Lancet Regional Health-Americas最新文献

{"title":"Differences between male and female mortality in Colombia: a population-based analysis since 1980","authors":"Oscar Espinosa ,&nbsp;Adrian D. Smith ,&nbsp;Valeria Bejarano ,&nbsp;Johnattan García-Ruiz","doi":"10.1016/j.lana.2025.101263","DOIUrl":"10.1016/j.lana.2025.101263","url":null,"abstract":"<div><h3>Background</h3><div>Globally, women have consistently exhibited lower mortality and higher life expectancy than men. While this sex gap is well-documented in high-income countries, evidence from Latin America remains scarce. Colombia's history of armed conflict and inequality presents a unique context to examine sex differences in mortality. This study aims to describe long-term trends in sex-specific mortality in Colombia over the past four decades, examining differences by age group, cause of death, geographic region, and health insurance scheme.</div></div><div><h3>Methods</h3><div>We analysed Colombian mortality data from 1980 to 2023 using national vital statistics (DANE) and health insurance records (BDUA). Age-standardised mortality rates were estimated across six age groups and 20 causes of death, following OECD guidelines. Mortality rate ratios (MRRs), and years of life lost were computed, while life expectancy was calculated using the Lee–Carter model.</div></div><div><h3>Findings</h3><div>A persistent and widening sex gap in mortality was observed. Male age-standardised mortality declined from 591 to 437 deaths per 100,000 between the 1980s and 2020s, while female mortality declined from 445 to 287. The mortality gap peaked in the 1990s (MRR, 1.58; 95% CI, 1.58–1.58) and remained high in the 2020s (MRR, 1.52; 95% CI, 1.52–1.52). The largest disparities occurred in the 15–59 age group and were primarily due to external causes, where male mortality was up to 874% higher (in the 2000s). In older adults, chronic diseases drove the gap. Conflict-affected regions such as Antioquia, Guaviare, and Arauca showed the highest disparities.</div></div><div><h3>Interpretation</h3><div>Colombia's persistent sex-based mortality gap likely reflects the interplay of contextual factors such as violence, social inequality, and structural barriers to care. Reducing excess male mortality—particularly among young men—may require targeted, gender-responsive policies that incorporate violence prevention, health system strengthening, and strategies to address social inequities.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"52 ","pages":"Article 101263"},"PeriodicalIF":7.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145223643","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":"Characterization of the most austral autochthonous dengue outbreak reported in the world (city of Bahía Blanca, Argentina, January–June 2024). A cross-sectional study","authors":"Guillermo Gabriel Barrenechea ,&nbsp;Rocío Sánchez ,&nbsp;Ornella Cynthia Calderón ,&nbsp;Ignacio Rodrigo Buffone ,&nbsp;Leonardo Soares Bastos","doi":"10.1016/j.lana.2025.101254","DOIUrl":"10.1016/j.lana.2025.101254","url":null,"abstract":"<div><h3>Background</h3><div>Dengue is a vector-borne viral disease that is expanding its boundaries, causing outbreaks and autochthonous viral circulation in places where it had not previously been recorded. The aim is to describe epidemiologically the first outbreak of dengue in the southernmost latitude of the planet ever recorded.</div></div><div><h3>Methods</h3><div>In Bahía Blanca (Buenos Aires, Argentina), dengue virus circulation was reported between January 1, 2024, and June 10, 2024. Cases were detected and reported to the Health Secretariat of the Municipality of Bahía Blanca, Province of Buenos Aires, Argentina. The cases were clinically diagnosed and tested positive for dengue virus (DENV) nonstructural protein 1 (NS1), RT-PCR, and/or IgM. Cases were classified as autochthonous when patients did not report traveling to areas with dengue circulation during the 15 days prior to the onset of symptoms. All serological and molecular analyses were performed at the Municipal Hospital. This study was conducted using clinical samples and data obtained during the outbreak, and all personal identifiers were excluded.</div></div><div><h3>Findings</h3><div>A total of 94 positive cases were reported out of 470 suspected cases. Of the total confirmed cases, 63 were classified as autochthonous and 28 as imported. Serotypes DENV1 and DENV2 were detected in both cases. The first autochthonous case was identified in the second epidemiological week, and the peak of the epidemic curve occurred in the thirteenth epidemiological week. Twenty-seven imported cases came from Argentine locations with autochthonous viral circulation, and one came from Paraguay.