NPJ Primary Care Respiratory Medicine最新文献

{"title":"Projecting the 20-year healthcare resource burden of asthma and COPD multimorbidity: insights from Singapore for integrated chronic respiratory care in South-East Asia.","authors":"Yah Ru Juang, Laura Huey Mien Lim, Sanjay H Chotirmall, Kelvin Bryan Tan, Mariko Siyue Koh, John A Abisheganaden, David B Price, Ming-Ju Tsai, Mei Fong Liew, Pei Yee Tiew, Anthony Chau Ang Yii, Wenjia Chen","doi":"10.1038/s41533-026-00502-9","DOIUrl":"10.1038/s41533-026-00502-9","url":null,"abstract":"<p><strong>Background: </strong>Asthma and chronic obstructive pulmonary disease (COPD) incur significant comorbidity and healthcare burden. However, their future economic burden remain unclear.</p><p><strong>Objective: </strong>To project 20-year (2024-2043) asthma and COPD multimorbidity costs in Singapore, illustrating broader Southeast Asian trends.</p><p><strong>Methods: </strong>Patients with asthma (all ages) or COPD ( <math><mo>≥</mo></math> 40 years) were identified from Singapore's health administrative data (2002-2019). Age- and sex-specific, disease-specific per-episode costs and annual healthcare utilisation rates (hospitalisation, emergency department, and outpatient) were estimated using generalised linear models and projected using change-point analysis. Population-level costs were projected using a probabilistic simulation model incorporating population forecasts. Costs were reported in 2023 Singaporean dollars (SGD$1 = US$0.76 = ₤0.60 = €0.69).</p><p><strong>Results: </strong>Asthma cases are projected to triple from 64,338 in 2019 to 192,409 by 2043 (95% confidence interval [CI]: 165,493-225,141), incurring $7.8 billion (95% CI: 4.4-17.1) from 2024-2043. Apart from asthma (16.4%), costs are driven by metabolic (20.0%), circulatory (14.3%), and other respiratory (9.2%) diseases, with children bearing the highest burden (girls: 39.9%; boys: 22.6%). COPD cases would grow from 8,988 in 2019 to 11,038 (95% CI: 8395-13,326) in 2043, incurring $2.4 billion (95% CI: 1.6-4.5) from 2024-2043. Apart from COPD (20.3%), metabolic (17.4%), circulatory (17.0%), and other respiratory diseases (9.8%) are the largest cost components, with elderly and adult males bearing the highest burdens (47.8% and 40.1%). In both cohorts, 20-year projected costs are dominated by outpatient (55%) and hospitalisation costs (30-40%).</p><p><strong>Conclusion: </strong>The 20-year multimorbidity costs of asthma and COPD are significant, especially in cardiometabolic comorbidities, underscoring the need for holistic, value-based care.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Asian Paradox\" in multiple primary lung cancer: a geographic monopole driven by phenotypic divergence.","authors":"Jianwei Shi, Yushun Gao","doi":"10.1038/s41533-026-00504-7","DOIUrl":"10.1038/s41533-026-00504-7","url":null,"abstract":"<p><p>The global clinical trial landscape for multiple primary lung cancer (MPLC) exhibits a striking geographic anomaly. Through a systematic analysis of 8212 lung cancer registrations (2015-2024), we identified a cohort of 17 trials explicitly targeting MPLC. Analysis revealed an absolute geographic monopole: 100% of these trials were investigator-initiated in China, with a complete absence of active protocols in Western registries. We argue that this segregation is not accidental but driven by the \"Asian phenotype\",which is characterized by indolent, multifocal ground-glass nodules (GGNs), demands lung-sparing local strategies distinct from the systemic paradigms favored in the West. We urge the international community to transition from universal guidelines to phenotype-stratified management frameworks.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":"36 1","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying patients with mild-to-moderate COPD who require intensified initial treatment to control annualized clinically important deterioration.","authors":"Zihui Wang, Yumin Zhou, Wei-Jie Guan, Junfeng Lin, Guannan Cai, Jinping Zheng, Fan Wu, Zhishan Deng, Nan-Shan Zhong, Pixin Ran","doi":"10.1038/s41533-026-00501-w","DOIUrl":"10.1038/s41533-026-00501-w","url":null,"abstract":"<p><strong>Background: </strong>The chronic obstructive pulmonary disease (COPD) guidelines recommend selecting initial treatment based on the severity of respiratory symptoms or exacerbation history. However, some patients still experience clinically important deterioration (CID) despite this strategy. Therefore, we aimed to identify the risk factors to guide initial treatment, focusing on mild-to-moderate COPD patients whose annualized CID cannot be controlled by a single-bronchodilator.