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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。
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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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引用次数: 0
Addressing equity gaps in fall-related injuries. 解决与跌倒有关的伤害方面的公平差距。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00155-5
Rebecca Ivers, Courtney Ryder, Brett Shannon
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引用次数: 0
Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence. 评估英国癫痫病社会经济不平等的程度和决定因素:证据的系统回顾和荟萃分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-01 DOI: 10.1016/S2468-2667(24)00132-4
Kathryn J Bush, Emer Cullen, Susanna Mills, Richard F M Chin, Rhys H Thomas, Andrew Kingston, William Owen Pickrell, Sheena E Ramsay

Background: Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown.

Methods: In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143).

Findings: We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes.

Interpretation: Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes.

Funding: Epilepsy Research Institute UK.

背景:癫痫发病率及其不良后果方面的社会经济不平等在国际上都有记录,但不平等的程度和影响这种关联的因素在不同国家可能有所不同。英国需要对癫痫采取公共卫生应对措施,在预防癫痫的同时不扩大不平等现象。然而,有关英国癫痫不平等现象的数据尚未进行综述,其根本决定因素也不得而知:在这项系统综述和荟萃分析中,我们检索了六个文献数据库(MEDLINE、Embase、PsycINFO、CINAHL、Web of Science 和 Scopus)以及发表于 1980 年 1 月 1 日至 2024 年 2 月 21 日之间的灰色文献,以确定英国按社会经济因素(个人水平或地区水平)报告癫痫发病率或癫痫相关不良后果的研究。我们纳入了纵向队列研究、使用常规收集的医疗保健数据的研究、横断面研究和匹配队列研究,并排除了会议摘要和未在综述和荟萃分析中报告实证结果的研究。多位审稿人(KJB、EC、SER、WOP 和 RHT)独立筛选研究,KJB 从纳入的研究中提取数据,第二位审稿人(SM 或 EC)检查数据提取情况。我们使用 "批判性评价技能计划 "核对表来评估研究质量。我们采用随机效应荟萃分析法汇集事故率比(IRR),并对不良后果结果进行叙述性综合。本研究已在PROPSPERO(CRD42023394143)上注册:我们通过数据库搜索确定了 2471 项独特的研究。我们纳入了 26 项研究,其中 10 项根据社会经济因素报告了癫痫发病率,16 项报告了与癫痫相关的不良后果。错误分类、参与和解释偏差被认为是研究质量的局限性。元分析表明,社会经济贫困与癫痫发病率之间存在关联,与低贫困组相比,高贫困组(IRR 1-34 [95% CI 1-16-1-56];I2=85%)和中贫困组(IRR 1-23 [95% CI 1-08-1-39];I2=63%)的癫痫发病风险更高。这种关联在仅包括儿童的研究中依然存在(高与低:IRR 1-36 [95% CI 1-19-1-57]; I2=0%)。只有两项研究探讨了影响癫痫发病率的因素。有关英国不良后果不平等的证据有限:在英国,癫痫发病率的社会经济不平等现象十分明显。为制定以证据为基础的癫痫公共卫生对策,需要开展进一步研究,以了解受影响人群、决定相关性的因素以及不良后果的不平等程度:英国癫痫研究所。
{"title":"Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence.","authors":"Kathryn J Bush, Emer Cullen, Susanna Mills, Richard F M Chin, Rhys H Thomas, Andrew Kingston, William Owen Pickrell, Sheena E Ramsay","doi":"10.1016/S2468-2667(24)00132-4","DOIUrl":"https://doi.org/10.1016/S2468-2667(24)00132-4","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143).</p><p><strong>Findings: </strong>We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I<sup>2</sup>=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I<sup>2</sup>=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I<sup>2</sup>=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes.</p><p><strong>Interpretation: </strong>Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes.</p><p><strong>Funding: </strong>Epilepsy Research Institute UK.</p>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":25.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141879908","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
Correction to Lancet Public Health 2024; 9: e495-522. 柳叶刀公共卫生》2024;9:e495-522 的更正。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00129-4
{"title":"Correction to Lancet Public Health 2024; 9: e495-522.","authors":"","doi":"10.1016/S2468-2667(24)00129-4","DOIUrl":"10.1016/S2468-2667(24)00129-4","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":25.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11252116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alcohol in France: room for improvement. 法国的酒精:改进的余地。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00124-5
Catherine Hill
{"title":"Alcohol in France: room for improvement.","authors":"Catherine Hill","doi":"10.1016/S2468-2667(24)00124-5","DOIUrl":"10.1016/S2468-2667(24)00124-5","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":25.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141473034","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
Our environment, our health. 我们的环境,我们的健康。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1016/S2468-2667(24)00127-0
The Lancet Public Health
{"title":"Our environment, our health.","authors":"The Lancet Public Health","doi":"10.1016/S2468-2667(24)00127-0","DOIUrl":"10.1016/S2468-2667(24)00127-0","url":null,"abstract":"","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":null,"pages":null},"PeriodicalIF":25.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328188","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 effects of alcohol container labels on consumption behaviour, knowledge, and support for labelling: a systematic review. 酒精容器标签对消费行为、知识和标签支持的影响:系统综述。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00097-5
Alexandra M E Zuckermann, Kate Morissette, Laura Boland, Alejandra Jaramillo Garcia, Francesca Reyes Domingo, Tim Stockwell, Erin Hobin

