, by birth cohort, for 34 types of cancer in the USA.</p><p><strong>Methods: </strong>In this analysis, we obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25-84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively. We calculated birth cohort-specific incidence rate ratios (IRRs) and mortality rate ratios (MRRs), adjusted for age and period effects, by nominal birth cohort, separated by 5 year intervals, from 1920 to 1990.</p><p><strong>Findings: </strong>We extracted data for 23 654 000 patients diagnosed with 34 types of cancer and 7 348 137 deaths from 25 cancers for the period Jan 1, 2000, to Dec 31, 2019. We found that IRRs increased with each successive birth cohort born since approximately 1920 for eight of 34 cancers (p<sub>cohort</sub><0·050). Notably, the incidence rate was approximately two-to-three times higher in the 1990 birth cohort than in the 1955 birth cohort for small intestine (IRR 3·56 [95% CI 2·96-4·27]), kidney and renal pelvis (2·92 [2·50-3·42]), and pancreatic (2·61 [2·22-3·07]) cancers in both male and female individuals; and for liver and intrahepatic bile duct cancer in female individuals (2·05 [1·23-3·44]). Additionally, the IRRs increased in younger cohorts, after a decline in older birth cohorts, for nine of the remaining cancers (p<sub>cohort</sub><0·050): oestrogen-receptor-positive breast cancer, uterine corpus cancer, colorectal cancer, non-cardia gastric cancer, gallbladder and other biliary cancer, ovarian cancer, testicular cancer, anal cancer in male individuals, and Kaposi sarcoma in male individuals. Across cancer types, the incidence rate in the 1990 birth cohort ranged from 12% (IRR<sub>1990 vs 1975</sub> 1·12 [95% CI 1·03-1·21] for ovarian cancer) to 169% (IRR<sub>1990 vs 1930</sub> 2·69 [2·34-3·08] for uterine corpus cancer) higher than the rate in the birth cohort with the lowest incidence rate. The MRRs increased in successively younger birth cohorts alongside IRRs for liver and intrahepatic bile duct cancer in female individuals, uterine corpus, gallbladder and other biliary, testicular, and colorectal cancers, while MRRs declined or stabilised in younger birth cohorts for most cancers types.</p><p><strong>Interpretation: </strong>17 of 34 cancers had an increasing incidence in younger birth cohorts, including nine that previously had declining incidence in older birth cohorts. These findings add to growing evidence of increased cancer risk in younger generations, highlighting the need to identify and tackle underlying risk factors.</p><p><strong>Funding: </strong>American Cancer Soci
背景:最近出生队列中癌症发病率的趋势在很大程度上反映了生命早期暴露的变化,并预示着未来的疾病负担。在此,我们按出生队列研究了美国 34 种癌症的发病率和死亡率趋势:在这项分析中,我们分别从北美中央癌症登记协会和美国国家卫生统计中心获得了 2000 年 1 月 1 日至 2019 年 12 月 31 日期间 34 种癌症的发病率数据和 25 种癌症的死亡率数据,这些数据的年龄在 25-84 岁之间。我们计算了出生队列的发病率比(IRRs)和死亡率比(MRRs),并对年龄和时期效应进行了调整,按名义出生队列,以 5 年为间隔,从 1920 年到 1990 年:我们提取了 2000 年 1 月 1 日至 2019 年 12 月 31 日期间 23 654 000 名确诊为 34 种癌症的患者和 7 348 137 名死于 25 种癌症的患者的数据。我们发现,与发病率最低的出生队列相比,自约 1920 年以来出生的每一出生队列中 34 种癌症中 8 种癌症的内部死亡率均有所上升(卵巢癌的内部死亡率 1990 年与 1975 年相比为 1-12 [95% CI 1-03-1-21]),最高可达 169%(子宫体癌的内部死亡率 1990 年与 1930 年相比为 2-69 [2-34-3-08])。随着女性肝癌和肝内胆管癌、子宫体癌、胆囊癌和其他胆道癌、睾丸癌和结直肠癌的内部比值的增加,年轻出生队列的中位比值也随之增加,而大多数癌症类型的中位比值在年轻出生队列中下降或保持稳定:34种癌症中有17种在较年轻的出生队列中发病率上升,其中包括9种以前在较年长的出生队列中发病率下降的癌症。这些发现补充了越来越多的证据表明年轻一代患癌症的风险增加,突出了识别和解决潜在风险因素的必要性:美国癌症协会。
