The Lancet Regional Health: Western Pacific最新文献

{"title":"Severity of respiratory syncytial virus versus SARS-CoV-2 Omicron and influenza infection amongst hospitalized Singaporean adults: a national cohort study","authors":"Liang En Wee ,&nbsp;Jue Tao Lim ,&nbsp;Reen Wan Li Ho ,&nbsp;Calvin J. Chiew ,&nbsp;Barnaby Young ,&nbsp;Indumathi Venkatachalam ,&nbsp;Jean Xiang Ying Sim ,&nbsp;Hau Yiang Cheong ,&nbsp;Tong Yong Ng ,&nbsp;Chee-Fu Yung ,&nbsp;David Chien Boon Lye ,&nbsp;Kelvin Bryan Tan","doi":"10.1016/j.lanwpc.2025.101494","DOIUrl":"10.1016/j.lanwpc.2025.101494","url":null,"abstract":"<div><h3>Background</h3><div>More data is required to contextualise respiratory-syncytial-virus (RSV) disease burden, versus other vaccine-preventable respiratory-viral-infections (RVIs) in older adults. We aimed to compare severity of RSV in hospitalized adults versus influenza/boosted COVID-19.</div></div><div><h3>Methods</h3><div>Retrospective population-based cohort study, including all adult RSV hospitalizations (2021–2023) in Singapore. Disease severity (28-day mortality/intensive-care-unit [ICU] admission) and healthcare utilization in RSV hospitalizations were compared with contemporaneous influenza hospitalizations and COVID-19 hospitalizations in 2023. Outcomes for COVID-19 were stratified by type/receipt of boosters. Comparative severity of RSV versus COVID-19/influenza was evaluated using multivariate logistic regression, adjusted for confounders. Generalized linear models were utilized to estimate excess length-of-stay/costs of RSV hospitalization versus COVID-19/influenza as a rate-ratio.</div></div><div><h3>Findings</h3><div>12,811 hospitalized adults were included (RSV: N = 1332; influenza: N = 3999; COVID-19: N = 7480). Amongst RSV hospitalizations, 5.4% (72/1332) died within 28 days; 3.8% (51/1332) required ICU. Median length-of-stay (RSV) was 5.0 days (IQR = 3.0–8.0). Older age/diabetes were associated with greater odds of 28-day mortality in RSV hospitalizations. Higher odds of 28-day mortality/ICU admission and higher healthcare utilization was observed in RSV hospitalizations versus influenza. Conversely, RSV was less severe than unboosted COVID-19, with lower odds of 28-day mortality (adjusted-odds-ratio, aOR = 0.56 [95% CI = 0.40–0.79]) and rate-ratio for length-of-stay/costs significantly &lt;1. However, higher odds of ICU (aOR = 1.80 [95% CI = 1.07–3.00]) were observed in RSV hospitalizations, versus COVID-19 hospitalizations boosted &lt;1 year prior with updated vaccines.</div></div><div><h3>Interpretation</h3><div>Hospitalizations attributed to RSV were more severe than influenza. RSV disease was less severe versus COVID-19 in unboosted patients but severity was not significantly different from COVID-19 in boosted individuals.</div></div><div><h3>Funding</h3><div><span>National Medical Research Council</span>, Singapore.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101494"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445754","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}

{"title":"The implementation of genome sequencing in rare genetic diseases diagnosis: a pilot study from the Hong Kong genome project","authors":"Wai Kei Jacky Lam ,&nbsp;Chak Sing Lau ,&nbsp;Ho Ming Luk ,&nbsp;Lisa Wing Chi Au ,&nbsp;Gary C.P. Chan ,&nbsp;Will Yap Hang Chan ,&nbsp;Shirley Sze Wing Cheng ,&nbsp;Timothy Hua Tse Cheng ,&nbsp;Li Li Cheung ,&nbsp;Yiu Fai Cheung ,&nbsp;Josephine Shuk Ching Chong ,&nbsp;Annie Tsz Wai Chu ,&nbsp;Claudia Ching Yan Chung ,&nbsp;Kin Lai Chung ,&nbsp;Cheuk Wing Fung ,&nbsp;Eva Lai Wah Fung ,&nbsp;Yuan Gao ,&nbsp;Stephanie Ho ,&nbsp;Shirley Pik Ying Hue ,&nbsp;Chi-Ho Lee ,&nbsp;Su-Vui Lo","doi":"10.1016/j.lanwpc.2025.101473","DOIUrl":"10.1016/j.lanwpc.2025.101473","url":null,"abstract":"<div><h3>Background</h3><div>Genome sequencing (GS) has revolutionised the diagnostic odyssey of patients with rare genetic diseases (RDs) and accelerated large-scale genome projects globally. However, the impact of GS on patients with RDs is yet to be investigated among genome projects in Asia. The Hong Kong Genome Project (HKGP) was implemented to benefit patients and families with RDs in Hong Kong, and to increase the inclusiveness of Chinese genomic data. This study evaluated the impact of short read GS (srGS), complemented by long read GS (lrGS) in a subset, on individuals recruited in the pilot phase of the HKGP.</div></div><div><h3>Methods</h3><div>GS was performed on a prospective cohort of patients with suspected genetic disease recruited by territory-wide referrals to the HKGP. All participants received srGS, while lrGS was applied to a subset to resolve technically challenging regions unclear from srGS and provide phasing information for potential compound heterozygous variants. A phenotypic-driven diagnostic workflow was implemented to filter and prioritise rare and likely disease-causing variants. The primary outcome was diagnostic yield. The impact on the diagnostic odyssey and clinical management was also assessed.