Alcohol container labels might reduce population-level alcohol-related harms, but investigations of their effectiveness have varied in approach and quality. A systematic synthesis is needed to adjust for these differences and to yield evidence to inform policy. Our objectives were to establish the effects of alcohol container labels bearing one or more health warnings, standard drink information, or low-risk drinking guidance on alcohol consumption behaviour, knowledge of label message, and support for labels. We completed a systematic review according to Cochrane and synthesis without meta-analysis standards. We included all peer-reviewed studies and grey literature published from Jan 1, 1989, to March 6, 2024, in English, French, German, or Spanish that investigated the effects of alcohol container labels compared with no-label or existing label control groups in any population on alcohol consumption behaviour, knowledge of label message, or support for labels. Data were synthesised narratively as impact statements and assessed for risk of bias and certainty in the evidence. A protocol was preregistered (PROSPERO CRD42020168240). We identified 40 publications that studied 31 labels and generated 17 impact statements. 24 (60%) of 40 publications focused on consumption behaviour and we had low or very low certainty in 13 (59%) of 22 outcomes. Alcohol container labels bearing health warnings might slow the rate of alcohol consumption (low certainty), reduce alcoholic beverage selection (moderate certainty), reduce consumption during pregnancy (low certainty), and reduce consumption before driving (moderate certainty). Interventions with multiple types of rotating alcohol container labels likely substantially decrease alcohol use (moderate certainty) and reduce alcohol sales (high certainty). To the best of our knowledge, this is the first systematic review on multiple types of alcohol container labels assessing their effects for certainty in the evidence. Limitations included heterogeneity in label designs and outcome measurements. Alcohol container labels probably influence some alcohol consumption behaviour, with multiple rotating messages being particularly effective, although effects might vary depending on individual health literacy or drinking behaviour. Alcohol container labels might therefore be effective components of policies designed to address population-level alcohol-related harms.