</p><p><strong>Methods: </strong>Patients in the tiotropium group from a randomized controlled trial were included. Over 2 years, annualized CID was defined as forced expiratory volume in one second (FEV₁) decline at least 100 ml, COPD assessment test (CAT) increasing at least 2 points, or having experienced at least two moderate or one severe acute exacerbations of COPD (AECOPD) in this study. Random coefficients model within a bayesian framework was adapted to estimate the change in FEV₁ and CAT scores. The logistic regression analysis was adapted to detect the risk factors. The risk of annualized CID was evaluated using the incidence risk ratio (IRR) for patients with risk factors.</p><p><strong>Results: </strong>Of 312 patients with mild-to-moderate COPD receiving tiotropium, 29.2% still experienced annualized CID. The proportions of patients who developed annualized CID regarding FEV₁, CAT, and AECOPD was 20.5, 8.0, and 6.1%, respectively. Post-bronchodilator FEV₁:FVC ≤ 60% (OR = 1.73, 95%CI: 1.06-2.84) and smoking pack-years ≥50 (OR = 1.95, 95%CI: 1.11-3.41) were associated with higher risk of experiencing annualized CID. The IRR of annualized CID was increased with more risk factors at baseline.</p><p><strong>Conclusion: </strong>Patients with more prominent airflow limitation and higher smoking pack-years warrant intensified initial treatment to control their annualized CID.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13230894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The janus-faced role of uric acid in COPD: evidence from East Asians population.","authors":"Shengyuan Zheng, Zehao Yu, Xiongfeng Tang, Yanguo Qin","doi":"10.1038/s41533-026-00509-2","DOIUrl":"10.1038/s41533-026-00509-2","url":null,"abstract":"<p><p>Uric acid as the final purine metabolite exhibits both antioxidative and proinflammatory properties. The association between uric acid and chronic obstructive pulmonary disease (COPD) remains ambiguous. This is particularly true within East Asian populations which lack comprehensive evidence. This study synthesizes data from 20 observational studies via a meta-analysis to compare uric acid levels in COPD patients and healthy controls. Furthermore, a two-sample Mendelian randomization (MR) approach was utilized, employing genome-wide association study (GWAS) data from East Asian populations to investigate the genetic causal relationship between uric acid and COPD. The meta-analysis demonstrated that uric acid concentrations in patients with COPD were significantly elevated compared to those in healthy controls (SMD = 1.57, 95% (CI): 1.11-2.02). This disparity was more pronounced in patients undergoing acute exacerbations and those with more severe airflow limitations. Conversely, MR analysis indicated that elevated uric acid levels were associated with a reduced risk of developing COPD (OR = 0.680, 95% CI: 0.543-0.852). The MR findings were corroborated through sensitivity analyses. Genetically predicted higher serum uric acid was causally associated with a lower risk of developing COPD in East Asians, whereas phenotypically elevated uric acid in patients with established COPD was associated with greater disease severity and exacerbation, suggesting distinct roles of uric acid in COPD susceptibility versus disease progression.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic differences in healthcare utilisation and diagnosis after first presentation with breathlessness: a retrospective cohort study using UK primary care records.","authors":"Harini Sathanapally, Urvee Karsanji, Jennifer Creese, Gillian Doe, Kamlesh Khunti, Michael Steiner, Claire Lawson, Rachael A Evans, Anvesha Singh","doi":"10.1038/s41533-026-00507-4","DOIUrl":"10.1038/s41533-026-00507-4","url":null,"abstract":"<p><p>There are known delays to diagnosis for chronic respiratory disease and recognised health inequalities in outcomes. We therefore investigated the association between ethnicity and subsequent healthcare utilisation and receipt of an explanatory diagnosis after a first presentation with breathlessness. Clinical Practice Research Datalink (CPRD) GOLD data linked to Hospital Episode Statistics (HES) and death registries were used to identify adults with a first-recorded code for breathlessness (index-date). Ethnicity was determined using the Hemingway