</div></div><div><h3>Findings</h3><div>A total of 1264 individuals from 520 families with a broad spectrum of RDs were recruited, with 94% of probands being Chinese. srGS was performed for all individuals and lrGS was performed in 21 individuals. The use of srGS achieved a molecular diagnosis in 24% (125/520) of probands, and an additional 4% (21/520) with the assistance from lrGS. Approximately one-third of the identified diagnostic variants being novel. Diagnostic yield was found to be significantly higher among adult probands compared to paediatric probands (32% vs 24%; p = 0.025). The diagnostic yield was significantly higher in probands without prior genetic testing (37%; n = 185) compared to those previously tested, including exome and genome sequencing (23%; n = 335) (p = 0.001). GS ended diagnostic odysseys with an average length of 15 years (0.5–59), and potentially impacted clinical management in 77% (113/146) of diagnosed probands.</div></div><div><h3>Interpretation</h3><div>This population-based genome project shed light on the consideration of integrating srGS and lrGS in clinical workflows for RDs. The identification of unique and prevalent variants from Southeast Asia increased the inclusiveness of Chinese genomic data, contributing to greater representation and genomic diversity.</div></div><div><h3>Funding</h3><div>The HKGP is a publicly funded genome sequencing initiative commissioned by the Health Bureau of the HKSAR Government.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101473"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178054","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}

{"title":"Prevalence, causes and outcomes of hospital admissions in Mongolia: a national registry-based descriptive analysis","authors":"Altanchimeg Sainbayar ,&nbsp;Ganbold Lundeg ,&nbsp;Naranpurev Mendsaikhan ,&nbsp;Jens Meier ,&nbsp;Martin W. Dünser","doi":"10.1016/j.lanwpc.2025.101470","DOIUrl":"10.1016/j.lanwpc.2025.101470","url":null,"abstract":"<div><h3>Background</h3><div>No systematic data on the prevalence of, reasons for, and outcomes of hospital admissions in Mongolia are currently available.</div></div><div><h3>Methods</h3><div>In a descriptive analysis, the Mongolian National Hospital Data registry was screened for all hospital admissions in adults from 1 January 2019 to 31 December 2023. The endpoints were the prevalence of and most common reasons for hospital admission, the length of hospital stay, and the hospital mortality rate. Descriptive methods, Chi-square tests, Mann-Whitney-U-tests, and ANOVA on ranks were used for data analysis.</div></div><div><h3>Findings</h3><div>3,449,083 cases were analysed. The median prevalence of hospital admissions per 100,000 population per year was 20,242 (IQR, 19,412–20,778). The most common main diagnoses were COVID-19 (8.7%; 299,409/3,449,083), chronic tubulo-interstitial nephritis (6.7%; 230,244/3,449,083), chronic arterial hypertension (2.5%; 86,213/3,449,083), chronic ischaemic heart disease (2.3%; 80,071/3,449,083), nerve root/plexus disorders (2.3%; 79,341/3,449,083), hypertensive heart disease (2.1%; 73,597/3,449,083), and lower back pain (1.8%; 60,614/3,449,083). The median length of hospital stay was 7 days (IQR, 6–9) and the hospital mortality rate was 0.66% (22,683/3,449,083). Differences in all endpoints were found between female and male participants, the periods before, during, and after the COVID-19 pandemic, regions of residence, seasons of admission, levels of admission hospitals, and public and private hospitals.</div></div><div><h3>Interpretation</h3><div>During a five-year period including the COVID-19 pandemic, the prevalence of hospital admissions in Mongolian adults was high during the study period. An analysis of the most common diagnoses leading to hospital admission suggested that many diagnoses could be managed without hospital admission in outpatient or primary care settings.</div></div><div><h3>Funding</h3><div>Institutional funding (<span>Mongolian National University of Medical Sciences</span> and the <span>Johannes Kepler University</span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101470"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178037","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}