酒精容器标签可能会减少人群中与酒精相关的危害,但对其有效性的调查在方法和质量上各不相同。我们需要进行系统的综合研究,以调整这些差异,并为制定政策提供依据。我们的目标是确定带有一个或多个健康警示、标准饮酒信息或低风险饮酒指导的酒精容器标签对饮酒行为、标签信息知识和标签支持的影响。我们按照 Cochrane 和不进行荟萃分析的综合标准完成了一项系统综述。我们纳入了从 1989 年 1 月 1 日到 2024 年 3 月 6 日以英语、法语、德语或西班牙语发表的所有同行评议研究和灰色文献,这些研究和文献调查了在任何人群中,与无标签或现有标签对照组相比,酒精容器标签对酒精消费行为、标签信息知识或对标签支持的影响。数据以影响声明的形式进行了叙述性综合,并对证据的偏倚风险和确定性进行了评估。研究方案已预先注册(PROSPERO CRD42020168240)。我们确定了 40 篇出版物,研究了 31 个标签,产生了 17 份影响声明。40 篇出版物中有 24 篇(60%)关注消费行为,22 项结果中有 13 项(59%)的确定性较低或非常低。带有健康警示的酒精容器标签可能会降低酒精消费率(低度确定性)、减少酒精饮料的选择(中度确定性)、减少孕期消费(低度确定性)和减少驾车前消费(中度确定性)。使用多种类型的旋转式酒精容器标签进行干预,可能会大大减少酒精的使用(中等确定性)并减少酒精的销售(高度确定性)。据我们所知,这是首次对多种类型的酒精容器标签进行系统综述,评估其效果的证据确定性。局限性包括标签设计和结果测量的异质性。酒精容器标签可能会影响一些饮酒行为,其中多重轮换信息尤其有效,尽管效果可能因个人健康素养或饮酒行为而异。因此,酒精容器标签可能是旨在解决人群酒精相关危害的政策的有效组成部分。
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引用次数: 0
Estimated effects of opioid agonist treatment in prison on all-cause mortality and overdose mortality in people released from prison in Norway: a prospective analysis of data from the Norwegian Prison Release Study (nPRIS). 狱中阿片类受体激动剂治疗对挪威刑满释放人员全因死亡率和用药过量死亡率的估计影响:对挪威监狱释放研究(nPRIS)数据的前瞻性分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00098-7
Anne Bukten, Marianne Riksheim Stavseth

Background: Overdose is the leading cause of death for people released from prison, and opioid agonist treatment is associated with reductions in mortality after imprisonment. However, few studies have explored the interplay of the potential modifiable risk factors and protective factors for mortality after release from prison. We aimed to describe all-cause mortality and overdose mortality among individuals released from Norwegian prisons during 2000-22 and to identify pre-existing risk factors associated with both types of mortality among these individuals for 6 months.

Methods: For this prospective analysis, we used data from the Norwegian Prison Release Study (nPRIS), which includes all people in prison in Norway between Jan 1, 2000, and Dec 31, 2022; the Norwegian Cause of Death Registry; the Norwegian Prison Registry; the Norwegian Patient Registry; and Statistics Norway. All prisons in Norway that were open during this period were included. People who did not have a Norwegian personal identification number or were serving their sentence outside of prison units were excluded from this analysis. To identify pre-existing risk factors associated with all-cause and overdose mortality among people released from prison, we left-censored the observation period on Jan 1, 2010, creating a subsample of individuals. We calculated crude mortality rates (CMRs) and corresponding 95% CIs as the number of deaths per 100 000 person-years for several time periods after release. The primary outcomes were all-cause mortality and overdose mortality according to the ICD-10, assessed in all participants and analysed via two separate Cox proportional-hazards models.

Findings: The total nPRIS cohort included 112 877 individuals released from prison in Norway between 2000 and 2022, 11 995 (10·6%) of whom were female and 100 865 (89·4%) of whom were male. We identified 13 004 instances of all-cause mortality and 3085 instances of overdose mortality during the 1 463 035 person-years. The estimated CMR for all-cause mortality was 889 (95% CI 874-904) per 100 000 person-years and for overdose mortality was 211 (203-218) per 100 000 person-years. Among people diagnosed with opioid use disorder before entering prison during 2010-22 (n=6830), provision of opioid agonist treatment was estimated to be associated with reductions in both all-cause mortality (hazard ratio 0·58, 95% CI 0·39-0·85) and overdose mortality (0·51, 0·31-0·82) in the 6 months after leaving prison after adjustment for sociodemographic, prison-related, and clinical characteristics.

