Lancet Regional Health-Americas最新文献

{"title":"Descriptive epidemiology of gastric cancer in Costa Rica from 1990 to 2022 and projection of deaths to 2050: a population-based study","authors":"Juan C. Vanegas ,&nbsp;Rolando Herrero ,&nbsp;Cristina Barboza-Solís ,&nbsp;Rebeca Ocampo ,&nbsp;Guillermo Torres ,&nbsp;Adolfo Ortiz-Barboza ,&nbsp;Vanessa Ramírez ,&nbsp;Clas Une ,&nbsp;Alejandro Calderón ,&nbsp;Carolina Porras ,&nbsp;Loretto J. Carvajal ,&nbsp;Romain Fantin","doi":"10.1016/j.lana.2025.101194","DOIUrl":"10.1016/j.lana.2025.101194","url":null,"abstract":"<div><h3>Background</h3><div>In Costa Rica, gastric cancer has been the leading cause of cancer death (both sexes) since the 1980s. The objective of this study was to analyze the incidence, mortality, and geographic distribution of stomach cancer in Costa Rica for the period 1990–2022, and to make projections of deaths up to 2050.</div></div><div><h3>Methods</h3><div>Incidence and mortality data were from the Costa Rican National Cancer Registry, the Costa Rican National Institute of Statistics and Census, and the Central American Population Research Center. Age-standardized incidence and mortality rates, annual percent changes (APC), and years of potential life lost (YPLL) were calculated. Crude mortality rates were estimated at the canton level. Mortality projections were made using Poisson models.</div></div><div><h3>Findings</h3><div>The standardized rates have been decreasing in all ages over 40 years old, in men and in women (in incidence, APC = −4.4% [−4.6, −4.3] in men, APC = −3.6% [−3.8, −3.3] in women; in mortality APC = −3.5% [−3.7, −3.4] in men, APC = −3.0% [−3.3, −2.8] in women). YPLL rates increased with age, but the age group with the highest number of YPLL was between 50 and 69 years. High mortality rates were observed in the mountainous areas east and south of the capital region, and one canton in Guanacaste. Most models projected increases in number of deaths of 50%–200% by the year 2050.</div></div><div><h3>Interpretation</h3><div>Despite declining mortality rates, the number of gastric cancer deaths is projected to rise, underscoring the need for targeted public health strategies-particularly programs for <em>Helicobacter pylori</em> detection and eradication, along with dietary and lifestyle interventions. Geographic disparities also support the development of region-specific cancer control strategies to reduce the burden in high-risk areas.</div></div><div><h3>Funding</h3><div>The study was supported by the <span>Agencia Costarricense de Investigaciones Biomédicas</span>—<span>Fundación INCIENSA</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101194"},"PeriodicalIF":7.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum kidney disease associated with placental abruption: a population-based retrospective cohort study","authors":"Cande V. Ananth ,&nbsp;Emily B. Rosenfeld ,&nbsp;Minxiu Shi ,&nbsp;Amy Backal ,&nbsp;Swathi Vasudevan ,&nbsp;Ruby Lin ,&nbsp;Rachel Lee ,&nbsp;Elizabeth A. Suarez","doi":"10.1016/j.lana.2025.101192","DOIUrl":"10.1016/j.lana.2025.101192","url":null,"abstract":"<div><h3>Background</h3><div>Placental abruption can lead to renal decompensation, including disseminated intravascular coagulation, and the release of cytokines and vasoactive substances, causing kidney damage. Despite the strong biological plausibility, whether this renal damage persists in the postpartum period is unknown. The aims of the study were to examine the association between abruption and kidney disease hospitalisation, and whether these risks are modified by hypertensive disorders of pregnancy (HDP).</div></div><div><h3>Methods</h3><div>We designed a population-based retrospective cohort study of hospital deliveries and readmissions in the US, 2010–2020. All persons who had a hospital delivery with and without an abruption diagnosis were followed up for readmission for kidney disease in the same calendar year. We fit Cox proportional hazards models to estimate the associations based on two outcomes: fatal or non-fatal kidney disease and in-hospital mortality. We evaluated whether HDP modified these risks.