{"title":"Immune checkpoint inhibitors and myocarditis in advanced non-small cell lung cancer: a nationwide cohort study","authors":"Fu-Xiao Li ,&nbsp;Jia-Xin Cai ,&nbsp;Ji-Bin Li ,&nbsp;Kong-Jia Luo ,&nbsp;Shi-Yu Wang ,&nbsp;Wei-Hua Meng ,&nbsp;Feng Sha ,&nbsp;Zhi-Rong Yang ,&nbsp;Allan Hackshaw ,&nbsp;Jin-Ling Tang","doi":"10.1016/j.lanwpc.2024.101305","DOIUrl":"10.1016/j.lanwpc.2024.101305","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Emerging evidence suggests immune checkpoint inhibitor (ICI) therapies can increase the risk of myocarditis —a life-threatening rare adverse event. High quality population-level evidence on the association remains lacking. We investigated this association in a large national cohort in China.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective cohort study of patients with stage IIIB-IV non-small cell lung cancer (NSCLC) using data from China's National Anti-Tumor Drug Surveillance System between January 2013 and December 2021. Those with a prior history of myocarditis before cancer diagnosis or ICI initiation were excluded. Exposure density sampling with replacements was applied to match each ICI user with up to 10 ICI non-users on major risk factors, so as to control the immortal time bias which typically exists in such pharmacoepidemiological studies. Multivariate Cox regression with time-dependent exposures was used to examine the association between ICI therapy and the incidence of myocarditis while controlling for confounders. Potential effect modifications of gender and other covariates at baseline (age, calendar year, bone metastasis, contralateral lung metastasis, chemotherapy, and glucocorticoid use) were examined. Several sensitivity analyses were performed: excluding ICI users initiated before 2019 because most ICI drugs were approved in China since June 2018; competing risk regression treating death as a competing event; restricting the length of follow-up to 3 or 6 months to investigate hazard ratios within a shorter observation window; using ICI non-users who received target therapy as an active comparator to further mitigate channeling bias since patients receiving these two drugs shared more similarities in the course of the disease. The Institutional Review Board of Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences (Shenzhen, China) approved the study (SIAT-IRB-220315-H0590). The study is based on existing de-identified electronic medical record data, and the informed consent was waived by ethics review.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 55,219 eligible patients were included and used for matching. The median age was 61 years, and 62% were males. At one-year follow-up (median 335 days), the matched cohort analyses show that 26 ICI users and 28 ICI non-users developed myocarditis, resulting in a cumulative incidence of 4.8 and 0.6 per 1000 person-years respectively. The adjusted hazard ratio (HR) of myocarditis for ICI use was 7.41 (95% confidence interval [CI]: 3.29-16.67). For programmed cell death receptor-1 users only, the HR was 8.39 (95% CI: 3.56-19.77). The hazard ratio increased to 10.93 and 11.63 when follow-up is restricted to 6 months. The findings remained stable in sensitivity analyses. No significant effect modifications were observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;ICI therapies in advanced NSCLC patients are associated with","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101305"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427889","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}

{"title":"Urban-rural disparities of loss of life expectancy due to lung cancer in China from 2005 to 2020: a nationwide study from China national mortality surveillance system","authors":"Xuehua Hu,&nbsp;Zhe Liu,&nbsp;Peng Yin","doi":"10.1016/j.lanwpc.2024.101297","DOIUrl":"10.1016/j.lanwpc.2024.101297","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Lung cancer remains the leading cancer type by mortality rate in China and most of its provinces. This study aims to explore the urban-rural disparities for years of life expectancy lost due to lung cancer in China from 2005 to 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data used for estimates of life expectancy were obtained from China National Mortality Surveillance System (NMSS) during 2005-2020. NMSS collects all deaths occurred both in hospitals and outside-of-hospitals in 605 counties/districts (209 in urban areas and 396 in rural areas) across all 31 provinces in mainland China with proved national and provincial representativeness. Demographic information, date of death and cause of death were recorded for all deceased cases. Underlying cause of death coded as C33-C34 based on the International Classification of Diseases, 10&lt;sup&gt;th&lt;/sup&gt; edition (ICD-10) was used for estimates of mortality rate of lung cancer. We used the abbreviated life table to calculate life expectancy. Loss of life expectancy due to lung cancer was calculated by subtracting the observed life expectancy