</div></div><div><h3>Interpretation</h3><div>This study provides clear evidence of the expansion of dengue fever to latitudes that were not included in previously published risk maps for Argentina. Reporting on the expansion of dengue fever to new areas should alert decision-makers to adopt public health policies aimed at reducing the burden of the disease.</div></div><div><h3>Funding</h3><div>LSB, GGB, RS were partially funded by the call 18/2023 by the <span>National Council for Scientific and Technological Development</span> (CNPq) and the Department of Science and Technology of Secretariat of Science, Technology, Innovation and Health Complex of <span>Ministry of Health of Brazil</span> (DECIT/SECTICS/MS). LSB also acknowledges research grants from <span>FAPERJ</span> (<span><span>E-26/201.277/2021</span></span>) and <span>CNPq</span> (<span><span>310530/2021-0</span></span>).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101254"},"PeriodicalIF":7.0,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220275","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":"Quantifying the mortality and morbidity impact of medicaid work requirements: a modeling study","authors":"Abhishek Pandey ,&nbsp;Yang Ye ,&nbsp;Carolyn Bawden ,&nbsp;Burton H. Singer ,&nbsp;Alison P. Galvani","doi":"10.1016/j.lana.2025.101232","DOIUrl":"10.1016/j.lana.2025.101232","url":null,"abstract":"<div><h3>Background</h3><div>Federal Medicaid work requirements, recently enacted under national legislation, are expected to cause substantial disenrollment among low-income adults. However, the public health consequences of these policies remain poorly quantified.</div></div><div><h3>Methods</h3><div>Extending our previously developed modeling framework, we projected national and state-level excess mortality and uncontrolled morbidity attributable to Medicaid coverage loss among expansion enrollees. Our three coverage loss scenarios were based on Congressional Budget Office projections and disenrollment patterns observed in Arkansas and New Hampshire. We incorporated administrative variation in automatic exemption capacity and reporting compliance. Mortality estimates used hazard ratios comparing insured and uninsured adults, while morbidity estimates focused on uncontrolled diabetes, hypertension, and high cholesterol.</div></div><div><h3>Findings</h3><div>We estimate between 7049 and 9252 excess deaths annually under the three national scenarios. We also project up to 113,607 additional cases of uncontrolled diabetes, 135,135 of hypertension, and 37,800 of high cholesterol. State-level excess deaths range from under 20 to over 2,100, with per-capita mortality highest in the District of Columbia and states such as New York and New Mexico. State performance varies widely based on administrative capacity. For example, North Carolina and Rhode Island would avert over 90 percent of deaths that could be avoided through stronger exemption systems, while Pennsylvania and South Dakota may only avert fewer than 30 percent.</div></div><div><h3>Interpretation</h3><div>Medicaid work requirements are projected to increase mortality and chronic disease burden across the United States. These findings highlight the role of state administrative capacity and underscore the public health cost of restricting insurance access.</div></div><div><h3>Funding</h3><div><span>Notsew Orm Sands Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101232"},"PeriodicalIF":7.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220273","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":"Doctors with borders? The decoupling of Canadian and US medical school accreditation","authors":"Anthony Zhong ,&nbsp;Yuxuan Jiang","doi":"10.1016/j.lana.2025.101256","DOIUrl":"10.1016/j.lana.2025.101256","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101256"},"PeriodicalIF":7.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220276","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":"Considering culture to optimise psychosocial treatments for caregivers of persons with Alzheimer's disease and related dementias","authors":"Sherry A. Beaudreau ,&nbsp;Julie Loebach Wetherell","doi":"10.1016/j.lana.2025.101265","DOIUrl":"10.1016/j.lana.2025.101265","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101265"},"PeriodicalIF":7.