The Lancet Regional Health: Western Pacific最新文献

{"title":"Prioritizing high-risk populations for soil-transmitted helminth control in the Western Pacific Region","authors":"Kefyalew Addis Alene , Haileab Fekadu Wolde , Beth Gilmour","doi":"10.1016/j.lanwpc.2025.101618","DOIUrl":"10.1016/j.lanwpc.2025.101618","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101618"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518611","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}

{"title":"Overcoming barriers in tuberculosis control: a case study from a remote community of South Australia","authors":"Joseph Inauen , Adrienne Storken , Carolyn Gill , Michelle Brigham , Martin Kelly , Simone Barry","doi":"10.1016/j.lanwpc.2025.101604","DOIUrl":"10.1016/j.lanwpc.2025.101604","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101604"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535123","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}

{"title":"The association between sexually transmitted infections and pregnancy outcomes in the Northern Territory, Australia: a population-based cohort study","authors":"Jennifer Dunne ,&nbsp;Gizachew A. Tessema ,&nbsp;Matthew Legge ,&nbsp;Sylvester Dodzi Nyadanu ,&nbsp;Aditi Roy ,&nbsp;Amanuel T. Gebremedhin ,&nbsp;Jacqueline Hendriks ,&nbsp;Tricia Reid-Moore ,&nbsp;Gavin Pereira","doi":"10.1016/j.lanwpc.2025.101610","DOIUrl":"10.1016/j.lanwpc.2025.101610","url":null,"abstract":"<div><h3>Background</h3><div>Often asymptomatic in nature, sexually transmitted infections (STIs) are highly prevalent in women of reproductive ages, leading to adverse perinatal outcomes. This study investigated the association between STIs during pregnancy and the risk of adverse perinatal outcomes using comprehensive population-linked data from the Northern Territory (NT), Australia.</div></div><div><h3>Methods</h3><div>This population-based retrospective cohort study examined births (live births and stillbirths) from the NT Perinatal Data Collection and the NT Notifiable Diseases register from 2005 to 2020. All singleton births (N = 59,465) were included, along with infectious disease notifications of four STIs that occurred during pregnancy: chlamydia, gonorrhoea, trichomoniasis, and syphilis. Relative risks (RR) for associations between STIs during pregnancy with adverse perinatal outcomes (pre-labour rupture of membranes, preterm birth, small-for-gestational age, stillbirth) were estimated using robust Poisson regression models.</div></div><div><h3>Findings</h3><div>For babies born with congenital syphilis (n = 23), there was an association with preterm birth (RR 3.34, 95% confidence interval (CI) 1.80–6.17) and small-for-gestational age (RR 2.22, 95% CI 1.34–3.67). Small-for-gestational age was associated with maternal chlamydia (RR 1.86, 95% CI 1.54–2.24), maternal gonorrhoea (RR 1.76, 95% CI 1.46–2.12), and maternal trichomoniasis (RR 1.10, 95% CI 1.01–1.20). Associations were also observed between gonorrhoea and stillbirth (RR 1.97, 95% CI 1.19–3.27), and trichomoniasis with preterm birth (RR 1.23, 95% CI 1.09–1.39).</div></div><div><h3>Interpretation</h3><div>STIs during pregnancy showed notable associations with adverse birth outcomes. Congenital syphilis most severely affected outcomes, tripling preterm birth risk and doubling small-for-gestational age risk. These findings underscore the importance of addressing barriers to STI screening and treatment prior to and during pregnancy.</div></div><div><h3>Funding</h3><div><span>National Health and Medical Research Council</span> and the <span>Western Australian Future Health Research and Innovation Fund</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101610"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534436","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}

{"title":"High rates of hepatitis B vertical transmission in Kiribati: a warning sign for meeting 2030 WHO elimination targets in the Pacific Islands?","authors":"Alice Lee ,&nbsp;Thomas Russell ,&nbsp;David Hilmers","doi":"10.1016/j.lanwpc.2025.101624","DOIUrl":"10.1016/j.lanwpc.2025.101624","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101624"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144548466","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}