in the population from the expected life expectancy without lung cancer death for each year. Loss of life expectancy due to lung cancer was compared between urban and rural areas and the secular trend of urban-rural disparity during 2005-2020 was explored. The study was approved by the Ethics Committee of The National Center for Chronic and Noncommunicable Disease Control and Prevention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Loss of life expectancy related to lung cancer increased from 0.550 years in 2005 to 0.630 years in 2020, consistently higher in urban areas than in rural areas during the study period. Loss of life expectancy due to lung cancer in urban areas declined from 0.703 years in 2005 to 0.691 year in 2020. Whilst in rural areas, it increased from 0.472 years in 2005 to 0.595 years in 2020. The gap between urban and rural areas narrowed down from 0.231 years in 2005 to 0.096 years in 2020 and this converging trend was seen in both men and women. The loss of life expectancy due to lung cancer among men was higher in urban areas than that in rural areas in the past 15 years. However, the gap between the two groups is gradually narrowing, decreasing from 0.270 years in 2005 to 0.118 years in 2020. The gap between urban and rural areas among women also narrowed down, from 0.159 years in 2005 to 0.066 years in 2020. In 2020, the provinces with the highest loss of life expectancy due to lung cancer are Heilongjiang (0.944), Tianjin (0.929), Zhejiang and Chongqing (both 0.915) while the lowest was Xizang (0.138), Qinghai (0.353) and Xinjiang (0.370).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Although urban-rural disparities of loss of life expectancy due to lung cancer narrowed down from 2005 to 2020, attention should be paid to rural areas and more tailored prevention and intervention measures should be in place to avoid the increa","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101297"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427604","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}

{"title":"Associations between hepatitis B virus infection and precancerous high-risk events of gastric cancer: a cross-sectional study (SIGES)","authors":"Jin-Chen Zou ,&nbsp;Mao-Yao Wen ,&nbsp;Yan Huang ,&nbsp;Xin-Zu Chen ,&nbsp;SIGES Research Group","doi":"10.1016/j.lanwpc.2024.101406","DOIUrl":"10.1016/j.lanwpc.2024.101406","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hepatitis B Virus (HBV) infection is a global public health issue, and China is also one of the epidemic areas of HBV infection. Studies found HBV infected individuals, especially with hepatitis B virus surface antigen (HBsAg) positive, might increase risk of gastric cancer. Whether precancerous high-risk events are associated with HBV infection needs further investigation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This cross-sectional study collected health check-up observations (18-75 years old) at the Health Management Center, West China Hospital of Sichuan University between 2018 and 2020. Data including demographic information (sex, age, ethnicity, education, body mass index, smoking, alcohol drinking, and family history of cancer), serological test results, i.e. gastrin-17 (G-17), pepsinogen-I (PG-I), pepsinogen-II (PG-II), HBV associated antigens and antibodies, Helicobacter pylori (Hp) infection, magnetically controlled capsule gastroscopy (MCCG) outcomes were retrieved. Observations were divided into three groups according to HBV infection status: Group A was not infected with HBV; Group B was past infection with HBV; and Group C was inactive HBsAg carriers or active HBV infected people (i.e., HBsAg positive). Associations between HBV infection and the incidence of precancerous high-risk events of gastric cancer and risk factors were analyzed in univariate and multivariate manners. Precancerous high-risk events included comorbidity with chronic gastritis, history of gastric ulcer, Hp infection, serological atrophic gastritis, high level of serum G-17, as well as atrophic gastritis, gastric polyps, and gastric ulcer by MCCG.