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220005","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":"Regional and national estimates of children affected by all-cause and COVID-19-associated orphanhood and caregiver death in Brazil, by age and family circumstance: a modeling study","authors":"Nicholas Steyn ,&nbsp;H. Juliette T. Unwin ,&nbsp;Jamie Ponmattam ,&nbsp;Andrés Villaveces ,&nbsp;Luiza Martins ,&nbsp;Lorraine Sherr ,&nbsp;Alexandra Blenkinsop ,&nbsp;Elizaveta Semenova ,&nbsp;Alice Stuart-Brown ,&nbsp;André Victor Ribeiro Amaral ,&nbsp;Oliver Ratmann ,&nbsp;Ricardo Parolin Schnekenberg ,&nbsp;Lucie Cluver ,&nbsp;Susan Hillis ,&nbsp;Laura Rawlings ,&nbsp;Lorena Barberia ,&nbsp;Andrea Santos Souza ,&nbsp;Marcia C. Castro ,&nbsp;Seth Flaxman","doi":"10.1016/j.lana.2025.101252","DOIUrl":"10.1016/j.lana.2025.101252","url":null,"abstract":"<div><h3>Background</h3><div>Orphanhood and caregiver death can have severe consequences for children. Timely and accurate data can guide policy, particularly during health crises like COVID-19. The aim of our study is to present national and subnational analysis of both all-cause and COVID-19-associated orphanhood and caregiver death in Brazil and compare our model outputs with bespoke administrative datasets.</div></div><div><h3>Methods</h3><div>We use publicly available national datasets to estimate the number of Brazilian children experiencing parent and caregiver loss due to all causes and COVID-19 in 2020–2021.</div></div><div><h3>Findings</h3><div>An estimated 1,300,000 (95% uncertainty interval, 1,190,000, 1,430,000) children in Brazil experienced loss of one or multiple parents and/or co-residing caregivers. 673,000 (652,000, 690,000) were estimated to have lost one or both parents, of which 149,000 (144,000, 154,000) were COVID-19 associated; 635,000 (534,000, 758,000) children were estimated to have lost a co-residing grandparent or other kin, of which 135,000 (85,900, 199,000) were COVID-19 associated. Orphanhood varied substantially across states, with the rate of all cause parental orphanhood highest in Roraima at 17.5 (15.6, 20.6) per 1000 children and the lowest in Santa Catarina at 9.5 (8.7, 10.4) per 1000 children. COVID-19-associated orphanhood was also unevenly distributed, with Mato Grosso experiencing the greatest rate, at 4.4 (3.9, 5.3) per 1000 children, while Pará experienced the lowest rate of 1.4 (1.2, 1.8) per 1000 children. Comparisons with limited data from Brazil’s civil registry offices and (manually reviewed death certificates in Campinas found a similar demographic distribution of orphanhood. However, our estimates suggested that administrative sources undercount orphanhood.</div></div><div><h3>Interpretation</h3><div>Our findings highlight the extent of orphanhood in Brazil and large inequalities between states. Comparisons between administrative data and model estimates show similar temporal patterns and proportions of maternal and paternal orphanhood but different magnitudes. This suggests that strengthening vital registration systems can put children at the center of public health responses globally.</div></div><div><h3>Funding</h3><div>This study was funded by “<span>Building Global Public Health Capacity</span> to Link Real-Time Modelling Data on COVID-19-associated Orphanhood and Caregiver Deaths to Inform Prevention, Preparedness and Protection from COVID-19 consequences” (2023 CDC/WHO grant) and the <span>Moderna Charitable Foundation</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101252"},"PeriodicalIF":7.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220274","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":"Corrigendum to Reduced nicotine in cigarettes in a marketplace with alternative nicotine systems: randomized clinical trial","authors":"Dorothy K. Hatsukami ,&nbsp;Joni A. Jensen ,&nbsp;Dana Mowls Carroll ,&nbsp;Xianghua Luo ,&nbsp;Lori G. Strayer ,&nbsp;Qing Cao ,&nbsp;Stephen S. Hecht ,&nbsp;Sharon E. Murphy ,&nbsp;Steven G. Carmella ,&nbsp;Rachel L. Denlinger-Apte ,&nbsp;Suzanne Colby ,&nbsp;Andrew A. Strasser ,&nbsp;F. Joseph McClernon ,&nbsp;Jennifer Tidey ,&nbsp;Neal L. Benowitz ,&nbsp;Eric C. Donny","doi":"10.1016/j.lana.2025.101244","DOIUrl":"10.1016/j.lana.2025.101244","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101244"},"PeriodicalIF":7.