{"title":"Waning immunity, prevailing non-vaccine type ptxP3 and macrolide-resistant strains in the 2024 pertussis outbreak in China: a multicentre cross-sectional descriptive study","authors":"Jiehao Cai ,&nbsp;Qiyi Liu ,&nbsp;Biquan Chen ,&nbsp;Yue Jiang ,&nbsp;Xiaoyan Zeng ,&nbsp;Jiebin Huang ,&nbsp;Daojiong Lin ,&nbsp;Huanyou Li ,&nbsp;Jinqiang Zhang ,&nbsp;Zhiqiang Zhuo ,&nbsp;Yanping Zhang ,&nbsp;Panpan Lv ,&nbsp;Qiang Wang ,&nbsp;Wenhong Zhang ,&nbsp;Mingliang Chen ,&nbsp;Mei Zeng","doi":"10.1016/j.lanwpc.2025.101628","DOIUrl":"10.1016/j.lanwpc.2025.101628","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In the spring and summer of 2024, an unexpected large outbreak of pertussis hit China, with the annual incidence of pertussis (34.03/100,000) more than 12-fold higher than that of 2023 (2.71/100,000). We aimed to assess clinical and molecular epidemiological patterns and unravel the reasons behind the 2024 pertussis outbreak.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;PCR-confirmed pertussis cases were enrolled from five sentinel hospitals in Shanghai, Anhui, Hainan, Fujian, and Inner Mongolia between 1 January and 30 September 2024. The epidemiological data of PCR-confirmed cases, as well as the clinical data and vaccination history of hospitalized cases were collected. Nasopharyngeal swab samples were collected from partial pertussis cases and their household contacts for &lt;em&gt;Bordetella pertussis&lt;/em&gt; culture during the local peak months. Antimicrobial susceptibility testing and whole genome sequencing were performed on all 394 isolates to evaluate six antibiotic susceptibility and characterize the antigenic, virulent, and phylogenetic characteristics of the circulating isolates.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 14,874 cases of pertussis were PCR-confirmed in the 5 sentinel hospitals, peaking in April to July. Infants represented 9.6% of cases and children aged 4–10 years represented 74.3% of cases in the five hospitals. Of the 7238 (48.7%) cases with vaccination data, 6563 (90.7%) were fully vaccinated. Breakthrough pertussis cases were mainly observed in fully vaccinated children since the age of 7 months. Among the 828 (5.6%) cases hospitalized for pertussis, 71.7% (594/828) cases had complications (pneumonia 69.7%, 577/828), 5.7% (47/828) were admitted to intensive care unit and 0.24% (2/828) cases died. Sixty-four per cent (403/630) of families had both the patient and at least one family member PCR-positive for &lt;em&gt;B. pertussis&lt;/em&gt;. In total, 394 &lt;em&gt;B. pertussis&lt;/em&gt; isolates were recovered from the 1921 nasopharyngeal swab samples. Ninety-nine point seven per cent (393/394) of isolates displayed high-level resistance to azithromycin (MIC range, 16–256 μg/ml), and 48.0% (189/394) isolates were susceptible to trimethoprim-sulfamethoxazole (MIC range, &lt;0.008/0.152–0.5/9.5 μg/ml). All the isolates were susceptible to levofloxacin, doxycycline, ceftazidime, and cefoperazone/sulbactam. All the isolates were assigned to ST-2 and 99.5% (392/394) belonged to the MT28-Shanghai clone by SNP-based analysis, carrying &lt;em&gt;ptxP3&lt;/em&gt; AgST4, 23S rRNA-13 (with erythromycin resistance), and &lt;em&gt;prn&lt;/em&gt;150. 23.4% (92/394) of isolates were predicted to be PRN-deficient.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The waning vaccine-derived protection and the prevailing macrolide-resistant MT28 clone harboring non-vaccine type &lt;em&gt;ptxP3&lt;/em&gt; are responsible for the 2024 large outbreak of pertussis in China. Our findings highlight the urgent need for revising national pertussis vaccination strategies and traditiona","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101628"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557356","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}