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 21,505 eligible observations were analyzed (Group B: 54.3% and Group C: 6.1%). When compared baselines to Group A, demographic characteristics of Group B and Group C were variously and significantly different, except family history of cancer (p=0.918) in Group B, while except ethnicity (p=0.061) and alcohol drinking status (p=0.316) in Group C. In Group B, the incidence of comorbidity with chronic gastritis (33.9‰ vs. 25.0‰, p&lt;0.001), serologic atrophic gastritis (18.7‰ vs. 13.9‰, p=0.008), and very-high serum G-17 level (28.6‰ vs. 20.9‰, p&lt;0.001) were significantly higher than those in Group A. In Group C, the incidence of gastric ulcer (74.1‰ vs. 7.9‰, p=0.002), and very-high serum G-17 level (28.9‰ vs. 20.9‰, p=0.002) were significantly higher than those in Group A. Univariate and multivariate analyses showed that Hp infection was an independent risk factor for serologic atrophic gastritis (aOR=1.85, 95% CI 1.44-2.39), but HBsAg positive not (aOR=1.15, 95% CI 0.75-1.74). HBV co-infection did not increase the risk of serological atrophic gastritis among Hp-infected persons (oOR=1.09, 95% CI 0.54-2.22). Hp-infected (aOR=2.79, 95% CI 2.44-3.21) and HBsAg-positive (aOR=1.28, 95% CI 1.02-1.59) were potential risk factors for high serum G-17 l","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101406"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427679","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}

{"title":"Economic burden of breast cancer in Chinese women: analysis o from 2016 to 2018 using national health insurance data","authors":"Yu Qi ,&nbsp;Yaqun Fu ,&nbsp;Yumeng Lv ,&nbsp;Ye Zhang ,&nbsp;Xia Wei ,&nbsp;Li Sun ,&nbsp;Bin Cui ,&nbsp;Ranjit Manchanda ,&nbsp;Rosa Legood ,&nbsp;Li Yang","doi":"10.1016/j.lanwpc.2024.101287","DOIUrl":"10.1016/j.lanwpc.2024.101287","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In 2022, there were approximately 19.96 million new cancer cases globally according to GLOBOCAN, with breast cancer emerging as the most commonly diagnosed female cancer. In China, there were 0.36 million new cases and 75,000 deaths due to breast cancer of women in 2022. However, studies focusing on the cost of treatment and the economic burden of female breast cancer patients in China were conducted within specific provinces, cities, or hospitals, and there lacks a comprehensive analysis of total treatment cost. This study aimed to analyze the costs associated with female breast cancer patients in China using data from the China Health Insurance Research Association (CHIRA) and to explore the factors influencing costs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Female breast cancer patients aged over 16 years were included in the CHIRA database between 2016 and 2018. Patients were identified according to ICD-10 code. Descriptive analysis and log-linear analysis were conducted to examine the treatments of breast cancer. The project was commissioned with an ethical exemption.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;A total of 28,464 breast cancer patients aged 16 years and older who were diagnosed with breast cancer in China between January 2016 and December 2018 were included in this study. The mean age of 54.49 years, and the highest proportion of breast cancer patients were aged 50-60 years (30.66%). Approximately 72.54% of patients were covered by Urban Employee Basic Medical Insurance (EBMI). In this study, 73.56% of breast cancer patients utilized inpatient services, although, this study found the proportion of patients seeking medical treatment in lower-level hospitals increased over time, over 82.07% of the study population still seek care at tertiary hospitals in China. The cost of treatment decreased with increasing age and increased among patients treated at higher-level hospitals. Age, health insurance type, region, and hospital level were found to be associated with both total medical costs and out-of-pocket expenses for breast cancer patients. The annual total medical cost per capita decreased for outpatients and increased for inpatients over the three years. Inequities have been identified in financial protection for patients covered by different health insurance schemes and in different regions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The costs of breast cancer patients in China exhibit significant regional and demographic differences, with Chinese patients being significantly younger compared to those in other countries. Efforts in expanding breast cancer screening are necessary to reduce the disease severity and financial burden. Considering the variance in quality of care across different levels of hospitals, efforts should also be made to enhance the quality of care for cancer treatment in lower-level hospitals, and to ensure favorable health outcomes for patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;T","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101287"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427727","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}