algorithm. Rates of primary care consultations, secondary care referrals and hospital admissions within six and 24 months after index-date were examined using negative binomial regression. Logistic regression was used to estimate odds of receiving an explanatory recorded diagnosis for breathlessness during these timeframes. Models were adjusted for age, sex, socioeconomic status and ≥ 2 pre-existing long-term conditions. Amongst 88,857 included patients, 3336 were of South Asian ethnicity and 1506 of Black ethnicity. Compared to patients of White ethnicity, South Asian patients had significantly increased rates of primary care consultations and unplanned hospital admissions within six and 24 months (24 months IRR 1.13 [1.10-1.16] and 1.34 [1.25-1.45] respectively). Conversely, patients of Black ethnicity had significantly lower rates of primary care consultations within 24 months (IRR 0.95 [0.92-0.99], but significantly increased rates of unplanned hospitalisations within six and 24 months (IRR 1.33 [1.19-1.50]). However, both groups had significantly lower odds of receiving an explanatory diagnosis for breathlessness. After a first presentation with breathlessness, we observed a higher rate of unplanned hospitalisations yet a lower rate of receiving an explanatory diagnosis in patients of non-white ethnicity. Understanding the reasons and implications of these differences is critical to reduce potential health inequalities.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling NHS winter pressures due to respiratory disease: the UK Centre for Applied Respiratory Research Innovation and Impact (CARRii).","authors":"Paul Stephenson, Monica Fletcher, Stuart D Faulkner, Chris Griffiths, Aziz Sheikh","doi":"10.1038/s41533-026-00500-x","DOIUrl":"10.1038/s41533-026-00500-x","url":null,"abstract":"<p><p>Seasonal respiratory viral infections are the major cause of increased pressure on national health systems such as the UK's national health service (NHS) during winter months. Emergency departments and hospitals are full as increasing numbers of patients require hospitalisation for lower respiratory tract infections and exacerbations of COPD, asthma, and other respiratory conditions. These winter pressures are largely predictable. Forecasting models give healthcare managers the chance to mitigate winter pressures by allocating resources more effectively. Despite this predictability and the production of NHS resilience plans, the UK is particularly susceptible to winter pressures. Communities facing social and environmental disadvantage are at increased risk of hospitalisation. Despite the focus on real-life research and guideline dissemination and implementation over the last 20-30 years, care of patients with respiratory conditions in the UK remains sub-optimal. To tackle winter pressures, a different approach is needed. The UK Centre for Applied Respiratory Research Innovation and Impact (CARRii) is a new UK-wide network which aims to drive policy change and use innovative ways of implementing research to achieve maximum impact on patient care. Its missions are to reduce NHS winter pressures and respiratory health inequalities, and its focus is on three areas: prevention; self-management and connected care; and optimisation of clinical care. CARRii unites leading experts across respiratory research, clinical medicine, data science, public health, industry innovation, and patient advocacy. CARRii's first Annual Scientific Meeting was held recently. Implementation of research is more likely to succeed if it is based on real-world data, there is multi-agency involvement in its design and implementation, it is patient-focussed, and policy makers are convinced of its benefits. By positioning implementation and impact as a central scientific goal, CARRii aims to show how healthcare systems can deliver respiratory solutions at scale. This requires investment and cross-sector collaboration. If successful, this approach will reduce winter pressures, improve health equity and strengthen system resilience.