Lancet Regional Health-Americas最新文献

{"title":"Evaluating the impact of the Malakit intervention on malaria transmission in the Guiana Shield: a mathematical modelling study","authors":"Yann Lambert ,&nbsp;Raphaëlle Métras ,&nbsp;Alice Sanna ,&nbsp;Muriel Galindo ,&nbsp;Hélène Hiwat ,&nbsp;Paola Marchesini ,&nbsp;Yassamine Lazrek ,&nbsp;Lise Musset ,&nbsp;Stephen Vreden ,&nbsp;Martha Cecilia Suárez-Mutis ,&nbsp;Oscar Mesones Lapouble ,&nbsp;Antoine Adenis ,&nbsp;Mathieu Nacher ,&nbsp;Pierre-Yves Boëlle ,&nbsp;Chiara Poletto ,&nbsp;Maylis Douine","doi":"10.1016/j.lana.2025.101123","DOIUrl":"10.1016/j.lana.2025.101123","url":null,"abstract":"<div><h3>Background</h3><div>Malaria elimination in mobile and hard-to-reach populations calls for novel, tailored interventions. In French Guiana, the malaria burden is high among the population working in illegal gold mining. Between April 2018 and March 2020, we implemented <em>Malakit</em>, a new intervention targeting gold miners, and relying on the distribution of kits for the self-diagnosis and self-treatment of malaria. In this study, we evaluate the impact of Malakit on malaria transmission.</div></div><div><h3>Methods</h3><div>We fitted mathematical models of the transmission of <em>Plasmodium falciparum</em> (<em>Pf</em>) and <em>Plasmodium vivax</em> (<em>Pv</em>) to surveillance data from Brazil and Suriname and to prevalence data from cross-sectional surveys to estimate the change in treatment coverages and reproduction numbers between the pre-intervention (2014–2018) and intervention (2018–2020) periods. Using counterfactual scenario analysis, we estimated the impact of the intervention on malaria incidence.</div></div><div><h3>Findings</h3><div>Treatment coverage increased in the intervention compared to the pre-intervention period, the effect being stronger for <em>Pf</em> malaria (from 20.6% [95% CrI 17.0, 25.7] to 81.7% [95% CrI 67.9, 96.4]) than <em>Pv</em> malaria (from 22.3% [95% CrI 19.3, 25.7] to 47.3% [95% CrI 42.6, 52.3]). Concomitantly, the mean reproduction number decreased from 0.96 (95% CrI 0.93, 1.00) to 0.34 (95% CrI 0.22, 0.46), for <em>Pf</em>, and from 1.13 (95% CrI 1.10, 1.16) to 0.86 (95% CrI 0.82, 0.90) for <em>Pv</em>. We estimated that between 2018 and 2020 Malakit helped avert a total of 1231 (95% CrI 589, 1870) and 2406 (95% CrI 1191, 3621) symptomatic infections by <em>Pf</em> and <em>Pv</em>, respectively, corresponding to a 44.2% reduction of the overall malaria incidence (95% CrI −52.5, −34.5).</div></div><div><h3>Interpretation</h3><div>Malakit had a significant impact on malaria transmission by improving the access to treatment for the population working in illegal gold mining in French Guiana. Building on the regional efforts of the past fifteen years, Malakit contributed to another step towards malaria elimination in the Guiana Shield.</div></div><div><h3>Funding</h3><div><span>European Union</span>, <span>Global Fund</span>, <span>MoH of Brazil</span>, <span>Cayenne Hospital</span>, <span>Health Regional Agency of French Guiana</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101123"},"PeriodicalIF":7.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144069644","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":"Prevalence and severity of chronic kidney disease in a population with type 1 diabetes from a United States health system: a real-world cohort study","authors":"Katherine R. Tuttle ,&nbsp;Christina L. Reynolds ,&nbsp;Lindsey M. Kornowske ,&nbsp;Cami R. Jones ,&nbsp;Radica Z. Alicic ,&nbsp;Kenn B. Daratha ,&nbsp;Joshua J. Neumiller ,&nbsp;Carla Greenbaum ,&nbsp;Meda E. Pavkov ,&nbsp;Fang Xu ,&nbsp;O. Kenrik Duru ,&nbsp;Susanne B. Nicholas ,&nbsp;Keith C. Norris ,&nbsp;CURE-CKD Consortium","doi":"10.1016/j.lana.2025.101130","DOIUrl":"10.1016/j.lana.2025.101130","url":null,"abstract":"<div><h3>Background</h3><div>A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system.