{"title":"Breast cancer prevalence and screening uptake among 1.46 million women in Inner Mongolia, China","authors":"Rui Guo ,&nbsp;Cheng Tan ,&nbsp;Yuxuan Gou ,&nbsp;Jinling Shi ,&nbsp;Fei Wang ,&nbsp;Yibo Wu","doi":"10.1016/j.lanwpc.2024.101316","DOIUrl":"10.1016/j.lanwpc.2024.101316","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;While disparities in breast cancer prevalence between urban and rural areas have been widely studied in China, economically underdeveloped regions such as Inner Mongolia remain under-researched. As an autonomous region with significant economic challenges, including industrial reliance and environmental health risks, Inner Mongolia exemplifies the intersection of socioeconomic disadvantage and health inequalities. This study aims to explore breast cancer prevalence and screening uptake in Inner Mongolia, focusing on the disparities in early detection services among different socioeconomic groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Data from the China Psychological and Behavioral Impact Survey (PBICR) and its breast cancer screening subset were analyzed, covering 1,459,868 women across 12 cities in Inner Mongolia from 2022 to 2024. Variables included demographics, behavioral factors, and family cancer history. Chi-square tests were used to examine differences in screening methods and prevalence across regions. Binary and ordinal logistic regression models identified factors influencing screening comprehensiveness, with a focus on the barriers faced by economically disadvantaged women.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among the women surveyed, 786 cases of breast cancer were reported, yielding a prevalence rate of 0.05%, consistent with the national average. The highest incidence was observed among women aged 40-50 years. Significant disparities in screening participation and methods were found (e.g., physical exams [χ&lt;sup&gt;2&lt;/sup&gt; = 1087.8, P &lt; 0.001], ultrasounds [χ&lt;sup&gt;2&lt;/sup&gt; = 97.276, P &lt; 0.001], X-ray exams [χ&lt;sup&gt;2&lt;/sup&gt; = 12643, P &lt; 0.001], and pathological exams [χ&lt;sup&gt;2&lt;/sup&gt; = 219.81, P &lt; 0.001]). Women from poverty-stricken households were less likely to receive comprehensive screening (β = -0.03, 95% CI: [-0.0377, -0.0193], P &lt; 0.001), while younger women (β = -0.06, 95% CI: [-0.0679, -0.0493], P &lt; 0.001) and those with higher education levels (primary school or below: β = -0.75, 95% CI: [-0.7678, -0.7337], university or above: β = 0.323, 95% CI: [0.3163, 0.3300], P &lt; 0.001) were more likely to opt for multiple screening methods. Geographical disparities were also evident, with rural areas exhibiting lower participation rates and more limited access to advanced screening technologies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study highlights significant health inequalities in breast cancer screening in Inner Mongolia, where economic hardship and geographical isolation disproportionately hinder access to early detection services. The findings suggest that policy interventions should prioritize economically underdeveloped regions to reduce health disparities and promote equitable healthcare access. Theoretically, this study underscores the importance of considering regional economic disparities in health inequality research, extending the current literature’s focus beyond ur","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101316"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427797","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}

{"title":"Characterizing the epidemiology and natural history of colorectal cancer using fecal immunochemical test data from screening programs: a modelling study","authors":"Zhenyu Wang ,&nbsp;Kathy Leung ,&nbsp;Horace C.W. Choi ,&nbsp;Wai Keung Leung ,&nbsp;Wai Lun Law ,&nbsp;Gabriel M. Leung ,&nbsp;Joseph T. Wu","doi":"10.1016/j.lanwpc.2024.101395","DOIUrl":"10.1016/j.lanwpc.2024.101395","url":null,"abstract":"<div><h3>Background</h3><div>The epidemiology and natural history of colorectal cancer (CRC) is poorly understood across many populations, hindering effective disease prevention. We hypothesize that quantitative fecal immunochemical test (FIT) data from CRC screening programs can be used to characterize the prevalence and disease progression of CRC.</div></div><div><h3>Methods</h3><div>We developed an inferential framework to characterize the epidemiology of CRC using quantitative FIT data from 248,692 first-time screenees of the Hong Kong CRC Screening Program during 2016- 2021 (aged 49-77; 56.4% female). Each screenee submitted two fecal samples and was referred for colonoscopy if one or both FIT values exceeded 100 ng/ml (13.1% FIT-positivity). A natural history model, comprising both the conventional adenoma and serrated pathways, was embedded to infer unobserved disease stages in FIT-negative screenees.