</div></div><div><h3>Findings</h3><div>Of 17,826,038 delivery hospitalisations, 194,740 (1.1%) were complicated by abruption. The median follow-up after delivery was 6.4 months (interquartile range, 3.7, 9.2) among abruption and non-abruption deliveries. The rates of hospitalisations with an acute kidney injury (AKI) diagnosis among abruption and non-abruption groups were 236 and 106 per 100,000 hospitalisations, respectively (adjusted hazard ratio [HR] 1.7, 95% confidence interval [CI], 1.5–1.9). The corresponding rates for hospitalisations with chronic kidney disease (CKD) diagnosis among abruption and non-abruption groups were 82 and 25 per 100,000 hospitalisations, respectively (HR 2.1, 95% CI, 1.6–2.7). The HR for AKI mortality associated with abruption was 4.1 (95% CI, 2.8–6.1). Kidney disease risks related to abruption were high among those without an HDP diagnosis; these risks were substantially higher among persons with HDP.</div></div><div><h3>Interpretation</h3><div>This population-based study shows that placental abruption, even in the absence of HDP, is associated with increased short-term postpartum risks of AKI and CKD hospitalisations. These risks are higher in the presence of HDP. This study underscores the importance of close postpartum monitoring of patients diagnosed with placental abruption in their pregnancies for the risk of kidney disease. It is also essential to elucidate whether these risks persist beyond the postpartum period and extend to the maternal life course.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101192"},"PeriodicalIF":7.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A combined water crisis and public health emergency in the Brazilian Amazon","authors":"Cassia Karimi Vieira Cativo ,&nbsp;Helena Ferreira Moura ,&nbsp;Alexander J. Smith ,&nbsp;Michael Liebrenz ,&nbsp;Edna Castro","doi":"10.1016/j.lana.2025.101197","DOIUrl":"10.1016/j.lana.2025.101197","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101197"},"PeriodicalIF":7.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human mobility, garimpos and spatiotemporal malaria transmission in the Yanomami Indigenous Territory: a retrospective observational study","authors":"Alisson F. Barbieri,&nbsp;Reinaldo O. Santos","doi":"10.1016/j.lana.2025.101188","DOIUrl":"10.1016/j.lana.2025.101188","url":null,"abstract":"<div><h3>Background</h3><div>Past research on human mobility and malaria transmission often used coarse spatial scales, limiting effectiveness for targeted control strategies — especially as transmission becomes more localized with lower incidence. This is seen in Brazil’s Yanomami Indigenous Territory (YIT), where illegal gold mining (<em>garimpo</em>) and weakened environmental policies have contributed to malaria resurgence. We used epidemiological surveillance data to identify and distinguish localities of likely infection and residence within and near the YIT. We then constructed Malaria Mobility Networks (MMNs) to analyse spatiotemporal malaria transmission patterns from 2007 to 2023.</div></div><div><h3>Methods</h3><div>MMN quantified diffusion effects and differentiated between autochthonous and imported malaria cases among localities. Integrating malaria and population location data into a regular grid improved the accuracy of malaria risk and transmission assessments.</div></div><div><h3>Findings</h3><div>We observed spatial concentration of malaria cases (86%) and population (91%), and most grids have incorrectly attributed malaria (94%) and population (86%) risks. We improved spatial identification of malaria cases in 12% (70% in <em>garimpos</em>) and corrected 20% inaccurate coordinates. Autochthonous malaria in indigenous localities reached 90% (2023), the highest MMN share compared to total cases. MMN involving infection in <em>garimpos</em> raised since 2019 and peaked around 27% in 2022, being more associated with urban residence.