{"title":"Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data.","authors":"Hyuna Sung, Chenxi Jiang, Priti Bandi, Adair Minihan, Miranda Fidler-Benaoudia, Farhad Islami, Rebecca L Siegel, Ahmedin Jemal","doi":"10.1016/S2468-2667(24)00156-7","DOIUrl":"https://doi.org/10.1016/S2468-2667(24)00156-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Trends in cancer incidence in recent birth cohorts largely reflect changes in exposures during early life and foreshadow the future disease burden. Herein, we examined cancer incidence and mortality trends, by birth cohort, for 34 types of cancer in the USA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this analysis, we obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25-84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively. We calculated birth cohort-specific incidence rate ratios (IRRs) and mortality rate ratios (MRRs), adjusted for age and period effects, by nominal birth cohort, separated by 5 year intervals, from 1920 to 1990.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We extracted data for 23 654 000 patients diagnosed with 34 types of cancer and 7 348 137 deaths from 25 cancers for the period Jan 1, 2000, to Dec 31, 2019. We found that IRRs increased with each successive birth cohort born since approximately 1920 for eight of 34 cancers (p&lt;sub&gt;cohort&lt;/sub&gt;&lt;0·050). Notably, the incidence rate was approximately two-to-three times higher in the 1990 birth cohort than in the 1955 birth cohort for small intestine (IRR 3·56 [95% CI 2·96-4·27]), kidney and renal pelvis (2·92 [2·50-3·42]), and pancreatic (2·61 [2·22-3·07]) cancers in both male and female individuals; and for liver and intrahepatic bile duct cancer in female individuals (2·05 [1·23-3·44]). Additionally, the IRRs increased in younger cohorts, after a decline in older birth cohorts, for nine of the remaining cancers (p&lt;sub&gt;cohort&lt;/sub&gt;&lt;0·050): oestrogen-receptor-positive breast cancer, uterine corpus cancer, colorectal cancer, non-cardia gastric cancer, gallbladder and other biliary cancer, ovarian cancer, testicular cancer, anal cancer in male individuals, and Kaposi sarcoma in male individuals. Across cancer types, the incidence rate in the 1990 birth cohort ranged from 12% (IRR&lt;sub&gt;1990 vs 1975&lt;/sub&gt; 1·12 [95% CI 1·03-1·21] for ovarian cancer) to 169% (IRR&lt;sub&gt;1990 vs 1930&lt;/sub&gt; 2·69 [2·34-3·08] for uterine corpus cancer) higher than the rate in the birth cohort with the lowest incidence rate. The MRRs increased in successively younger birth cohorts alongside IRRs for liver and intrahepatic bile duct cancer in female individuals, uterine corpus, gallbladder and other biliary, testicular, and colorectal cancers, while MRRs declined or stabilised in younger birth cohorts for most cancers types.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;17 of 34 cancers had an increasing incidence in younger birth cohorts, including nine that previously had declining incidence in older birth cohorts. These findings add to growing evidence of increased cancer risk in younger generations, highlighting the need to identify and tackle underlying risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding: &lt;/strong&gt;American Cancer Soci","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"9 8","pages":"e583-e593"},"PeriodicalIF":25.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879909","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}
引用次数: 0
Mortality due to falls by county, age group, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities. 2000-19 年美国按郡、年龄组、种族和民族分列的跌倒死亡率:对健康差异的系统分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00122-1
<p><strong>Background: </strong>Fall-related mortality has increased rapidly over the past two decades in the USA, but the extent to which mortality varies across racial and ethnic populations, counties, and age groups is not well understood. The aim of this study was to estimate age-standardised mortality rates due to falls by racial and ethnic population, county, and age group over a 20-year period.