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cough sound-based deep learning algorithm for accessible prompt detection of chronic obstructive pulmonary disease with smartphones.","authors":"Jun Zhou, Jingwen Huang, Qian Wang, Junhai Yan, Huifang Cao, Lin Huang, Si Chen, Xiaolu Ruan, Wenyu Zhu, Jiaxuan Mao, Yang Liu, Zhaoyang Bu, Mo Yang, Qian Wang, Yi Zhou, Ethan Fan, Leanne Tong, Xianwen Sun, Dongxing Zhao, Ping Wang, Min Zhou, Jieming Qu","doi":"10.1038/s41533-026-00486-6","DOIUrl":"10.1038/s41533-026-00486-6","url":null,"abstract":"<p><p>Early COPD diagnosis is vital for effective management, yet conventional tools such as professional spirometers are often inaccessible in resource-limited settings. We present Cough Search, a smartphone-based deep learning algorithm that uses voluntary cough sounds to detect COPD, offering a cost-efficient and accessible diagnostic approach. The presented COPD detection algorithm (Cough Search) employs a transformer-based neural network model. It was trained on a training cohort (406 COPD and 1631 non-COPD) with hyperparameters tuned on the balanced internal validation cohort (151 COPD and 225 non-COPD participants). The algorithm was finally validated on the external validation cohort (105 COPD and 617 non-COPD participants from four hospitals). Participants were classified as COPD or non-COPD based on spirometry and clinical diagnoses. Cough Search achieved an area under the receiver operating characteristic curve (AUC) of 0.92 and 0.94 in the internal and external validation cohorts, respectively. In the external validation cohort study, the model demonstrated high sensitivity (92%) and specificity (86%) in distinguishing COPD from non-COPD cases. Performance remained robust across all COPD stages, with a sensitivity exceeding 93% for severe stages (GOLD 3-4) and above 91% for moderate stages (GOLD 1-2). The algorithm maintained its accuracy across non-COPD respiratory conditions and smartphone models. Cough Search shows promise as a scalable, accessible tool for COPD detection, particularly in underserved areas, potentially transforming early COPD diagnosis and management. Trial registration: ClinicalTrials.gov Identifier: NCT06082791.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147531370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asthma clinical decision support systems in primary care: an updated scoping review of implementation.","authors":"Holly Tibble, Bohee Lee, Imogen Skene","doi":"10.1038/s41533-026-00498-2","DOIUrl":"10.1038/s41533-026-00498-2","url":null,"abstract":"<p><p>Despite advances in digital health technologies, the integration of clinical decision support systems (CDSSs) into routine primary care for asthma has been extremely limited. Asthma CDSSs employ diverse approaches, from prescribing support to risk prediction, but it remains unclear which are most likely to achieve sustained, real-world impact. Our objectives were to determine the mechanisms of action, clinical practice integration approaches, outputs and outcomes of asthma CDSSs in recent literature. Five electronic databases (Embase via Ovid, PubMed, CENTRAL, the Health Technology Assessment (HTA) Database, and the ISRCTN registry of clinical trials) were searched to identify papers published between 2012 and 2024 describing pilot studies, feasibility studies, or clinical trials, of primary care-based asthma CDSS. Two independent reviewers screened the retrieved literature and extracted the data on study designs, interventions, outcomes and mechanisms of action, and results. Across 18 included trials, interventions demonstrated substantial heterogeneity in mechanisms, integration methods, and targeted clinical behaviours. Although some studies showed improvements in adherence to prescribing best practices and the delivery of personalised action plans, most reported modest or declining system use over time and inconsistent effects on asthma control or severe attack outcomes. Continued progress will depend on integrating behavioural theory, improving workflow compatibility, and generating rigorous evidence to guide the development of CDSSs with genuine potential for sustainable impact.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living with breathing pattern disorder: a scoping review.","authors":"Catherine Moffat, Susan Walker, Jonathan Fuld, Shanlee Higgins","doi":"10.1038/s41533-026-00495-5","DOIUrl":"10.1038/s41533-026-00495-5","url":null,"abstract":"<p><p>A scoping review was conducted using the Arksey and O'Malley framework to develop a comprehensive overview of how the experience of breathing pattern disorder (BPD) has been conceptualized and reported in the literature. The Applied Social Sciences Index and Abstracts (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline and PsycINFO electronic databases were searched from the earliest available reports until 13^th May 2025. The reference lists of included reports were also screened for appropriate literature. Only reports relating to adults and published in English were included. Sixty-two reports were included in the final review. The following eight themes emerged; 1: Symptoms were diverse and frequently mimicked serious pathology. 