</div></div><div><h3>Interpretation</h3><div>Spatial analysis reveals spatiotemporal linkages between residence-based human mobility and malaria, supporting improved epidemiological surveillance. MMN demonstrates how spatiotemporal patterns of malaria transmission aligns with <em>garimpo</em> dynamics and their regional connections. Persistent malaria in indigenous localities stems from interactions with <em>garimpos</em> within the YIT and robust <em>garimpo</em>-urban networks that facilitate disease transmission.</div></div><div><h3>Funding</h3><div><span><em>Bolsa de Produtividade de Pesquisa</em></span> (grant number PQ <span><span>306567/2016-4</span></span>), <span>Brazilian National Research Council</span> (CNPq).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101188"},"PeriodicalIF":7.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of weather and extreme events on malaria transmission in the Brazilian Amazon: a case-crossover and population-based study","authors":"Nicholas J. Arisco ,&nbsp;Cassio Peterka ,&nbsp;Joel Schwartz ,&nbsp;Marcia C. Castro","doi":"10.1016/j.lana.2025.101189","DOIUrl":"10.1016/j.lana.2025.101189","url":null,"abstract":"<div><h3>Background</h3><div>Since 1950, there have been increasingly atypical climatological patterns in the Amazon, some caused by El Niño-Southern Oscillation (ENSO) events (El Niño or La Niña). In 2023–2024, the region faced the most severe droughts in recorded history. These weather patterns are major drivers of malaria. Deforestation has exacerbated these impacts. This study estimates the impact of weather and ENSO events on malaria transmission in the Brazilian Amazon from 2003 to 2022.</div></div><div><h3>Methods</h3><div>We used daily individual-level data on reported malaria cases from the Brazilian Malaria Epidemiological Surveillance Information System (Sivep-Malaria). A case-crossover approach was used to analyze the effects of lagged weather variables and ENSO events on malaria transmission at the Amazon-wide and state levels. Generalized additive quasi-Poisson models were used to assess the influence of ENSO events on malaria cases.</div></div><div><h3>Findings</h3><div>From 2003 to 2022, 5,381,105 malaria cases were recorded in the Brazilian Amazon. Temperatures between 25.64 and 30.85 °C and precipitation &gt;4.46 cm in the week prior to infection increased malaria infection risk up to 9% (95% CI: 8–10%) and 86% (95% CI: 35–155%), respectively. Two- and three-week lagged temperatures &gt;25.64 °C and diurnal variation &gt;6.75 °C reduced malaria infection risk by a maximum of 27% (95% CI: 19–33%) and 59% (95% CI: 52–69%). State-specific variations in relationships were notable. ENSO events significantly influenced weather conditions and malaria transmission, with El Niño and La Niña associated with a net reduction in malaria cases of 2179 (95% CI: 1837, 2520) and 37,258 (95% CI: 37,171, 37,345), respectively, with marked spatiotemporal heterogeneity in effect.</div></div><div><h3>Interpretation</h3><div>This study clarifies the short- and long-term influences of weather and ENSO events on malaria transmission in the Brazilian Amazon. The results underscore the high degree of heterogeneity in the effects of weather on malaria transmission in the region, and the need for proactive and fine-scale malaria control based on weather forecasting and the development of early warning systems to achieve malaria elimination.</div></div><div><h3>Funding</h3><div>This research was supported by the <span>Division of Intramural Research</span> at the <span>National Institute of Allergy and Infectious Diseases</span> (Award Number: 2U19AI089681-08) and the <span>Foundation for the National Institutes of Health</span> (Award Number: NIH/T32 AI007535).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101189"},"PeriodicalIF":7.