Lancet Regional Health-Americas最新文献

{"title":"Risk factors and survival impact of severe radiation-related late toxicities in head and neck cancer–a cohort study","authors":"John Mohan Mathew ,&nbsp;Jolie Ringash ,&nbsp;Jie Su ,&nbsp;Wilfred Levin ,&nbsp;Scott Bratman ,&nbsp;B.C. John Cho ,&nbsp;Ezra Hahn ,&nbsp;Ali Hosni Abdalaty ,&nbsp;Andrew Hope ,&nbsp;John Kim ,&nbsp;Andrew McPartlin ,&nbsp;Brian O'Sullivan ,&nbsp;C. Jillian Tsai ,&nbsp;John Waldron ,&nbsp;Anna Spreafico ,&nbsp;David Goldstein ,&nbsp;Melanie Woodside ,&nbsp;Dustin Jan Cruz ,&nbsp;Samantha Parmelee ,&nbsp;Jennifer Yin Yee Kwan ,&nbsp;Philip Wong","doi":"10.1016/j.lana.2025.101218","DOIUrl":"10.1016/j.lana.2025.101218","url":null,"abstract":"<div><h3>Background</h3><div>Radiation late toxicities (RLTs) are complications of curative-intent radiotherapy (RT) for head and neck cancer (HNC) and are increasingly relevant due to younger age at diagnosis and improved survival outcomes.</div></div><div><h3>Methods</h3><div>We conducted a cohort study of HNC patients who received ≥50 Gy as part of curative treatment between January 2003 and December 2020 at a Canadian quaternary cancer center. Risk factors for severe RLTs (≥RTOG Grade 3) were evaluated using time-to-event analyses. Actuarial rates of RLT and overall survival (OS) were estimated using competing risk and Kaplan–Meier methods, respectively. Cox proportional hazard models identified factors associated with RLT and OS.</div></div><div><h3>Findings</h3><div>Among 7622 patients, 12.6% (n = 958) developed RLTs without disease progression, with a 5-year actuarial incidence of 16% (95% CI: 15–16). A <em>survivors</em> subgroup (n = 4650) with ≥2 years of follow-up and no recurrence was also identified. Modifiable risk factors for RLTs included RT technique, dose, neck irradiation, neck dissection, smoking status, and chemotherapy (p ≤ 0.012). Non-modifiable factors included younger age, female sex, and oral cavity primaries (p ≤ 0.012). In multivariable analysis, RLTs were associated with increased mortality (HR = 2.1, 95% CI: 1.8–2.5, p &lt; 0.001), but RLT's impact on OS was lessened among patients referred to the Adult Radiation Late Effects Clinic (ARLEC) (HR = 1.7, 95% CI: 1.3–2.4).</div></div><div><h3>Interpretation</h3><div>RLTs are common and associated with worse survival among HNC survivors. Identification of modifiable risk factors provides opportunities for prevention. Multidisciplinary management of RLTs in specialized clinics may help improve the outcomes in this growing survivorship population.</div></div><div><h3>Funding</h3><div>No external funding was utilized for this study.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101218"},"PeriodicalIF":7.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932938","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 cost-effectiveness of tafenoquine following screening with STANDARD™ G6PD screening for the treatment of vivax malaria in the Brazilian Public Health System","authors":"Henry Maia Peixoto ,&nbsp;Luiza Lena Bastos Gottin ,&nbsp;Jose Diego de Brito-Sousa ,&nbsp;Vanderson Sampaio ,&nbsp;Penny Grewal Daumerie ,&nbsp;Elodie Jambert ,&nbsp;Wuelton Monteiro ,&nbsp;Marcus V.G. Lacerda ,&nbsp;Angela Devine","doi":"10.1016/j.lana.2025.101216","DOIUrl":"10.1016/j.lana.2025.101216","url":null,"abstract":"<div><h3>Background</h3><div>Vivax malaria requires radical cure to clear both the blood-stage and liver-stage parasites. Brazil, like most endemic countries, has been prescribing a 7-day primaquine regimen for radical cure without testing for glucose-6-phosphate-dehydrogenase (G6PD) deficiency to exclude those at risk of primaquine-induced haemolysis. Tafenoquine, a new single-dose drug for radical cure requires G6PD screening before prescription to ensure safety. This study aims to assess the cost-effectiveness of prescribing tafenoquine after semi-quantitative G6PD screening from the Brazilian Public Health System perspective.</div></div><div><h3>Methods</h3><div>A decision tree model was developed for adults presenting with vivax malaria over 12-months. The <em>tafenoquine strategy</em> of semi-quantitative G6PD testing before prescription of single-dose tafenoquine to those with ≥70% G6PD activity was compared with: (1) <em>current practice</em>: 7-day low-dose primaquine (0.5 mg/kg/day) without G6PD screening and (2) <em>primaquine screening strategy:</em> 7-day low-dose primaquine (0.5 mg/kg/day) for patients with ≥30% G6PD activity determined by semi-quantitative G6PD screening. The primary outcome was the cost per disability-adjusted life-year (DALY) averted, compared with the Brazilian willingness-to-pay threshold of US$7752 (R$40,000).</div></div><div><h3>Findings</h3><div>The <em>tafenoquine strategy</em> was US$2894 (R$14,934) per DALY averted compared to <em>current practice</em>, well below the willingness-to-pay threshold. The <em>tafenoquine strategy</em> dominated the <em>primaquine screening strategy</em>, averting 0.14 DALYs with cost savings of US$13 (R$66). In both comparisons, the <em>tafenoquine strategy</em> had a &gt;98% likelihood of being cost-effective.