</div></div><div><h3>Methods</h3><div>Type 1 diabetes was identified through the Providence health system electronic health records during 2013–2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) &lt; 60 mL/min/1.73 m², urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR &lt; 45 mL/min/1.73 m², dialysis, or transplant).</div></div><div><h3>Findings</h3><div>The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26–1.47); age 60–79 years (reference 12–17 years; 2.22 [1.83–2.69]); Asian (reference White; 1.71 [1.20–2.44]), Black or African American (1.76 [1.45–2.14]), and Other race (1.33 [1.04–1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23–3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28–5.38]) populations.</div></div><div><h3>Interpretation</h3><div>CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes.</div></div><div><h3>Funding</h3><div>This work was supported in part by <span>CDC</span> project numbers <span><span>75D301-21-P-12254</span></span> and <span><span>75D301-23-C-18264</span></span>, and in part by <span>Brigham Research Institute</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101130"},"PeriodicalIF":7.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946874","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 “Identifying when racial and ethnic disparities arise along the continuum of transplant care: a national registry study”- The Lancet Regional Health—Americas October 2024; Volume 38: 100895; DOI: 10.1016/j.lana.2024.100895","authors":"Maya N. Clark-Cutaia ,&nbsp;Gayathri Menon ,&nbsp;Yiting Li ,&nbsp;Garyn T. Metoyer ,&nbsp;Mary Grace Bowring ,&nbsp;Byoungjun Kim ,&nbsp;Babak J. Orandi ,&nbsp;Stephen P. Wall ,&nbsp;Melissa D. Hladek ,&nbsp;Tanjala S. Purnell ,&nbsp;Dorry L. Segev ,&nbsp;Mara A. McAdams-DeMarco","doi":"10.1016/j.lana.2025.101132","DOIUrl":"10.1016/j.lana.2025.101132","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101132"},"PeriodicalIF":7.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946873","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":"Lack of treatment options for endemic helminth infections in Chile affects patient care and public health","authors":"Thomas Weitzel ,&nbsp;María Elvira Balcells ,&nbsp;Claudia P. Cortes ,&nbsp;Alberto Fica ,&nbsp;Renzo Tassara ,&nbsp;Jeannette Dabanch ,&nbsp;Marisa Torres ,&nbsp;Rafael Araos ,&nbsp;Katia Abarca ,&nbsp;Marcelo Wolff ,&nbsp;Pablo Vial","doi":"10.1016/j.lana.2025.101131","DOIUrl":"10.1016/j.lana.2025.101131","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101131"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934857","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":"Air pollution is a major risk factor for the development of Alzheimer's disease, cognition deficits, systemic and neural inflammation in urban children","authors":"Lilian Calderón-Garcidueñas","doi":"10.1016/j.lana.2025.101129","DOIUrl":"10.1016/j.lana.2025.101129","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101129"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934859","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":"Status of cardiovascular health in United States immigrants using the American Heart Association's Life's Essential 8 framework: a population-based study of prevalence estimates and determinants","authors":"Nour Makarem ,&nbsp;Rahul Hosalli ,&nbsp;Ariana Lopez ,&nbsp;Vanessa Dinh ,&nbsp;Billy A. Caceres ,&nbsp;Amanda C. McClain ,&nbsp;Pricila H. Mullachery ,&nbsp;Tala Al-Rousan ,&nbsp;Odayme Quesada","doi":"10.1016/j.lana.2025.101107","DOIUrl":"10.1016/j.lana.2025.101107","url":null,"abstract":"<div><h3>Background</h3><div>The United States (US) has the largest immigrant population globally. Immigrants endure social and structural factors that adversely influence cardiovascular health (CVH), a construct focused on health preservation, not merely the absence of disease, and defined by eight modifiable health factors and behaviors that support healthy longevity. We compared overall and individual CVH metrics between immigrants and non-immigrants and characterized CVH and its determinants among immigrant sub-populations.