Lancet Regional Health-Americas最新文献

{"title":"Biases inherent in all-cause mortality studies: implications for shaping the 2025–2030 dietary guidelines for Americans on alcohol consumption","authors":"Kevin Shield , Katherine Keyes , Priscilla Martinez , Adam J. Milam , Jürgen Rehm , Timothy S. Naimi","doi":"10.1016/j.lana.2025.101083","DOIUrl":"10.1016/j.lana.2025.101083","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101083"},"PeriodicalIF":7.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal analysis of substance use disorder mortality in the United States: an observational study of emerging hotspots and vulnerable populations (2005–2020)","authors":"Santiago Escobar ,&nbsp;Neil J. MacKinnon ,&nbsp;Preshit Ambade ,&nbsp;Zach Hoffman ,&nbsp;Diego F. Cuadros","doi":"10.1016/j.lana.2025.101075","DOIUrl":"10.1016/j.lana.2025.101075","url":null,"abstract":"<div><h3>Background</h3><div>The escalating substance use disorder (SUD) crisis in the contiguous United States (US), with rising mortality since 1999, necessitates a spatiotemporal analysis to identify high-risk areas and vulnerable populations. This study examines the geospatial distribution and clustering patterns of SUD mortality, assessing disparities by race and urban-rural status.</div></div><div><h3>Methods</h3><div>We analyzed county-level ecological data on SUD-related deaths from the Centers for Disease Control and Prevention (CDC) from 2005 to 2020. Using spatial scan statistics, we identified significant clusters of elevated SUD mortality and assessed shifts over time. The analysis stratified results by race (White and Black subpopulations) and urban-rural classification to explore disparities.</div></div><div><h3>Findings</h3><div>Among 3142 U.S. counties, we identified 27 significant spatiotemporal clusters of elevated SUD mortality, primarily emerging post-2013 and persisting until 2020. The epidemic's epicenter shifted from the western to the eastern U.S. around 2016. Clusters in the White population (n = 26) had an estimated mortality rate of 28.42 per 100,000 person-years (95% confidence interval [CI]: 28.30–28.54), compared to 14.83 per 100,000 person-years (95% CI: 14.74–14.92) outside clusters. For the Black population (n = 17), the mortality rate was 33.16 per 100,000 person-years (95% CI: 32.80–33.51) within clusters, versus 13.36 per 100,000 person-years (95% CI: 13.14–13.59) outside. Clusters in the Black population emerged later, mostly after 2013, while White clusters followed a pattern similar to the general population. The urban SUD mortality rate was 1.30 per 10,000 per year, while the rural mortality rate was 1.03 per 10,000 per year. Within clusters, urban counties had a mortality rate of 1.61 per 10,000, compared to 0.97 per 10,000 outside. Rural counties had 1.43 per 10,000 in clusters, while non-clustered rural areas had 0.81 per 10,000.</div></div><div><h3>Interpretation</h3><div>The shifting geographic and racial patterns of SUD mortality underscore the need for targeted, region-specific interventions. The increasing impact on Black populations and urban centers in the East highlights the importance of equitable access to treatment and harm reduction services. Real-time surveillance and tailored urban-rural strategies are essential to mitigate the evolving crisis.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101075"},"PeriodicalIF":7.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 impacts on decarceration for Indigenous, Black, and other racialized people in Ontario, Canada: an interrupted time series study","authors":"Akwasi Owusu-Bempah ,&nbsp;Nina Lamberti ,&nbsp;Ruth Croxford ,&nbsp;Beverley Osei ,&nbsp;Amanda Butler ,&nbsp;Ruth Elwood Martin ,&nbsp;Jessica Jurgutis ,&nbsp;Kate McLeod ,&nbsp;Martha Paynter ,&nbsp;Howard Sapers ,&nbsp;Raya Semeniuk ,&nbsp;Fiona G. Kouyoumdjian","doi":"10.1016/j.lana.2025.101088","DOIUrl":"10.1016/j.lana.2025.101088","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic response in many jurisdictions included efforts to depopulate correctional facilities. In the context of the overrepresentation of Indigenous and Black people in Canadian correctional facilities, we aimed to assess COVID-19 impacts on decarceration by race and Indigenous identity in Ontario, Canada.