</p><p><strong>Methods: </strong>Redistribution methods for insufficient cause of death codes and validated small-area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual fall-related mortality. Estimates from 2000 to 2019 were stratified by county (n=3110) and five mutually exclusive racial and ethnic populations: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (Asian), Black, Latino or Hispanic (Latino), and White. Estimates were corrected for misreporting of race and ethnicity on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial and ethnic population combinations with a mean annual population of less than 1000. Age-standardised mortality is presented for all ages combined and for age groups 20-64 years (younger adults) and 65 years and older (older adults).</p><p><strong>Findings: </strong>Nationally, in 2019, the overall age-standardised fall-related mortality rate for the total population was 13·4 deaths per 100 000 population (95% uncertainty interval 13·3-13·6), an increase of 65·3% (61·9-68·8) from 8·1 deaths per 100 000 (8·0-8·3) in 2000, with the largest increases observed in older adults. Fall-related mortality at the national level was highest across all years in the AIAN population (in 2019, 15·9 deaths per 100 000 population [95% uncertainty interval 14·0-18·2]) and White population (14·8 deaths per 100 000 [14·6-15·0]), and was about half as high among the Latino (8·7 deaths per 100 000 [8·3-9·0]), Black (8·1 deaths per 100 000 [7·9-8·4]), and Asian (7·5 deaths per 100 000 [7·1-7·9]) populations. The disparities between racial and ethnic populations varied widely by age group, with mortality among younger adults highest for the AIAN population and mortality among older adults highest for the White population. The national-level patterns were observed broadly at the county level, although there was considerable spatial variation across ages and racial and ethnic populations. For younger adults, among almost all counties with unmasked estimates, there was higher mortality in the AIAN population than in all other racial and ethnic populations, while there were pockets of high mortality in the Latino population, particularly in the Mountain West region. For older adults, mortality was particularly high in the White population within clusters of counties across states including Florida, Minnesota, and Wisconsi
背景:在过去二十年里,美国与跌倒有关的死亡率迅速上升,但人们对不同种族和民族人口、郡和年龄组的死亡率差异程度还不甚了解。本研究旨在估算 20 年间不同种族和民族人口、县和年龄组因跌倒而导致的年龄标准化死亡率:方法:对美国国家生命统计系统的死亡登记数据和美国国家卫生统计中心的人口数据采用了死因代码不足的重新分配方法和经过验证的小区域估算方法,以估算每年与跌倒有关的死亡率。2000 年至 2019 年的估计值按县(n=3110)和五个相互排斥的种族和民族人口进行了分层:美国印第安人或阿拉斯加原住民(AIAN)、亚洲人或太平洋岛民(Asian)、黑人、拉丁裔或西班牙裔(Latino)以及白人。使用已公布的错误分类比率对死亡证明上的种族和民族误报进行了估计校正。我们屏蔽(即不显示)了年平均人口少于 1000 人的县及种族和民族人口组合的估计值。结果显示了所有年龄组以及 20-64 岁年龄组(年轻成年人)和 65 岁及以上年龄组(老年人)的年龄标准化死亡率:在全国范围内,2019 年总人口中与跌倒相关的年龄标准化死亡率为每 10 万人 13-4 例死亡(95% 不确定区间为 13-3-13-6),比 2000 年的每 10 万人 8-1 例死亡(8-0-8-3)增加了 65-3%(61-9-68-8),其中老年人的增幅最大。在全国范围内,亚裔美国人(2019 年,每 10 万人中有 15-9 例死亡[95% 不确定区间为 14-0-18-2])和白人(每 10 万人中有 14-8 例死亡[14-6-15-0])与秋季相关的死亡率在所有年份中都是最高的,而拉丁裔(每 10 万人中有 8-7 例死亡[8-3-9-0])、黑人(每 10 万人中有 8-1 例死亡[7-9-8-4])和亚裔(每 10 万人中有 7-5 例死亡[7-1-7-9])人口中与秋季相关的死亡率则只有其一半左右。不同年龄段的种族和族裔人口之间的差异很大,亚裔美国人中年轻人的死亡率最高,而白人中老年人的死亡率最高。尽管不同年龄、不同种族和族裔人口之间存在相当大的空间差异,但在县一级也能大致观察到国家一级的模式。就年轻成年人而言,在几乎所有有未掩盖估计值的县中,亚裔美国人的死亡率高于所有其他种族和族裔人口,而拉丁裔人口的死亡率也有小部分较高,尤其是在山西地区。就老年人而言,在佛罗里达州、明尼苏达州和威斯康星州等州的县群中,白人的死亡率尤其高:在研究期间,每个种族和民族以及几乎每个县的跌倒死亡率都有所上升。不同地域、年龄、种族和民族之间死亡率的巨大差异凸显了可能从有效的跌倒预防干预措施以及更多预防研究中获益最多的地区和人群:美国国立卫生研究院(校内研究计划、国立少数民族健康和健康差异研究所、国立心肺血液研究所、校内研究计划、国立癌症研究所、国立老龄化研究所、国立关节炎、肌肉骨骼和皮肤病研究所、疾病预防办公室以及行为和社会科学研究办公室)。
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引用次数: 0
Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011-19: a multiple mediation analysis of national surveillance data. 2011-19 年结核病诊断和治疗结果中种族和民族差异的风险因素:对国家监测数据的多重中介分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00151-8
Mathilda Regan, Terrika Barham, Yunfei Li, Nicole A Swartwood, Garrett R Beeler Asay, Ted Cohen, C Robert Horsburgh, Awal Khan, Suzanne M Marks, Ranell L Myles, Joshua A Salomon, Julie L Self, Carla A Winston, Nicolas A Menzies