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158271","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":"From paradise to precarity: Hawai'i's public health gaps foreshadow U.S. coastal vulnerabilities","authors":"Hao Chi,&nbsp;Hua Yang,&nbsp;T. Samuel Shomaker,&nbsp;Youping Deng","doi":"10.1016/j.lana.2025.101259","DOIUrl":"10.1016/j.lana.2025.101259","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101259"},"PeriodicalIF":7.0,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158270","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 duality of retail pharmacy clinics in Mexico: from threat to opportunity","authors":"Diego Ramonfaur ,&nbsp;Moises Auron ,&nbsp;Guillermo Torre-Amione","doi":"10.1016/j.lana.2025.101258","DOIUrl":"10.1016/j.lana.2025.101258","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101258"},"PeriodicalIF":7.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158272","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":"Favorable outcomes of restrictive treatment indications in chronic lymphocytic leukemia: a retrospective analysis of Brazilian Registry of CLL","authors":"Fernanda de Morais Marques ,&nbsp;Verena Pfister ,&nbsp;Flavia Parra ,&nbsp;Leila Perobelli ,&nbsp;Valeria Buccheri ,&nbsp;Mihoko Yamamoto ,&nbsp;Rodrigo Santucci ,&nbsp;Sergio Costa Fortier ,&nbsp;Vinicius Campos de Molla ,&nbsp;Maura Rosane Valerio Ikoma-Colturato ,&nbsp;Glaciano Ribeiro ,&nbsp;Nelson Hamerschlak ,&nbsp;Abel Costa ,&nbsp;Laura Maria Fogliatto ,&nbsp;Vera Lucia de Piratininga Figueiredo ,&nbsp;Talita Silveira ,&nbsp;Marcelo Pitombeira de Lacerda ,&nbsp;Matheus Vescovi Gonçalves ,&nbsp;Carlos Sérgio Chiattone ,&nbsp;Jennifer R. Brown ,&nbsp;Celso Arrais-Rodrigues","doi":"10.1016/j.lana.2025.101234","DOIUrl":"10.1016/j.lana.2025.101234","url":null,"abstract":"<div><h3>Background</h3><div>The Brazilian Group of CLL (BGCLL) has proposed a more restrictive approach for treatment initiation compared to the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) guidelines. Here, we report on the safety and efficacy of this strategy.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients with CLL registered in the Brazilian CLL Registry between January 2009 and July 2023 who met the minimum data availability criteria for analysis. The BGCLL criteria employ stricter thresholds for cytopenias, defining them as hemoglobin levels below 9.5 g/dL or platelet counts below 50,000/mm³, as opposed to the IWCLL criteria of below 10 g/dL and below 100,000/mm³, respectively. Furthermore, the BGCLL criteria do not consider progressive lymphocytosis or disease-related symptoms to be criteria for treatment initiation when cytopenias or symptomatic masses are absent. Survival outcomes were estimated using the Kaplan–Meier method and compared with log-rank tests. Cox proportional hazards models were used for multivariable analysis, with results expressed as hazard ratios and 95% confidence intervals. A P-value &lt;0.05 was considered statistically significant.</div></div><div><h3>Findings</h3><div>A total of 2511 patients were enrolled from 41 centers. Of these, 1404 patients (56%) met the IWCLL criteria for treatment initiation (liberal criteria), whereas only 788 patients (31%) met the BGCLL criteria (restrictive criteria). Patients with liberal criteria had a better overall survival than those with restrictive criteria (85% vs. 68%, respectively), suggesting that restrictive criteria were more predictive of prognosis than liberal criteria. In addition, patients treated for cytopenias had significantly worse overall survival (69%) compared to those treated for any other indication (97%, P &lt; 0.0001). Patients with disease-related symptoms, progressive lymphocytosis, and extranodal involvement as isolated indications for treatment had similar overall survival to those with no indication for treatment.</div></div><div><h3>Interpretation</h3><div>Our results demonstrate that a more restrictive approach to treatment initiation in CLL, as proposed by the BGCLL, better identifies patients with higher disease burden and poorer outcomes, while sparing others unnecessary therapy.</div></div><div><h3>Funding</h3><div><span>Brazilian Registry of CLL</span>–<span>Brazilian Association of Hematology and Hemotherapy</span> (ABHH)/<span>Coordenação de Aperfeiçoamento de Pessoal de Nível Superior</span> (CAPES).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101234"},"PeriodicalIF":7.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119279","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}