</div></div><div><h3>Interpretation</h3><div>The prescription of tafenoquine to those who test G6PD normal with a semi-quantitative test is a cost-effective strategy for the radical cure of vivax malaria in Brazil. While the cost-effectiveness in other settings may vary due to differences in costs and the epidemiology of vivax malaria and G6PD deficiency, the robustness of these findings should be reassuring, particularly where healthcare facilities expect to see a large number of patients annually.</div></div><div><h3>Funding</h3><div><span>Medicines for Malaria Ventures</span>.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"51 ","pages":"Article 101216"},"PeriodicalIF":7.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933714","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":"Beyond health: positioning mental health on the political agenda of the Americas at the 55th General Assembly of the Organization of American States","authors":"Amy Tausch,&nbsp;Renato Oliveira e Souza","doi":"10.1016/j.lana.2025.101215","DOIUrl":"10.1016/j.lana.2025.101215","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101215"},"PeriodicalIF":7.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044091","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":"Complementary approaches to improve cognitive health through prevention in Brazil","authors":"Claudia K. Suemoto ,&nbsp;Cleusa P. Ferri ,&nbsp;Wyllians V. Borelli ,&nbsp;Raphael M. Castilhos","doi":"10.1016/j.lana.2025.101227","DOIUrl":"10.1016/j.lana.2025.101227","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101227"},"PeriodicalIF":7.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932149","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":"Placental abruption and kidney disease: evidence for enhanced postpartum surveillance","authors":"The Lancet Regional Health – Americas","doi":"10.1016/j.lana.2025.101247","DOIUrl":"10.1016/j.lana.2025.101247","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101247"},"PeriodicalIF":7.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044090","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":"Is it time for Canada to revisit its approach to prostate cancer screening?","authors":"David-Dan Nguyen ,&nbsp;Aisha Lofters ,&nbsp;Christopher J.D. Wallis ,&nbsp;Alexandre R. Zlotta ,&nbsp;Neil E. Fleshner ,&nbsp;Quoc-Dien Trinh ,&nbsp;Antonio Finelli ,&nbsp;Laura C. Rosella ,&nbsp;Allan S. Detsky ,&nbsp;Monique J. Roobol ,&nbsp;Girish S. Kulkarni","doi":"10.1016/j.lana.2025.101180","DOIUrl":"10.1016/j.lana.2025.101180","url":null,"abstract":"<div><div>Prostate cancer is the third leading cause of cancer death among Canadian men. Despite advances in the last decade mitigating overdiagnosis and overtreatment, Canadian guidelines have recommended against routine prostate-specific antigen (PSA) screening since 2014. This has resulted in opportunistic screening, marked by inequitable access, low-value testing, and missed opportunities for early detection. We review global policy developments, emerging trial data, and implementation strategies, which suggest that organised, risk-stratified screening may improve outcomes and equity. However, overdiagnosis and associated harms remain a concern within organised programs. To address this uncertainty and generate timely, policy-relevant evidence, we propose implementing population-wide, adaptive platform trials embedded in the healthcare system. This design would enable real-time integration of new technologies, standardised protocols, and equitable access—hallmarks of a learning healthcare system. Such a model could help Canada modernise prostate cancer screening while carefully weighing benefits, harms, and equity in a rapidly evolving landscape.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101180"},"PeriodicalIF":7.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044602","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 new definition of obesity: an analysis of a population-based survey in an Andean country","authors":"Jamee Guerra Valencia ,&nbsp;Akram Hernández-Vásquez ,&nbsp;Percy Mayta-Tristán ,&nbsp;Lorena Saavedra-Garcia ,&nbsp;Rodrigo Vargas-Fernández","doi":"10.1016/j.lana.2025.101217","DOIUrl":"10.1016/j.lana.2025.101217","url":null,"abstract":"<div><h3>Background</h3><div>Traditional obesity classification based on body mass index (BMI) fails to capture body fat distribution or clinical dysfunction, and may therefore fail to identify people at highest cardiometabolic risk. The Lancet Diabetes &amp; Endocrinology Commission recently proposed a new framework distinguishing preclinical from clinical obesity based on excessive adiposity and clinical dysfunction. We aimed to estimate the prevalence of clinical and preclinical obesity in Peruvian adults using the Commission’s criteria and adapted regional cutoffs, and to generate ethnicity-specific reference curves for waist circumference (WC) and waist-to-height ratio (WHtR).