Background: Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities.

Methods: We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the ExtremesRace-Income]). We estimated the marginal contribution of each mediator using Shapley values.

Findings: During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty.

Interpretation: Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority.

Funding: US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement.

背景:尽管过去二十年来美国结核病发病率和死亡率总体下降,但结核病结果的种族和民族差异依然存在。我们的目的是研究健康方面的不平等和邻里层面的社会脆弱性在多大程度上介导了这些差异:我们从美国国家结核病监测系统中提取了 2011-19 年间结核病患者的数据。排除了耐多药结核病患者或种族和民族数据缺失者。我们研究了美国出生者和非美国出生者之间在结核病结果方面的潜在差异,并对治疗未完成风险较高的群体(包括死后诊断、治疗中断或治疗期间死亡的综合结果)进行了中介分析。我们使用连续多重中介分析法评估了八个潜在的中介因素:三种合并症(艾滋病、终末期肾病和糖尿病)、无家可归和四个人口普查区级衡量指标(贫困、失业、保险覆盖率和种族经济隔离[以极端种族-收入集中指数衡量])。我们使用 Shapley 值估算了每个中介因素的边际贡献:2011-19 年间,27 788 名美国出生的患者和 57 225 名非美国出生的患者被诊断为活动性肺结核,其中分别有 27 605 人和 56 253 人符合我们分析的资格标准。我们没有观察到非美国出生者在结核病治疗结果上存在种族和民族差异的证据。因此,后续分析仅限于在美国出生的个人。与白人相比,黑人和西班牙裔患者未完成结核病治疗的风险更高(调整后的相对风险分别为 1-27,95% CI 1-19-1-35;1-22,1-11-1-33)。在多重中介分析中,八个测量中介解释了黑人和西班牙裔分别有 67% 和 65% 的差异。对黑人和西班牙裔个人而言,造成这些差异的最大因素是并发终末期肾病、并发艾滋病毒、人口普查区一级的种族经济隔离和人口普查区一级的贫困:我们的研究结果表明,有必要采取措施减少美国出生的人在结核病治疗结果上的差异,尤其是在种族和经济高度分化的社区。缓解导致合并症发病率及其病例管理差异的结构性和环境因素应成为优先事项:美国疾病控制和预防中心国家艾滋病、病毒性肝炎、性传播疾病和结核病预防中心流行病学和经济建模协议。
{"title":"Risk factors underlying racial and ethnic disparities in tuberculosis diagnosis and treatment outcomes, 2011-19: a multiple mediation analysis of national surveillance data.","authors":"Mathilda Regan, Terrika Barham, Yunfei Li, Nicole A Swartwood, Garrett R Beeler Asay, Ted Cohen, C Robert Horsburgh, Awal Khan, Suzanne M Marks, Ranell L Myles, Joshua A Salomon, Julie L Self, Carla A Winston, Nicolas A Menzies","doi":"10.1016/S2468-2667(24)00151-8","DOIUrl":"10.1016/S2468-2667(24)00151-8","url":null,"abstract":"<p><strong>Background: </strong>Despite an overall decline in tuberculosis incidence and mortality in the USA in the past two decades, racial and ethnic disparities in tuberculosis outcomes persist. We aimed to examine the extent to which inequalities in health and neighbourhood-level social vulnerability mediate these disparities.</p><p><strong>Methods: </strong>We extracted data from the US National Tuberculosis Surveillance System on individuals with tuberculosis during 2011-19. Individuals with multidrug-resistant tuberculosis or missing data on race and ethnicity were excluded. We examined potential disparities in tuberculosis outcomes among US-born and non-US-born individuals and conducted a mediation analysis for groups with a higher risk of treatment incompletion (a summary outcome comprising diagnosis after death, treatment discontinuation, or death during treatment). We