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144655617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbapenemases producing gram-negative bacteria surveillance in Latin America and the caribbean: a retrospective observational study from 2015 to 2020","authors":"Marcelo Pillonetto ,&nbsp;Priscila Lamb Wink ,&nbsp;Roberto G. Melano ,&nbsp;María Antonieta Jiménez-Pearson ,&nbsp;Nancy Lorena Melgarejo Touchet ,&nbsp;Sandra Yamile Saavedra Rojas ,&nbsp;Debora N.O. Kulek ,&nbsp;Andre Luiz Abreu ,&nbsp;Renata Tigulini Peral ,&nbsp;Rogerio Miorando ,&nbsp;Hatim Sati ,&nbsp;Genara Romero Thomas ,&nbsp;Marcelo Galas ,&nbsp;Pilar Ramon Pardo ,&nbsp;Carlos R.V. Kiffer ,&nbsp;Ana Paula D'Alincourt Carvalho Assef","doi":"10.1016/j.lana.2025.101185","DOIUrl":"10.1016/j.lana.2025.101185","url":null,"abstract":"<div><h3>Background</h3><div>The rise of multidrug-resistant (MDR) bacteria represents a public health threat, with carbapenem resistance exacerbating this challenge. This study investigates carbapenemase-producing bacteria (CPB) across the Latin America and the Caribbean (LAC) region.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted across 12 LAC countries from 2015 to 2020. A total of 58,909 isolates were analyzed utilizing polymerase chain reaction (PCR) to detect key carbapenemases in Enterobacterales, <em>Pseudomonas aeruginosa</em>, and <em>Acinetobacter baumannii</em> complex (ABC).</div></div><div><h3>Findings</h3><div>47,804/58,909 (81.14%) carbapenemases were identified, with Brazil accounting for 73% of these. The majority were reported in carbapenem-resistant Enterobacterales–CRE (65.33%; 31,230/47,804), followed by carbapenem-resistant ABC-CRAB (22.05%; 10,542/47,804), and carbapenem-resistant <em>P. aeruginosa</em>–CRPA (6050/47,804; 12.66%). Among CRE, <em>bla</em>_KPC was the most detected gene (78.67%; 24,569/31,230), with <em>Klebsiella pneumoniae</em> being the most commonly associated species (75.9%). A relevant upward trend in <em>bla</em>_NDM was observed. CRPA exhibited diverse profiles, with <em>bla</em>_VIM (47.64%) being the most common. In CRAB, <em>bla</em>_OXA-23 was found in 88.80% (9361/10,542) of isolates. Carbapenemase co-production was detected in 2.60% (1190/47,804) of isolates, with CRPA <em>bla</em>_IMP + <em>bla</em>_VIM being the most frequent.</div></div><div><h3>Interpretation</h3><div>This study highlights a high prevalence of CPB in LAC, with a stable trend in <em>bla</em>_KPC but a rising trend in <em>bla</em>_NDM. These findings underscore the urgent need for strengthened surveillance and public health interventions to combat carbapenemase-mediated resistance in the region.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101185"},"PeriodicalIF":7.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy Brazil: a multisectoral strategy for tackling neglected diseases and promoting health equity","authors":"Ethel Leonor Maciel ,&nbsp;Draurio Barreira ,&nbsp;Ada Maria Cruz ,&nbsp;Nísia Veronica Trindade Lima","doi":"10.1016/j.lana.2025.101187","DOIUrl":"10.1016/j.lana.2025.101187","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101187"},"PeriodicalIF":7.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality trends among Indigenous women of reproductive age in Brazil: a time series analysis","authors":"Guilherme A.T. Ferreira ,&nbsp;Mariângela L. Cherchiglia ,&nbsp;Márcio Valk ,&nbsp;Flávia B. Pilecco","doi":"10.1016/j.lana.2025.101183","DOIUrl":"10.1016/j.lana.2025.101183","url":null,"abstract":"<div><h3>Background</h3><div>Reports on Brazilian Indigenous peoples highlight mortality disparities, yet little is known about death aetiology—particularly among women of reproductive age—or how structural discrimination based on race/skin colour influences mortality rates in this group. This study aimed to assess and compare cause-specific mortality rates between Indigenous and White Brazilian women of reproductive age, identifying health disparities to inform targeted public health interventions.</div></div><div><h3>Methods</h3><div>This ecological study used mortality data from Brazil's Mortality Information System (SIM). Population estimates were based on census projections. We calculated annual age-standardized mortality rates (ASMR) for women of reproductive age (10–49 years) from Indigenous and White groups who died between 2010 and 2019 all over the country. Causes of death were classified by ICD-10. Trends were estimated using Prais-Winsten regression, expressed as annual percentage change.