</div></div><div><h3>Findings</h3><div>We estimated that without screening, 41.1% (95% credible interval = 39.4%-44.0%) of males and 31.0% (29.7%-32.4%) of females would have colorectal neoplastic diseases at age 50. Among them, approximately 7-8% would have advanced colorectal neoplasia (advanced adenoma, serrated lesions, or CRC). The prevalence of advanced neoplasia increases with age, approximately by 0.5% per year after age 50. The annual progression rate to CRC was around 4% for advanced adenoma and 1-2% for serrated lesions. Males with advanced neoplasia generally had higher FIT concentrations than females. In detecting advanced neoplasia, the negative predictive value of FIT was above 99% across all ages, while the positive predictive value was 15-20% at age 50, increasing by around 1% each subsequent year. FIT demonstrates high sensitivity in detecting CRC, ranging from 83% to 98% in both genders.</div></div><div><h3>Interpretation</h3><div>Quantitative FIT-based CRC screening data can be used to effectively characterize the epidemiology and natural history of colorectal cancer. Our novel framework provides a solid foundation for optimizing the effectiveness and cost-effectiveness of screening programs.</div></div><div><h3>Funding</h3><div><span>Health and Medical Research Fund</span> (HMRF), Hong Kong Special Administrative Region, China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101395"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427815","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}

{"title":"Cost-effectiveness of susceptibility-guided therapy under varying rates of clarithromycin resistance","authors":"Shihan Xu,&nbsp;Xianzhu Zhou,&nbsp;Yiqi Du","doi":"10.1016/j.lanwpc.2024.101370","DOIUrl":"10.1016/j.lanwpc.2024.101370","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;With resistance of &lt;em&gt;Helicobacter polyri&lt;/em&gt; to antibiotics reaching alarming levels worldwide, the Maastricht VI/Florence consensus report recommended that susceptibility tests are routinely performed to improve cure rates, even before prescribing first-line treatment. However, the routine use of susceptibility-guided test in clinical practice remains to be established owing to economical and practical issues. We conducted a decision analysis to compare the cost-effectiveness of susceptibility-guided versus empirical therapy for treatment-naïve &lt;em&gt;H. pylori&lt;/em&gt; patients, considering the changing rates of clarithromycin resistance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A decision analysis model is developed to estimate the costs, health outcomes, and cost-effectiveness of our research protocol, using TreeAge Pro (Healthcare Version) 2022 (TreeAge Software). The protocol is mainly based on the 2022 Chinese guideline on Hp eradication treatment and expert opinion. We hypothesized that H. pylori-infected, treatment-naive patients would undergo empirical or susceptibility-guided first-line and second-line treatment. Patients who failed second-line treatment were considered to have failed eradication. In the empirical treatment (EMT) group, clarithromycin quadruple therapy and Levofloxacin quadruple therapy are used as the first-line and second-line regimens, respectively. In the susceptibility-guided therapy (SGT) group, patients with clarithromycin resistance are initially treated with high-dose dual therapy, while those sensitive to clarithromycin receive clarithromycin quadruple therapy. Furazolidone quadruple therapy is employed as the second-line regimen in SGT group. Model parameters are derived from previous literature and China Medical Insurance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In the base case analysis (clarithromycin resistant rate =37%), it takes $3757.01 to additionally cure 1 Hp-infected patient using SGT compared to EMT, and the ICER tended to decrease sharply following the increase of clarithromycin resistance rate. Besides, the average cost of EMT tended to increase subsequent to the increase of clarithromycin resistance rate, in contrast to SGT. However, the cost of SGT treatment consistently exceeds that of EMT by more than $70. Following the implementation of second-line therapy, the eradication rate in the SGT group improves by no more than 5% compared to the EMT group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This study showed that SGT is more effective but requires additional costs, thus being inferior to the EMT group in terms of cost-effectiveness. This may be because of the following points: First, the addition of bismuth ensures that the clarithromycin quadruple therapy maintains a high eradication rate even in patients with clarithromycin resistance. Second, after the administration of second-line therapy, the EMT group achieves a high eradication rate of over 90%, even if clarithro","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101370"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427986","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}