Interpretation: In people diagnosed with opioid use disorder released from Norwegian prisons, opioid agonist treatment provided while in prison was a protective factor for both all-cause and overdose mortality at 6 months. Provision of opioid agonist treatment while in prison is crucial in reducing mortality for 6 months after release and

背景:用药过量是导致刑满释放人员死亡的主要原因,而阿片类激动剂治疗与降低入狱后的死亡率有关。然而,很少有研究探讨了可改变的潜在风险因素和保护因素对出狱后死亡率的相互影响。我们旨在描述 2000-22 年间挪威监狱释放人员的全因死亡率和用药过量死亡率,并确定与这些人员 6 个月内两种死亡率相关的原有风险因素:在这项前瞻性分析中,我们使用了挪威监狱释放研究(nPRIS)、挪威死因登记处、挪威监狱登记处、挪威病人登记处和挪威统计局提供的数据,其中包括2000年1月1日至2022年12月31日期间挪威监狱中的所有人员。在此期间开放的所有挪威监狱均被纳入研究范围。没有挪威个人身份号码或在监狱外服刑的人员不在分析之列。为了确定与刑满释放人员的全因死亡率和用药过量死亡率相关的原有风险因素,我们在 2010 年 1 月 1 日对观察期进行了左截断,从而创建了一个个人子样本。我们计算了粗死亡率 (CMR) 和相应的 95% CI,即释放后几个时间段内每 10 万人年的死亡人数。主要结果是根据 ICD-10 评估的所有参与者的全因死亡率和用药过量死亡率,并通过两个独立的 Cox 比例危险模型进行分析:nPRIS队列共包括112 877名2000年至2022年间从挪威监狱释放的人员,其中11 995人(10-6%)为女性,100 865人(89-4%)为男性。在这 1 463 035 人年中,我们发现了 13 004 例全因死亡和 3085 例药物过量死亡。全因死亡率的估计CMR为每10万人年889例(95% CI为874-904例),过量死亡率为每10万人年211例(203-218例)。在2010-22年期间入狱前被诊断患有阿片类药物使用障碍的人员中(n=6830),在对社会人口学、监狱相关和临床特征进行调整后,估计提供阿片类药物激动剂治疗与出狱后6个月内全因死亡率(危险比0-58,95% CI 0-39-0-85)和过量死亡率(0-51,0-31-0-82)的降低有关:挪威监狱释放的被诊断患有阿片类药物使用障碍的人员中,在狱中接受阿片类药物激动剂治疗是6个月内全因死亡率和用药过量死亡率的保护因素。在狱中提供阿片类激动剂治疗对降低出狱后6个月的死亡率至关重要,所有有治疗需求的狱中人员都应接受治疗:挪威东南部地区卫生局和挪威研究理事会。
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引用次数: 0
Effect of alcohol health warning labels on knowledge related to the ill effects of alcohol on cancer risk and their public perceptions in 14 European countries: an online survey experiment. 在 14 个欧洲国家,酒精健康警示标签对酒精致癌风险相关知识及其公众认知的影响:在线调查实验。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00102-6
Daniela Correia, Daša Kokole, Jürgen Rehm, Alexander Tran, Carina Ferreira-Borges, Gauden Galea, Tiina Likki, Aleksandra Olsen, Maria Neufeld

Background: Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their content and format. Our study aimed to investigate the effect of health warnings on knowledge that alcohol causes cancer, the perceptions of three different message topics (responsible drinking, general health harm of alcohol, and alcohol causing cancer), and the role of images included with the cancer message.

Methods: In this online survey experiment, distributed in 14 European countries and targeting adults of the legal alcohol-purchase age who consumed alcohol, participants were randomly allocated to one of six label conditions using a pseudorandom number generator stratified by survey language before completing a questionnaire with items measuring knowledge and label perceptions. Effect on knowledge was assessed as a primary outcome by comparing participants who had increased knowledge after exposure to labels with the rest of the sample, for the six label conditions. Label perceptions were compared between label conditions as secondary outcomes.