used sequential multiple mediation to evaluate eight potential mediators: three comorbid conditions (HIV, end-stage renal disease, and diabetes), homelessness, and four census tract-level measures (poverty, unemployment, insurance coverage, and racialised economic segregation [measured by Index of Concentration at the Extremes<sub>Race-Income</sub>]). We estimated the marginal contribution of each mediator using Shapley values.</p><p><strong>Findings: </strong>During 2011-19, 27 788 US-born individuals and 57 225 non-US-born individuals were diagnosed with active tuberculosis, of whom 27 605 and 56 253 individuals, respectively, met eligibility criteria for our analyses. We did not observe evidence of disparities in tuberculosis outcomes for non-US-born individuals by race and ethnicity. Therefore, subsequent analyses were restricted to US-born individuals. Relative to White individuals, Black and Hispanic individuals had a higher risk of not completing tuberculosis treatment (adjusted relative risk 1·27, 95% CI 1·19-1·35; 1·22, 1·11-1·33, respectively). In multiple mediator analysis, the eight measured mediators explained 67% of the disparity for Black individuals and 65% for Hispanic individuals. The biggest contributors to these disparities for Black individuals and Hispanic individuals were concomitant end-stage renal disease, concomitant HIV, census tract-level racialised economic segregation, and census tract-level poverty.</p><p><strong>Interpretation: </strong>Our findings underscore the need for initiatives to reduce disparities in tuberculosis outcomes among US-born individuals, particularly in highly racially and economically polarised neighbourhoods. Mitigating the structural and environmental factors that lead to disparities in the prevalence of comorbidities and their case management should be a priority.</p><p><strong>Funding: </strong>US Centers for Disease Control and Prevention National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention Epidemiologic and Economic Modeling Agreement.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"9 8","pages":"e564-e572"},"PeriodicalIF":25.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879912","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}
引用次数: 0
The long-term effects of domestic and international tuberculosis service improvements on tuberculosis trends within the USA: a mathematical modelling study. 国内和国际结核病服务改进对美国结核病趋势的长期影响:数学模型研究。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00150-6
Nicolas A Menzies, Nicole A Swartwood, Ted Cohen, Suzanne M Marks, Susan A Maloney, Courtney Chappelle, Jeffrey W Miller, Garrett R Beeler Asay, Anand A Date, C Robert Horsburgh, Joshua A Salomon