</div></div><div><h3>Methods</h3><div>The analytic sample included 13,471 adults (19% immigrants, i.e., foreign-born, 51% female), ages 20–79 y (mean ± SD for immigrants and non-immigrants: 44.8 ± 4.8 y and 45.7 ± 11.2 y, respectively) from the 2013 to 2018 National Health and Nutrition Examination Survey. CVH was characterized consistent with the American Heart Association's (AHA) Life's Essential 8 (LE8) guidelines (metrics: body mass index (BMI), blood glucose, blood lipids, blood pressure, nicotine use, sleep health, diet quality, and physical activity; score range: 0–100, low CVH: LE8 score &lt;50). CVH scores were compared among immigrants and non-immigrants and by sex, ethnicity, years in the US, and citizenship among immigrants. Survey-weighted regression models evaluated psychosocial and demographic factors in relation to CVH.</div></div><div><h3>Findings</h3><div>Immigrants had higher overall CVH scores (69.1 vs. 66.4) (p &lt; 0.0001) and significantly higher subscores for diet (52.5 vs. 38.8), nicotine exposure (80.3 vs. 68.0), BMI (61.6 vs. 57.1), and blood pressure (74.1 vs. 71.8), but lower physical activity (47.0 vs. 52.6), glucose (82.2 vs. 86.1), and cholesterol (63.0 vs. 68.5) scores compared to non-immigrants. Among immigrants, those who were male vs. female (67.5 vs. 70.7) (p = 0.003), Hispanic vs. non-Hispanic (66.6 vs. 71.5) (p &lt; 0.0001), and living in the US ≥15 y vs. &lt;15 y (67.7 vs. 71.8) (p &lt; 0.0001) had lower CVH. In regression models, being male, 45+ y, or Hispanic, having food insecurity, lower education and income, depression, no health insurance, and ≥15 y living in the US were associated with lower CVH.</div></div><div><h3>Interpretation</h3><div>While US immigrants have more favorable overall CVH compared to US-born persons, CVH status is complex and heterogenous across immigrant sub-populations. Glycemic control, physical inactivity, and blood lipids may be important targets for CVH promotion interventions in this population; Hispanic immigrants and those who lived in the US for ≥15 y may represent key subpopulations to engage in these efforts.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span> and <span>American Heart Association</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101107"},"PeriodicalIF":7.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942117","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 epidemiology of bacterial meningitis in the United States during 2008–2023: an analysis of active, laboratory, population-based, multistate surveillance data","authors":"Namrata Prasad ,&nbsp;Miwako Kobayashi ,&nbsp;Jennifer P. Collins ,&nbsp;Amy B. Rubis ,&nbsp;Gordana Derado ,&nbsp;Miranda J. Delahoy ,&nbsp;Daniel C. Payne ,&nbsp;Lesley McGee ,&nbsp;Sopio Chochua ,&nbsp;Henju Marjuki ,&nbsp;Lucy A. McNamara ,&nbsp;LeAnne M. Fox ,&nbsp;Arthur Reingold ,&nbsp;Megan Barnes ,&nbsp;Susan Petit ,&nbsp;Monica M. Farley ,&nbsp;Lee H. Harrison ,&nbsp;Ruth Lynfield ,&nbsp;Jessica Houston ,&nbsp;Bridget J. Anderson ,&nbsp;Melissa Arvay","doi":"10.1016/j.lana.2025.101120","DOIUrl":"10.1016/j.lana.2025.101120","url":null,"abstract":"<div><h3>Background</h3><div>Bacterial meningitis is a severe syndrome with dynamic epidemiology, but assessments of current trends are limited. We aimed to describe changing epidemiologic patterns among common bacterial causes of meningitis in the United States.</div></div><div><h3>Methods</h3><div>We analyzed data on bacterial meningitis cases caused by <em>Streptococcus pneumoniae</em>, group B <em>Streptococcus</em> (GBS), <em>Haemophilus influenzae, Neisseria meningitidis</em>, and <em>Listeria monocytogenes</em> in 10 U.S. surveillance sites. We compared incidence (cases per 100,000) across four epidemiologic periods: 2008–2009, 2010–2019, 2020–2021, and 2022–2023.