Findings: 19 110 participants completed the survey and were eligible for analysis. Our results showed that a third of the participants exposed to the cancer message increased their knowledge of alcohol causing cancer (increase for 1131 [32·5%, 95% CI 29·8 to 35·2] of 3409 participants [weighted percentage] for text-only message; increase for 1096 [33·3%, 30·4 to 36·2] of 3198 [weighted percentage] for message inlcuding pictogram; and increase for 1030 [32·5%, 29·6 to 35·4] of 3242 [weighted percentage] for message including graphic image), compared with an increase for 76 (2·4%, -1·2 to 6·0) of 3018 participants who viewed the control message. Logistic regression showed that cancer messages increased knowledge compared with the control label (odds ratio [OR]text only 20·20, 95% CI 15·88 to 26·12; ORpictogram 21·16, 16·62 to 27·38; ORgraphic-image 20·61, 16·19 to 26·68). Cancer messages had the highest perceived impact and relevance, followed by general health harm and responsibility messages. Text-only and pictogram cancer messages were seen as clear, comprehensive, and acceptable, whereas those including an image of a patient with cancer had lower acceptability and the highest avoidance rating of all the labels. The only identified interaction between perceptions and experimental conditions (with gender) indicated higher comprehensibility and acceptability ratings of cancer labels than responsibility messages and control labels by women, with the results reversed in men.

Interpretation: Health warnings are an effective policy option to increase knowledge of alcohol causing cancer, with a generalisable effect across several countries. Europeans consider alcohol health-warning labels to be comprehensibl

背景:酒精健康警示标签是一种有助于减少酒精相关危害的政策选择,但其效果和公众认知取决于标签的内容和形式。我们的研究旨在调查健康警示对酒精致癌知识的影响、对三种不同信息主题(负责任饮酒、酒精对健康的一般危害和酒精致癌)的认知,以及癌症信息中包含的图片的作用:这项在线调查实验在欧洲 14 个国家进行,目标受众是达到法定饮酒年龄的成年人。参与者在填写调查问卷之前,先使用伪随机数生成器按调查语言分层随机分配到六种标签条件之一,然后再填写一份调查问卷,其中包括测量知识和标签感知的项目。在六种标签条件下,通过比较接触标签后知识增加的参与者和其他样本参与者,评估对知识的影响作为主要结果。作为次要结果,对不同标签条件下的标签认知进行了比较:19 110 名参与者完成了调查并符合分析条件。我们的结果表明,三分之一接触过癌症信息的参与者增加了对酒精致癌的认识(在 3409 名参与者中,有 1131 人[32-5%,95% CI 29-8 至 35-2][加权百分比]增加了对纯文字信息的认识,1096 人[33-3%,95% CI 29-8 至 35-2]增加了对酒精致癌的认识);在 3198 名参与者中有 1096 人[33-3%,30-4 至 36-2][加权百分比]增加了对包含象形图的信息的了解;在 3242 名参与者中有 1030 人[32-5%,29-6 至 35-4][加权百分比]增加了对包含图形图像的信息的了解),而在 3018 名参与者中有 76 人(2-4%,-1-2 至 6-0)增加了对对照组信息的了解。逻辑回归结果表明,与对照组相比,癌症信息增加了人们对癌症的了解(几率比[OR]:纯文字 20-20,95% CI 15-88 到 26-12;OR:图形 21-16,16-62 到 27-38;OR:图形图像 20-61,16-19 到 26-68)。癌症信息的影响力和相关性最高,其次是一般健康危害和责任信息。纯文字和象形图癌症信息被认为是清晰、全面和可接受的,而包含癌症患者图像的信息可接受性较低,在所有标签中回避率最高。认知与实验条件(性别)之间唯一确定的交互作用表明,女性对癌症标签的可理解性和可接受性的评价高于责任信息和对照标签,而男性的结果则相反:健康警示是一种有效的政策选择,可以提高人们对酒精致癌的认识,并在多个国家产生普遍影响。欧洲人认为酒精健康警示标签是可以理解和接受的,其中针对癌症的健康警示具有最大的影响力和相关性:资金来源:EU4Health。
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Lancet Public Health
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