</div></div><div><h3>Methods</h3><div>We accessed correctional administrative data for all people incarcerated in provincial correctional facilities in Ontario, Canada between 2015 and 2022. We categorized people using self-reported data into one of five identity groups: Indigenous, non-Indigenous Black, non-Indigenous non-Black racialized, non-Indigenous white, or missing. We conducted interrupted time series analyses, treating COVID-19 as an event on April 1, 2020, for each of admissions, releases, number of people in custody, and person-time in custody.</div></div><div><h3>Findings</h3><div>Of 148,937 people who experienced incarceration, 85.4% were male and 14.5% were female, the mean age was 35.2 years (SD 12.2), and 11.7% were Indigenous, 12.1% were non-Indigenous Black, 12.1% were non-Indigenous non-Black racialized, and 48.9% were non-Indigenous white. Decarceration in the spring of 2020 benefitted all four race/Indigenous identity groups, with significant decreases in all four decarceration indicators for all groups. There was a significant interaction between COVID-19 decarceration and race/Indigenous identity group for the number of people in custody (p &lt; 0.0001) and person-time in custody (p = 0.042), with decarceration disproportionately benefitting non-Indigenous white people. Compared with the period prior to April 2020, the relative rates of being in custody and of person-time in custody, respectively, were 0.70 (95% CI 0.68–0.73) and 0.73 (95% CI 0.70–0.76) for non-Indigenous white people, lower than those for Indigenous people: 0.76 (95% CI 0.72–0.81) and 0.82 (95% CI 0.76–0.88), non-Indigenous Black people: 0.76 (95% CI 0.74–0.78) and 0.79 (95% CI 0.76–0.81), and non-Indigenous non-Black racialized people: 0.76 (95% CI 0.73–0.79) and 0.79 (95% CI 0.76–0.83).</div></div><div><h3>Interpretation</h3><div>Decarceration in Ontario in 2020 was inequitable, exacerbating the disproportionate exposure of people who are Indigenous and Black to time in custody and to the adverse health impacts associated with incarceration during the COVID-19 pandemic. These findings emphasize the need for targeted strategies to foster equitable health and justice outcomes, including during public health emergencies.</div></div><div><h3>Funding</h3><div>Department of Family Medicine, <span>McMaster University</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101088"},"PeriodicalIF":7.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the introduction of a package of care involving early detection of opportunistic infections, a prospective multicenter cohort study of people living with HIV/AIDS in Brazil","authors":"Alessandro C. Pasqualotto ,&nbsp;Omar Sued ,&nbsp;Nicole Reis ,&nbsp;Larissa R. Silva ,&nbsp;Renata B.A. Soares ,&nbsp;Cassia S.M. Godoy ,&nbsp;Marineide G. Melo ,&nbsp;Nayla A. Hatem ,&nbsp;Bruna Regis Razzolini ,&nbsp;Andressa Noal ,&nbsp;Tarsila Vieceli ,&nbsp;Diego R. Falci ,&nbsp;Freddy Perez","doi":"10.1016/j.lana.2025.101085","DOIUrl":"10.1016/j.lana.2025.101085","url":null,"abstract":"<div><h3>Background</h3><div>Opportunistic infections (OIs) significantly contribute to morbidity and mortality in advanced HIV disease. This study evaluates the efficacy of point-of-care (POC) diagnostics for tuberculosis (TB), histoplasmosis, and cryptococcosis in routine HIV care in Brazil.</div></div><div><h3>Methods</h3><div>A prospective multicenter cohort study was conducted across five hospitals enrolling people living with HIV (PLHIV) with CD4+ T-cell count &lt;200 cells/mm³ or OI symptoms, regardless of CD4 count, HIV-naïve patients, those initiating treatment, and individuals with unsuppressed viral load lost to follow-up (&gt;3 months). POC tests included VISITECT CD4 Advanced Disease, TB LAM Ag (Abbott), GeneXpert MTB/RIF (Cepheid), Histoplasma antigen LFA (MiraVista), and CrAg LFA (IMMY). Patients were followed at 30 and 90 days. Retrospective data for six months pre-study was collected for comparison.