</div></div><div><h3>Findings</h3><div>We identified 5,032 bacterial meningitis cases; among those with outcome data, 11% (573/5028) died. <em>S. pneumoniae</em> was the dominant pathogen (59% [2922/5032]) throughout. However, GBS predominated among infants aged 0–2 months (85% [660/775]), the age group with the highest incidence. Between 2008–2009 and 2010–2019, overall bacterial meningitis incidence declined from 1.3 to 1.1, driven by decreases in <em>S. pneumoniae</em> meningitis caused by serotypes contained in the 13-valent pneumococcal conjugate vaccine (PCV13) and <em>N. meningitidis</em> meningitis. Meningitis caused by non-b <em>H. influenzae</em> strains increased during this period. During 2020–2021, incidence declined to 0.7, driven by decreases in <em>S. pneumoniae, H. influenzae,</em> and <em>N. meningitidis</em> meningitis, regardless of organism subtype. During 2022–2023, incidence increased to 1.0, driven by increases in <em>S. pneumoniae</em> and <em>H. influenzae</em> meningitis. Case fatality ratios remained stable throughout.</div></div><div><h3>Interpretation</h3><div>Bacterial meningitis incidence rates have declined since 2008, with a notable low during 2020–2021, followed by a resurgence during 2022–2023. Case fatality remains high. Strategies that provide effective and broader pneumococcal and <em>H. influenzae</em> serotype protection and prevent infant GBS meningitis could reduce residual meningitis burden.</div></div><div><h3>Funding</h3><div><span>U.S. Centers for Disease Control and Prevention</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101120"},"PeriodicalIF":7.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936724","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":"Health impact of a hypothetical intervention on immune burden of cytomegalovirus (CMV) among older adults in the US: a prospective analysis of the Health and Retirement Study Cohort","authors":"Yuelin He ,&nbsp;Jessica Faul ,&nbsp;Kate Duchowny ,&nbsp;Chihua Li ,&nbsp;Rebecca Stebbins ,&nbsp;Grace A. Noppert","doi":"10.1016/j.lana.2025.101122","DOIUrl":"10.1016/j.lana.2025.101122","url":null,"abstract":"<div><h3>Background</h3><div>Cytomegalovirus (CMV) infection has been indicted in the etiology of multiple aging-related diseases. We aimed to quantify the proportion of diseases that could be prevented with a potential CMV treatment among US older individuals.</div></div><div><h3>Methods</h3><div>We analyzed disease prevalence among 8934 eligible individuals from the US Health and Retirement Study (HRS) in 2016–2020. In our hypothetical intervention, the treatment would improve immune control of CMV and shift the distribution of continuous CMV IgG antibody levels from the highest quartile to the lower 3 quartiles. We estimated top-quartile CMV level attributable fractions for 7 outcomes: heart diseases, stroke, high blood pressure, high cholesterol, cancers, diabetes, and difficulty with Activities of Daily Living using a novel logistic regression-based approach which allows for continuous covariate adjustment for counterfactual prevalence, stratified by gender and race/ethnicity.</div></div><div><h3>Findings</h3><div>In the study sample, a hypothetical intervention that decreased CMV IgG below the highest quartile level in 2016 would result in a 3·57 (95% Confidence Interval: 1·54, 5·60) percentage points reduction of diabetes cases and a 1·81 (95% CI: 0·75, 2·86) percentage points reduction of high blood pressure cases among Non-Hispanic White (NHW) women. Among NHW men, the same intervention would lead to a 2·43 (95% CI: 0·49, 4·37) percentage points reduction of diabetes, a 2·89 (95% CI: 0·93, 4·86) percentage points reduction of heart diseases and a 2·52 (95% CI: 1·39, 3·65) percentage points reduction of high blood pressure.