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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。
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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
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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
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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
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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
Changes in prevalence and incidence of dementia and risk factors for dementia: an analysis from cohort studies. 痴呆症患病率和发病率以及痴呆症风险因素的变化:队列研究分析。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00120-8
Naaheed Mukadam, Frank J Wolters, Sebastian Walsh, Lindsay Wallace, Carol Brayne, Fiona E Matthews, Simona Sacuiu, Ingmar Skoog, Sudha Seshadri, Alexa Beiser, Saptaparni Ghosh, Gill Livingston
<p><strong>Background: </strong>Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs).</p><p><strong>Methods: </strong>We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms "systematic review" AND "dementia" AND ("prevalence" OR "incidence"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors.</p><p><strong>Findings: </strong>We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis.</p><p><strong>Interpretation: </strong>Our findings suggest that lifestyle interventions such as compulsory education and reducin
背景:一些队列研究报告称,随着时间的推移,痴呆症患病率和发病率有所下降,但这些研究结果并不一致。我们利用已发表的基于人群的队列研究,回顾了痴呆症患病率和发病率随时间推移而变化的证据,这些研究在每一波次中都采用了一致的方法,并旨在利用人群可归因分数(PAFs)量化风险因素随时间推移而发生的相关变化:我们搜索了有关研究痴呆症患病率或发病率随时间变化的队列研究的系统综述。我们使用检索词 "系统综述 "和 "痴呆症 "和("患病率 "或 "发病率")检索了 PubMed 上从数据库开始到 2023 年 1 月 12 日的出版物,没有语言限制。我们在 2024 年 3 月 28 日重复了这一搜索。在符合条件的系统综述中,我们检索了参考文献并选择了同行评议出版物中的队列研究,这些研究在同一地理位置、至少两个时间点测量了痴呆症的流行率或发病率,并报告了年龄标准化的痴呆症流行率或发病率。此外,数据必须来自以人口为基础的样本,对参与者的认知状况进行评估,并使用有效的标准来诊断痴呆症。我们从每篇论文中提取了有关痴呆症风险因素的摘要级数据,如果发表的论文中没有此类数据,我们会联系作者,并计算出每个风险因素在所有可用时间点上的 PAFs。在可能的情况下,我们将痴呆症患病率或发病率的变化与风险因素患病率的变化联系起来:我们在初步搜索中发现了 1925 条记录,其中有五篇符合条件的系统综述。在这些系统综述中,我们发现了 71 篇可能符合条件的主要论文,其中 27 篇被纳入我们的分析。27 篇主要论文中有 13 篇(48%)报告了痴呆症患病率的变化,10 篇(37%)报告了痴呆症发病率的变化,4 篇(15%)报告了痴呆症发病率和患病率的变化。欧洲(5 项)和美国(5 项)报告痴呆症发病率随时间变化的研究一致报告痴呆症发病率在下降。日本的一项研究报告痴呆症患病率和发病率均有所上升,尼日利亚的一项研究报告发病率保持稳定。总体而言,在各项研究中,受教育程度较低或吸烟或两者的 PAFs 随时间推移普遍下降,而肥胖、高血压和糖尿病的 PAFs 则普遍上升。在弗雷明汉研究(美国马萨诸塞州弗雷明汉,1997-2013 年)中,教育程度较低和吸烟的 PAFs 下降与痴呆症发病率下降有关,这是唯一一项有足够数据进行分析的研究:我们的研究结果表明,义务教育和通过国家层面的政策变化降低吸烟率等生活方式干预措施可能与观察到的痴呆症发病率下降有关,因此也可能与未来痴呆症发病率下降有关。还需要在中低收入国家开展更多研究,因为这些国家的痴呆症发病率最高,而且还在继续增加:国家健康与护理研究所三校痴呆症研究计划。
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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
<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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]<sub>text only</sub> 20·20, 95% CI 15·88 to 26·12; OR<sub>pictogram</sub> 21·16, 16·62 to 27·38; OR<sub>graphic-image</sub> 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.</p><p><strong>Interpretation: </strong>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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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
<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Interpretation: </strong>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
Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France. 酒精康复与癌症风险:法国全国医院队列研究。
IF 25.4 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-07-01 DOI: 10.1016/S2468-2667(24)00107-5
Michaël Schwarzinger, Carina Ferreira-Borges, Maria Neufeld, François Alla, Jürgen Rehm

Background: Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence.

Methods: We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors.

Findings: 10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses.

Interpretation: Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence.

Funding: European Union's EU4Health programme.

背景:尽管饮酒是癌症的既定风险因素,但有关减少或停止饮酒对癌症发病率影响的证据却很少。我们的主要研究目的是评估酒精康复和戒酒对酒精依赖者癌症发病率的影响:我们在全国范围内开展了一项医院回顾性队列研究,研究对象包括居住在法国本土、2018-21年出院的所有成年人。在控制了潜在混杂风险因素的情况下,采用多变量考克斯比例危险模型估算了在医院接受康复治疗或有禁欲史与未接受康复治疗或禁欲的酒精依赖者对不同性别酒精相关癌症发病风险的影响:2018-21年间,10 260 056名男性和13 739 369名女性从法国医院出院。其中645 720名男性(6-3%)和219 323名女性(1-6%)被确认为酒精依赖。酒精依赖与酒精相关的男女癌症部位(肝细胞癌以及口腔癌、咽癌、喉癌、食道癌和结直肠癌)密切相关,但乳腺癌除外。与没有康复或戒酒的酒精依赖者相比,康复治疗或戒酒的风险明显较低(调整后危险比:0-58,99-89%):男性为 0-58,99-89% CI 为 0-56-0-60;女性为 0-62,0-57-0-66)。在男女两性中,与酒精相关的每种癌症部位的相对风险均显著降低,所有亚组分析和敏感性分析均支持这一结果:我们的研究结果表明,酒精康复和戒酒对降低酒精相关癌症风险有明显的益处。由于只有五分之二的酒精依赖症患者有康复治疗或戒酒史,因此在降低癌症发病率方面还有很大的潜力有待挖掘:资金来源:欧盟的 EU4Health 计划。
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