{"title":"Blueprint to achieve national exclusive breastfeeding targets by 2030 among Aboriginal Australian women","authors":"Utpal K. Mondal ,&nbsp;Jamie Newman ,&nbsp;Colin MacDougall ,&nbsp;Peter Gibbs ,&nbsp;Sok Cheon Pak ,&nbsp;Phil Naden ,&nbsp;Bernd Kalinna ,&nbsp;Muhammad J.A. Shiddiky ,&nbsp;Md Ferdous Rahman ,&nbsp;Allen G. Ross","doi":"10.1016/j.lanwpc.2025.101616","DOIUrl":"10.1016/j.lanwpc.2025.101616","url":null,"abstract":"<div><div>Exclusive breastfeeding (EBF) for six months provides significant health benefits for both mothers and infants, protecting babies from infection, supporting cognitive development, and reducing the risk of obesity and chronic diseases. Additionally, EBF lowers mother's risk of postpartum complications, type 2 diabetes, breast and ovarian cancers. Globally, the prevalence of EBF among infants under six months has reached 48%, nearing the World Health Assembly's 2025 target of 50%. However, the six-month EBF rate for Indigenous mothers in Australia remains low (18.8%), falling significantly below the national target of 50% set for 2025. There are notable disparities across Australian states and territories, with only the Northern Territory (NT) meeting this target. The NT's success is attributed to substantial state-level investment in healthcare for Indigenous Australians, with the highest per capita spending ($11,082 AUD/person/annum) and the highest proportion of Aboriginal and Torres Strait Islander health practitioners (256 per 100,000 population). Additionally, Aboriginal Community Controlled Health Organisations (ACCHOs) have played a vital role in delivering culturally safe, community-led breastfeeding programs, contributing to higher EBF rates. These findings suggest that the NT's approach could serve as a ‘blueprint’ for improving breastfeeding outcomes nationwide. With continued federal support and a comprehensive national policy, achieving the national EBF target for First Nations Peoples by 2030 may be attainable.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101616"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549314","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}

{"title":"Prevalence of germline BRCA1/2 pathogenic variants in unselected Korean patients with HER2-negative metastatic breast cancer: a nationwide prospective study (KCSG BR19-10)","authors":"Hee Kyung Ahn ,&nbsp;Jee Hung Kim ,&nbsp;Su-Jin Koh ,&nbsp;Joohyuk Sohn ,&nbsp;Myoung Joo Kang ,&nbsp;Kyung Hae Jung ,&nbsp;Kyoung Eun Lee ,&nbsp;Jieun Lee ,&nbsp;Sung Ae Koh ,&nbsp;Yee Soo Chae ,&nbsp;Jae Ho Byun ,&nbsp;In Hae Park ,&nbsp;Hee-Jun Kim ,&nbsp;Jee Hyun Kim ,&nbsp;Han Jo Kim ,&nbsp;Joo Young Jung ,&nbsp;Jung Lim Lee ,&nbsp;Yoon Young Cho ,&nbsp;Kyong Hwa Park ,&nbsp;Ji-Yeon Kim ,&nbsp;Yeon Hee Park","doi":"10.1016/j.lanwpc.2025.101622","DOIUrl":"10.1016/j.lanwpc.2025.101622","url":null,"abstract":"<div><h3>Background</h3><div>Assessment of germline (g) <em>BRCA1/2</em> status is recommended for all patients with HER2-negative metastatic breast cancer (MBC) to identify candidates for poly(ADP-ribose) polymerase (PARP) inhibitor therapy, which is not always possible in clinical practice due to limited testing resources. In this study, we investigate the cross-sectional prevalence of g<em>BRCA1/2</em> pathogenic variant (PV) carriers in unselected Korean patients with HER2-negative MBC.</div></div><div><h3>Methods</h3><div>Patients diagnosed with HER2-negative metastatic BC receiving palliative systemic treatment were eligible for inclusion in the study. Peripheral blood was prospectively drawn from each patient and g<em>BRCA1/2</em> status was assessed by next-generation sequencing using an NGeneBio BRCAaccuTest.</div></div><div><h3>Findings</h3><div>A total of 586 patients were enrolled between October 2019 and March 2022, and the prevalence of g<em>BRCA1/2</em> PV was analyzed in 570 patients. The median age at enrollment was 54 years (interquartile range, 48–61) and 567 patients were female. Among the 570 patients with g<em>BRCA1/2</em> analysis, 481 had hormone receptor–positive/HER2-negative breast cancer (BC) and 89 had triple-negative breast cancer (TNBC). The overall prevalence of g<em>BRCA1/2</em> PV carriers was 7.4% (42/570, 95% confidence interval (CI) 5.4%–9.8%) in unselected patients with HER2-negative MBC [g<em>BRCA1</em>, 1.8% (95% CI 0.8%–3.2%), 10/570; g<em>BRCA2</em>, 5.6%(95% CI % - 7.8%), 32/570]. The overall prevalence of g<em>BRCA1/2</em> PV carriers in Korean patients with HER2-negative MBC and a low risk of hereditary breast ovarian cancer syndrome (HBOC) was 5.7% [19/332, 95% confidence interval 3.5%–8.8%; TNBC 10.5% (95% CI 1.3%–33.1%), <em>2/19; HR-positive/HER2-negative</em> 5.4%(95% CI 3.2%–8.6%), 17/313].</div></div><div><h3>Interpretation</h3><div>Our study measured the size of the current underestimation of g<em>BRCA1/2</em> PV carriers in unselected Korean patients with HER2-negative MBC, particularly in patients without high risk factors for HBOC. An active screening strategy for unselected HER2-negative MBC should be pursued to avoid missing potential candidates for systemic treatment with PARP inhibitors.</div></div><div><h3>Funding</h3><div>Pfizer.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101622"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557357","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}