2: Symptom triggers were often stress related. 3: Precipitating life experiences for BPD included physical or psychological trauma, chronic anxiety or stress. 4: The diagnostic pathway was often prolonged and complex. 5: Patient reaction to diagnosis varied from welcoming, sceptical or rejection. 6: Healthcare use was frequent due to symptoms mimicking serious pathology and a prolonged diagnostic pathway. 7: BPD was associated with panic, anxiety, fear, phobias and depression. 8: BPD was also associated with reduced quality of life and poorer asthma control. Evidence for the experience of BPD is poorly represented in the literature, mainly viewed from a Western perspective and found in simple case reports over 25 years old and snippets within empirical studies. Literature searching was confounded by the change in terminology over time, and the lack of agreed definition and diagnostic methods for BPD. Further research is required employing more diverse and rigorous study designs to clarify the definition and diagnostic methods for the condition, as well as explore experience of BPD, including experience from outside Europe and North America.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital follow-up adherence among screen-positive lung cancer utilizing a mobile LDCT in community in Hainan, China: a prospective cohort study.","authors":"Leiwen Fu, Zhijing Zhou, Wei Shu, Na Qin, Lijie Zhang, Yuxian Sun, Hao Wen, Yang Liu, Liang Li, Jian Du","doi":"10.1038/s41533-026-00481-x","DOIUrl":"10.1038/s41533-026-00481-x","url":null,"abstract":"<p><strong>Background: </strong>China has the highest global disease burden for both lung cancer and tuberculosis (TB). Mobile low-dose computed tomography (LDCT) screening offers dual detection of early-stage lung malignancies and active TB radiographic manifestations. However, evidence regarding community-based post-screening compliance remains inadequate. This study aimed to evaluate hospital follow-up adherence and its associated factors among individuals who screened positive for lung cancer or TB in a community-based, non-risk-based LDCT screening program.</p><p><strong>Methods: </strong>A prospective cohort study was conducted in Dongfang, Hainan Province, from June to September 2024. Permanent residents aged ≥40 years were enrolled in a community-based, non-risk-stratified mobile LDCT screening program. At the time of screening, participants completed a structured questionnaire to capture demographic characteristics, risk factors, and health status. Screening images were interpreted according to established guidelines; individuals with findings indicative of Lung-RADS category 4 (4 A, 4B, 4X) or suspected active pulmonary TB were considered screen-positive. The primary outcome, adherence to hospital-based diagnostic follow-up within six months, was objectively assessed by linking screening records to the provincial medical insurance claims database. Multivariable logistic regression was used to identify factors associated with adherence, stratified by screening finding.</p><p><strong>Results: </strong>Among 22,933 participants (14,134 female and 8799 men), 547 (2.4%) had LDCT findings classified as Lung-RADS 4 and 653 (2.9%) displayed radiological features compatible with TB. Diagnostic follow-up within six months was completed by 303/547 lung-cancer suspects (55.4%) and 336/653 pulmonary TB suspects (51.5%). Among adherent individuals, 98 lung cancers (32.3%) and 95 active pulmonary TB cases (28.3%) were confirmed. In the lung-cancer cohort, respiratory symptoms increased the likelihood of follow-up (adjusted odds ratio [aOR] 2.47, 95% CI 1.13-5.41), whereas retired status decreased it (aOR 0.52, 0.32-0.85). In the pulmonary TB cohort, female sex was positively associated with adherence (aOR 1.39, 1.02-1.90), while formal employment was negatively associated (aOR 0.53, 0.31 - 0.90).</p><p><strong>Conclusions: </strong>This study highlights the need for targeted interventions to optimize diagnostic follow-up and maximize the clinical and public health impact of integrated lung cancer-TB screening programs.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13350871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}