Background: For settings with low tuberculosis incidence, disease elimination is a long-term goal. We investigated pathways to tuberculosis pre-elimination (incidence <1·0 cases per 100 000 people) and elimination (incidence <0·1 cases per 100 000 people) in the USA, where incidence was estimated at 2·9 per 100 000 people in 2023.

Methods: Using a mathematical modelling framework, we simulated how US tuberculosis incidence could be affected by changes in tuberculosis services in the countries of origin for future migrants to the USA, as well as changes in tuberculosis services inside the USA. To do so, we used a linked set of transmission dynamic models, calibrated to demographic and epidemiological data for each setting. We constructed intervention scenarios representing improvements in tuberculosis services internationally and within the USA, individually and in combination, plus a base-case scenario representing continuation of current services. We simulated health and economic outcomes until 2100, using a Bayesian approach to quantify uncertainty in these outcomes.

Findings: Under the base-case scenario, US tuberculosis incidence was projected to decline to 1·8 cases per 100 000 (95% uncertainty interval [UI] 1·5-2·1) in the total population by 2050. Intervention scenarios produced substantial reductions in tuberculosis incidence, with the combination of all domestic and international interventions projected to achieve pre-elimination by 2033 (95% UI 2031-2037). Compared with the base-case scenario, this combination of interventions could avert 101 000 tuberculosis cases (95% UI 84 000-120 000) and 13 300 tuberculosis deaths (95% UI 10 500-16 300) in the USA from 2025 to 2050. Tuberculosis elimination was not projected before 2100.

Interpretation: Strengthening tuberculosis services domestically, promoting the development of more effective technologies and interventions, and supporting tuberculosis programmes in countries with a high tuberculosis burden are key strategies for accelerating progress towards tuberculosis elimination in the USA.

Funding: US Centers for Disease Control and Prevention.

背景:在结核病发病率较低的地区,消灭结核病是一个长期目标。我们调查了肺结核消灭前(发病率方法)的途径:通过数学模型框架,我们模拟了美国结核病发病率如何受到未来移民到美国的原籍国结核病服务变化以及美国国内结核病服务变化的影响。为此,我们使用了一套关联的传播动态模型,并根据每种环境下的人口和流行病学数据进行了校准。我们构建了干预方案,分别代表了国际和美国国内结核病服务的改进(单独或组合),以及代表继续提供当前服务的基础方案。我们模拟了 2100 年前的健康和经济结果,并使用贝叶斯方法量化了这些结果的不确定性:根据基础方案,预计到 2050 年,美国结核病发病率将下降到每 10 万人 1-8 例(95% 不确定区间 [UI] 1-5-2-1)。干预方案大幅降低了结核病发病率,预计到 2033 年(95% UI 为 2031-2037 年),所有国内和国际干预措施将达到消灭前水平。与基础方案相比,从 2025 年到 2050 年,这种干预措施组合可使美国避免 101 000 例结核病病例(95% UI 84 000-120 000)和 13 300 例结核病死亡(95% UI 10 500-16 300)。预计在 2100 年前不会消灭结核病:加强国内结核病防治服务、促进开发更有效的技术和干预措施、支持结核病高负担国家的结核病防治计划,是美国加快消除结核病进程的关键战略:美国疾病控制和预防中心。
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Lancet Public Health
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