{"title":"Thymic characteristics in patients with autoimmune diseases: a multicentre radiological observational study","authors":"Haoxiao Chang ,&nbsp;Junqiang Yan ,&nbsp;Anxin Wang ,&nbsp;Ningning Wang ,&nbsp;Peng Liu ,&nbsp;Yemin Shi ,&nbsp;Xin Zhao ,&nbsp;Jinqiao Zhu ,&nbsp;Yuan Cai ,&nbsp;Xue Xia ,&nbsp;Yunyi Hao ,&nbsp;Shiyi Yin ,&nbsp;Jing Wang ,&nbsp;Xinli Wang ,&nbsp;Lina Sun ,&nbsp;Jia Ma ,&nbsp;Xiaoyu Huang ,&nbsp;Haonan Guan ,&nbsp;De-Cai Tian ,&nbsp;Kaibin Shi ,&nbsp;Wei-Na Jin","doi":"10.1016/j.lanwpc.2025.101615","DOIUrl":"10.1016/j.lanwpc.2025.101615","url":null,"abstract":"<div><h3>Background</h3><div>Autoimmune diseases comprise a spectrum of illnesses stemming from a common etiology: the loss of self-tolerance. The organ crucial for the establishment and maintenance of central and peripheral tolerance, namely the thymus, has rarely been explored across these diseases.</div></div><div><h3>Methods</h3><div>In a multicentre radiological case–control study, we characterized the thymus in 16 prevalent autoimmune diseases using chest computed tomography (CT) images from patients and age- and sex-1:1 matched healthy controls. Participants underwent a routine CT examination, and baseline information on demographic, clinical, and potential risk factors was gathered at the time of enrollment. A semi-automatic algorithm was developed and employed for the analysis of thymic radiological characteristics, encompassing structural features and density. Thymic fatty replacement was evaluated using a four-point visual scoring scale (0–3). This study is registered with the Chinese Clinical Trial Registry (ChiCTR2300078417).</div></div><div><h3>Findings</h3><div>After matching, 2441 participants in each group were included in case–control study. As individuals age, the thymus undergoes involution, leading to marked changes in thymic features over time, yet the degree of thymic feature alterations varies among groups. Compared to healthy controls, multiple characteristics of the thymus were distinct in the autoimmune disease patients, featuring higher trapezoidal proportions (68.21% vs 46.29%; p &lt; 0.0001), larger bilobed size, and reduced density (−9.50; 95% CI, −10.95 to −8.04; p &lt; 0.0001). In addition, the autoimmune disease patients displayed a greater proportion of fatty replacement (score 0, score 1, and score 2, 94.23% vs 87.83%, p &lt; 0.0001). This consistent trend of thymic characteristic alternations, was observed across the 16 diseases (albeit varying in degree) and in newly diagnosed as early-stage patients. Notably, the subgroup for female patients of childbearing age (≤49 years) exhibited an especially prominent difference in thymic density (−16.23; 95% CI, −19.19 to −13.26; p &lt; 0.0001 in all comparisons) and in the proportion of fatty replacement (85.37% vs 71.68%; p &lt; 0.0001).</div></div><div><h3>Interpretation</h3><div>Radiological assessments reveal a consistent pattern of exacerbated age-dependent thymic involution across 16 autoimmune diseases, suggesting a common underlying mechanism in the development of these diseases. This mechanism may involve the compromise of self-tolerance due to thymic involution.</div></div><div><h3>Funding</h3><div>The <span>National Key R&amp;D Program of China</span>, the <span>National Science Foundation of China</span>, and the <span>Tianjin Key Medical Discipline (Specialty) Construction Project</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101615"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514135","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}