</div></div><div><h3>Findings</h3><div>Among 419 PLHIV (55% cisgender men, 44% cisgender women, 1% transgender; mean age: 42 years, SD ± 11.1), 46% had confirmed OIs: TB (34%), cryptococcosis (12%), histoplasmosis (10%). Co-infections were frequent, with TB and histoplasmosis (44%). Cryptococcal meningitis and severe histoplasmosis were diagnosed in 5% and 6%, respectively. TB LAM was positive in 27% of tested patients, with 74% having disseminated TB. POC testing increased detection rates for TB, (1.8-fold) cryptococcosis (2.8-fold), and histoplasmosis (2.8-fold) compared to historical data. Survival rates were 87% at 30 days and 80% at 90 days, with cryptococcal antigenemia associated with higher mortality.</div></div><div><h3>Interpretation</h3><div>POC testing improved OI diagnosis, aligning with WHO guidelines. These findings highlight the importance of integrating rapid diagnostics into HIV programs and the need for further research on long-term outcomes.</div></div><div><h3>Funding</h3><div><span>Pan American Health Organization</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101085"},"PeriodicalIF":7.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving outcomes in MASLD: the role of H. pylori eradication and lifestyle interventions","authors":"Zhiyi Zhang","doi":"10.1016/j.lana.2025.101066","DOIUrl":"10.1016/j.lana.2025.101066","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101066"},"PeriodicalIF":7.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving outcomes in MASLD: the role of Helicobacter pylori eradication and lifestyle interventions–author's response to Zhang","authors":"Christian S. Alvarez ,&nbsp;M. Constanza Camargo ,&nbsp;M. Larissa Avilés-Santa ,&nbsp;Olga Garcia-Bedoya ,&nbsp;Maria S. Pattany ,&nbsp;Bharat Thyagarajan ,&nbsp;Barry I. Graubard ,&nbsp;Katherine A. McGlynn","doi":"10.1016/j.lana.2025.101080","DOIUrl":"10.1016/j.lana.2025.101080","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101080"},"PeriodicalIF":7.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing intersectional cancer disparities through education","authors":"Davidi Tawfiles ,&nbsp;Brent R. Weil ,&nbsp;Terry L. Buchmiller ,&nbsp;Isaac G. Alty ,&nbsp;Puneeth Iyengar ,&nbsp;Nancy Y. Lee ,&nbsp;Craig W. Lillehei ,&nbsp;Edward Christopher Dee","doi":"10.1016/j.lana.2025.101086","DOIUrl":"10.1016/j.lana.2025.101086","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101086"},"PeriodicalIF":7.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Call to build health equity","authors":"Rocío Sáenz ,&nbsp;Ximena Avellaneda ,&nbsp;Carlos F. Cáceres ,&nbsp;Arachu Castro ,&nbsp;Leonela Castro ,&nbsp;Luiz Augusto Galvão ,&nbsp;Ingrid Gómez ,&nbsp;Wendy López ,&nbsp;Pedro Mas ,&nbsp;Jossel Quesada ,&nbsp;Amy Ritterbusch ,&nbsp;Wilmer Sancho ,&nbsp;Luis Fernando Solís ,&nbsp;Manuel Urbina ,&nbsp;Board of Directors and Technical Secretariat of the Health Equity Network of the Americas (HENA)","doi":"10.1016/j.lana.2025.101071","DOIUrl":"10.1016/j.lana.2025.101071","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101071"},"PeriodicalIF":7.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequity of NIH cancer funding in the United States: an ecological study predicting funding based on disease burden from 2008 through 2023","authors":"Eli Berglas ,&nbsp;David Musheyev ,&nbsp;Aaron B. Lavi ,&nbsp;Rachel S. Berglas ,&nbsp;Rachel Berglas ,&nbsp;Abdo E. Kabarriti","doi":"10.1016/j.lana.2025.101081","DOIUrl":"10.1016/j.lana.2025.101081","url":null,"abstract":"<div><h3>Background</h3><div>Disease burden has been used to predict National Institutes of Health (NIH) funding but included diseases with little underlying relationship. Here we focus on cancers to create a more appropriate model to allow for more targeted scrutinization of funding allocation.</div></div><div><h3>Methods</h3><div>An ecological study using NIH funding data (2008–2023) was performed. Inclusion of cancers was based on their presence in the NIH Research Portfolio Online Reporting Tool and the 2021 Global Burden of Disease (GBD) study. Disability-adjusted life years (DALY) were collected and to evaluate the impact of public interest, Google Trends data was used. Multivariable linear regression determined appropriate funding based on disease burden and public interest. To quantify how each cancer’s funding differed from model predictions residual values were used to calculate the percent over/under funding.