</div></div><div><h3>Findings</h3><div>We analysed 3185 deaths among Indigenous women and 274,393 among White women. ASMR among Indigenous women did not decline for any ICD-10 cause. Unlike White women, Indigenous women exhibited rising ASMR for digestive (+12·36%), circulatory (+8·88%), and respiratory (+4·56%) causes. Both groups experienced rising ASMR due to neoplasms and endocrine, metabolic, and nutritional diseases, with higher increases among Indigenous women. Maternal deaths remained stable in both groups but at different magnitudes. ASMR from external and infectious/parasitic causes remained stable among Indigenous women but declined among White women.</div></div><div><h3>Interpretation</h3><div>Mortality from predominantly chronic circulatory, digestive and respiratory diseases is increasing without a decline in infectious/parasitic, maternal, or external causes. Further investigation into rising chronic disease deaths could reveal inequities driving early mortality. Identifying gaps in Indigenous health policies may guide more effective interventions tailored to Indigenous people needs.</div></div><div><h3>Funding</h3><div>This study was funded by <span>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior</span> (CAPES), <span>Ministério da Educação</span>, and <span>Pró-Reitoria de Pesquisa, Universidade Federal de Minas Gerais</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101183"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"H5N1 preparedness must integrate rural and agricultural realities","authors":"Bradley A. Firchow","doi":"10.1016/j.lana.2025.101186","DOIUrl":"10.1016/j.lana.2025.101186","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101186"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population attributable fractions of modifiable dementia risk factors for cognitive impairment—the ELSA-Brasil cohort study","authors":"Raphael Machado Castilhos ,&nbsp;Vanessa Bielefeldt Leotti ,&nbsp;Natan Feter ,&nbsp;Alessandra C. Goulart ,&nbsp;André Russowsky Brunoni ,&nbsp;Claudia Kimie Suemoto ,&nbsp;Luana Giatti ,&nbsp;Maria Carmen Viana ,&nbsp;Sandhi Maria Barreto ,&nbsp;Sheila Alvim ,&nbsp;Bruce B. Duncan ,&nbsp;Maria Inês Schmidt","doi":"10.1016/j.lana.2025.101184","DOIUrl":"10.1016/j.lana.2025.101184","url":null,"abstract":"<div><h3>Background</h3><div>Population attributable fractions (PAF) of modifiable dementia risk factors are rarely estimated in low- and middle-income countries. We aim to estimate the relative risk (RR) for cognitive impairment and calculate the PAF in the <em>Estudo Longitudinal da Saúde do Adulto</em> (ELSA-Brasil).</div></div><div><h3>Methods</h3><div>We analyzed adults aged 35–74 at the baseline (2008–2010) and wave 3 (2017–2019). We estimated the prevalence of eight modifiable dementia risk factors at baseline: hypertension, physical inactivity, diabetes, depression, obesity, low education, smoking, and excessive alcohol consumption. Cognition was evaluated at baseline and wave 3 using six standardized tests for the Brazilian Portuguese. A global cognitive score from the individual cognitive tests was created using calculated z-scores each test. A global z-score below −1.5 was considered indicative of cognitive impairment. We calculated the RR and PAF for cognitive impairment at wave 3.</div></div><div><h3>Findings</h3><div>We followed 10,058 adults (56.7% women, median age of 50 [IQR: 44–56] years) for 8.1 (0.6) years. The eight-year incidence of cognitive impairment in wave 3 was 5.5% (n = 549). Low education had the largest RR (4.32) followed by hypertension (1.43), diabetes (1.27), and smoking (1.35). Low education had the largest PAF (95% CI), 14.2% (11.2–17.3), followed by hypertension 13% (7–19), diabetes 4.2% (0.7–7.7), and smoking 3.2% (0.45–6). The total PAF for significant risk factors was 34.7% (28.2–41.3).</div></div><div><h3>Interpretation</h3><div>The findings highlight the importance of early-life and midlife prevention strategies in low- and middle-income countries, with a focus on addressing educational and cardiovascular risk factors.</div></div><div><h3>Funding</h3><div>RMC received <span>Alzheimer's Association</span> grant (AARGD-21-846545).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101184"},"PeriodicalIF":7.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}