{"title":"Temporal trends in ischemic stroke and female sex as a risk modifier in atrial fibrillation: insights from non-anticoagulated Asian patients in a nationwide cohort study","authors":"Dong-Seon Kang ,&nbsp;Pil-Sung Yang ,&nbsp;Jinseob Kim ,&nbsp;Daehoon Kim ,&nbsp;Eunsun Jang ,&nbsp;Hee Tae Yu ,&nbsp;Tae-Hoon Kim ,&nbsp;Jung Hoon Sung ,&nbsp;Hui-Nam Pak ,&nbsp;Gregory Y.H. Lip ,&nbsp;Boyoung Joung","doi":"10.1016/j.lanwpc.2025.101619","DOIUrl":"10.1016/j.lanwpc.2025.101619","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies from Western populations have reported changing temporal trends in ischemic stroke (IS) incidence in females with atrial fibrillation (AF) when compared with males. Nationwide data on such temporal trends in AF-related IS incidence by sex are limited in Asian populations.</div></div><div><h3>Methods</h3><div>This population-based retrospective cohort study included patients with incident AF diagnosed between 2005 and 2016 from the Korean National Health Insurance Service. Patients with valvular heart disease, prior IS, or anticoagulant use were excluded. Incidence rates (IRs) per 100 person-years and hazard ratios (HRs) for IS were calculated by Fine and Gray competing risk regression.</div></div><div><h3>Findings</h3><div>After exclusions, 290,081 females (mean age: 64.4 years, SD 16.3) and 338,100 males (mean age: 60.1 years, SD 14.9) were included. The mean follow-up duration was 5.7 (SD 4.1) years. At baseline, the CHA₂DS₂-VA scores were higher in females than in males (2.0 vs. 1.6, <em>P</em> &lt; 0.0001). IRs for IS declined over time in both sexes (<em>P for trend</em> &lt; 0.0001). The IS incidence in females compared to males was significantly higher in 2005–2006 (1.55 vs. 1.40; HR_unadj: 1.12, 95% confidence interval: 1.06–1.19); however, it was no longer significant in 2015–2016 (1.20 vs. 1.17; HR_unadj: 1.03, 95% confidence interval: 0.99–1.08). The reduction in relative risk primarily originated from the subgroup with CHA₂DS₂-VA scores 0–1. Females with CHA₂DS₂-VA scores ≥3 consistently showed higher IRs for IS compared to males regardless of adjustment.</div></div><div><h3>Interpretation</h3><div>Sex differences in IS incidence decreased over calendar-year intervals, mainly in low-risk patients with AF. The persistently high IS incidence in high-risk females with AF suggests that sex still remains an important risk modifier.</div></div><div><h3>Funding</h3><div><span>Patient-Centered Clinical Research Coordinating Center</span>, Republic of Korea.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101619"},"PeriodicalIF":7.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549313","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}

{"title":"Methodological considerations in CKM risk stratification: age validation of PREVENT equations","authors":"Jianyu Zhu","doi":"10.1016/j.lanwpc.2025.101613","DOIUrl":"10.1016/j.lanwpc.2025.101613","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"60 ","pages":"Article 101613"},"PeriodicalIF":7.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471257","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}