</div></div><div><h3>Findings</h3><div>Fifteen cancers met inclusion criteria. Neuroblastoma had the greatest ratio of funding to DALYs per 100,000 people (US$14,000,000) while lung cancer had the lowest (US$300,000). Stomach cancer was the most underfunded (197.9% [95% CI: 136.0%, 276.2%]) while brain cancer was the most overfunded (64.1% [95% CI: 53.8%, 72.1%]). Even at their lowest funding values in the study period brain, breast, and colorectal cancer all had greater than 40% overfunding. Contrarily, the lowest annual funding for leukemia, uterine, and stomach cancer received less than 150% of expected funding. Despite its overfunding brain cancer had an increase in DALYs in the study period.</div></div><div><h3>Interpretation</h3><div>Modeling by disease category demonstrated disparities in funding indicating the need for reevaluation for possible funding inequities. The year-by-year approach taken in this study will drive the ability for future research to better understand NIH funding decisions. Additionally, the role of public interest in research funding needs to be further evaluated to ensure that popularity does not override disease burden, in funding decisions.</div></div><div><h3>Funding</h3><div>No Funding.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"45 ","pages":"Article 101081"},"PeriodicalIF":7.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future health expenditures and its determinants in Latin America and the Caribbean: a multi-country projection study","authors":"Krishna D. Rao ,&nbsp;Timothy Roberton ,&nbsp;Andres I. Vecino_Ortiz ,&nbsp;Caitlin M. Noonan ,&nbsp;Angelica Lopez Hernandez ,&nbsp;Claudio A. Mora-Garcia ,&nbsp;Andrea M. Prado ,&nbsp;Carla Jorge Machado ,&nbsp;Angela Vega-Landaeta ,&nbsp;Natalia Palacio-Martínez ,&nbsp;Yvonne N. Flóres ,&nbsp;T. Alafia Samuels ,&nbsp;Charmaine Metivier ,&nbsp;Christine Laptiste ,&nbsp;Althea La Foucade ,&nbsp;Vyjanti Beharry ,&nbsp;Daniel Maceira","doi":"10.1016/j.lana.2024.100781","DOIUrl":"10.1016/j.lana.2024.100781","url":null,"abstract":"<div><h3>Background</h3><div>Countries in Latin America and the Caribbean (LAC) have experienced important demographic, epidemiological, economic, and policy developments that raise concerns about their ability to afford health expenditures in the future. This paper forecasts how current health expenditures (CHE) in LAC countries will change over the next 30 years and identifies key drivers of health expenditure growth.</div></div><div><h3>Methods</h3><div>A statistical model to forecast CHE based on changing disease burden, economic growth, technology, and demography was developed. CHE by age and disease group at baseline (2018/19) were estimated for countries in the LAC region based on seven index countries. Baseline expenditures were projected to 2050.</div></div><div><h3>Findings</h3><div>Per capita CHE will increase across the LAC region (median increase 2.75 times) between baseline and 2050. All Latin American countries are expected to double per capita CHE in this period. Expected increases in Caribbean countries are more variable. Large increases in CHE growth related to neoplasms, circulatory system and genitourinary conditions are observed. Growth in CHE will be highest in older age groups.</div></div><div><h3>Interpretation</h3><div>Increases in health expenditures will be driven largely by economic growth and technology, while demography and epidemiology had smaller effects. The control of health expenditures and more efficient use of health resources must become a priority for the LAC region.</div></div><div><h3>Funding</h3><div>This study was funded by the <span>Inter-American Development Bank</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"44 ","pages":"Article 100781"},"PeriodicalIF":7.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825515","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}