</div></div><div><h3>Interpretation</h3><div>Our findings provide initial evidence for the potential population health impact of CMV intervention, specifically on high blood pressure, diabetes, and heart diseases.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span>, <span>National Institute on Aging</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"47 ","pages":"Article 101122"},"PeriodicalIF":7.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143935538","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":"Are diverse databases actually creating equity in genomics?","authors":"Chelsey R. Carter ,&nbsp;Brett Maricque","doi":"10.1016/j.lana.2025.101112","DOIUrl":"10.1016/j.lana.2025.101112","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101112"},"PeriodicalIF":7.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143934858","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":"Short- and long-term increased risk of all-cause mortality in a tuberculosis cohort attributed to SARS-CoV-2 infection: a time-dependent survival analysis in Chile","authors":"Vargas-García Salvador ,&nbsp;Eduardo A. Undurraga ,&nbsp;Nadia Escobar ,&nbsp;Christian García ,&nbsp;Natalia Vergara ,&nbsp;María Elvira Balcells","doi":"10.1016/j.lana.2025.101119","DOIUrl":"10.1016/j.lana.2025.101119","url":null,"abstract":"<div><h3>Background</h3><div>Concurrent tuberculosis (TB) and COVID-19 increases the risk of mortality; however, most studies have focused primarily on short-term outcomes. We assessed the short and long-term impact of TB and SARS-CoV-2 coinfection on all-cause mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective nationwide cohort study in Chile, including adults diagnosed with active TB from January 1st, 2020, to December 31st, 2021, with follow-up until November 30th, 2022. SARS-CoV-2 coinfection was defined as occurring from 30 days before to six months after TB diagnosis. Short-term mortality was defined as death within 90 days of TB or TB/SARS-CoV-2 diagnosis, and long-term mortality as death occurring after 90 days. We used a time-dependent Cox survival analysis, adjusting for sociodemographic factors, SARS-CoV-2 vaccination, and relevant comorbidities including HIV, diabetes and <em>Mycobacterium tuberculosis</em> drug-resistance status.</div></div><div><h3>Findings</h3><div>The cohort included 3721 adults (median age: 47 years, interquartile range [IQR]: 32–61); of whom 63·4% were male, and 79·4% had pulmonary TB. The median follow-up was 586 days (IQR: 401–820), with 680 deaths (18·3%) recorded. A SARS-CoV-2 coinfection was identified in 393 individuals (10·5%); the mortality in this group was higher in short-term (≤90 days: 14·5% vs. 11·4%) and long-term (&gt;90 days: 11·5% vs. 5·9%) compared to TB alone. Coinfection increased the risk of all-cause mortality during the entire follow-up (aHR [adjusted Hazard Ratio]: 2·8, 95% CI: 2·26–3·47), over three-fold in the short-term (aHR 3·4, 95% CI: 2·57–4·51) and nearly two-fold in the long-term (aHR: 1·72, 95% CI: 1·18–2·52). Excess mortality persisted beyond the first year (aHR: 2·04, 95% CI: 1·09–3·82). SARS-CoV-2 vaccination reduced mortality risk in the TB cohort by 35% (95% CI: 19–46%).</div></div><div><h3>Interpretation</h3><div>Tuberculosis and SARS-CoV-2 coinfection was associated with significantly increased all-cause mortality in both the short and long-term, with elevated risk persisting beyond TB treatment completion. These findings highlight the need for continued post-treatment follow-up and prioritization of SARS-CoV-2 vaccination among individuals with TB.</div></div><div><h3>Funding</h3><div><span>ANID-FONDECYT</span>, Chile, and <span>CONAHCYT</span>, Mexico.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"46 ","pages":"Article 101119"},"PeriodicalIF":7.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928472","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}