</div></div><div><h3>Methods</h3><div>This cross-sectional analysis used nationally representative data from 2021 to 2023 Peruvian Demographic and Health Surveys (ENDES), including 84,622 adults aged ≥20 years. Clinical obesity was defined as excess body fat (BMI, WC, or WHtR) plus diabetes or hypertension diagnosis. Preclinical obesity was defined as excess body fat without clinical dysfunction. Age-adjusted prevalence estimates were calculated using four anthropometric criteria and stratified by sex. Ethnicity-specific WC and WHtR reference curves were generated using GAMLSS models, stratified by age and sex.</div></div><div><h3>Findings</h3><div>A total of 84,622 participants were included in the study. Among these participants, mean age was 44.1 (range: 20–97) years, and 48,300 participants (51.7%) were female. Clinical obesity age-adjusted prevalence ranged from 15.7% to 22.1%, and preclinical obesity from 28.7% to 53.8%, depending on cutoffs used. Up to 13.5% of individuals with normal BMI and 21% of those overweight met criteria for clinical obesity. Women showed the highest prevalence estimates of preclinical obesity, ranging from 33.4% to 65.8%, whereas men reached their highest prevalence (41.3%) when the International Diabetes Federation (IDF) cutoffs were applied. In the case of clinical obesity, women had higher prevalence estimates of clinical obesity when applying the Lancet Commission approach (18.7%) and the Peruvian national guidelines (21.4%). Men showed higher prevalence estimates when using the cutoffs proposed by the Latin American Consortium of Studies in Obesity (LASO) (16.8%) and the IDF (22.8%). Reference curves showed that Quechua-Aymara individuals had lower WC and WHtR values compared to Afro-Peruvian and other groups at the 97th percentile, in both men and women.</div></div><div><h3>Interpretation</h3><div>Reliance on BMI alone underestimates a large proportion of clinically relevant cases. Incorporating WC-measurements and clinical dysfunction into diagnostic frameworks could improve identification, prevention, and policy responses to obesity in Peru and similar settings.</div></div><div><h3>Funding</h3><div>The authors received no financial support.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101217"},"PeriodicalIF":7.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917904","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 nomogram to predict development of brain metastasis in non-small cell lung cancer patients: a retrospective analysis using routinely available medical records","authors":"Hannah Wilding ,&nbsp;Nicholas Mikolajewicz ,&nbsp;Debarati Bhanja ,&nbsp;Camille Moeckel ,&nbsp;Ahmad Ozair ,&nbsp;Leonardo de Macedo Filho ,&nbsp;Kyle Tuohy ,&nbsp;Nima Hamidi ,&nbsp;Mara Trifoi ,&nbsp;Brianna Snyder ,&nbsp;Bailey Kuechenmeister ,&nbsp;Schahin Salmanian ,&nbsp;Manmeet Ahluwalia ,&nbsp;Alireza Mansouri","doi":"10.1016/j.lana.2025.101213","DOIUrl":"10.1016/j.lana.2025.101213","url":null,"abstract":"<div><h3>Background</h3><div>Brain metastases (BrM) are a frequent complication among patients with non-small cell lung cancer (NSCLC). While guidelines exist for baseline CNS screening in advanced NSCLC, surveillance strategies for early-stage disease remain limited. This study aimed to develop a time-dependent BrM risk prediction nomogram using readily available clinical information.</div></div><div><h3>Methods</h3><div>We analyzed a retrospective cohort of NSCLC patients at Penn State Health. Our objectives were to (1) systematically evaluate the performance of existing BrM risk prediction algorithms and (2) construct novel nomograms for BrM risk prediction in NSCLC. Using Cox-proportional hazard models with L1-regularization, we predicted BrM risk at 6-month, 1-year, and 2-year follow-up intervals.</div></div><div><h3>Findings</h3><div>The patient cohort included 1904 patients (median age 68 years, range 38–94 years, BrM incidence 22.8%). The cohort included 1059 males (55.6%) and 845 females (44.4%). Of the cohort, 92.8% of patients identified as White (n = 1766), 1.0% as Asian (n = 19), 4.0% as Black (n = 77), and 2.2% as another race (n = 42). The Zhang 2021 model demonstrated the highest performance in predicting BrM incidence in our cohort, achieving an AUROC of 0.91 (95% CI: 0.87, 0.95). Two novel models were developed: a baseline model incorporating clinical and imaging data at diagnosis (cTNM stage, age at diagnosis), and an extended model including additional clinical and treatment data (number of extracranial metastatic sites, prior radiotherapy, chemotherapy, surgery, and histology) (<span><span>https://nmikolajewicz.shinyapps.io/nomogram_wilding2024/</span><svg><path></path></svg></span>). While both models showed similar short-term performance, the extended model demonstrated superior predictive capacity (AUROC 0.91 at 3-years) for longer-term outcomes. Our nomograms rely exclusively on clinical features routinely documented in patient records, thereby requiring no additional investigations.</div></div><div><h3>Interpretation</h3><div>These clinically accessible nomograms for BrM prediction will facilitate prognostic modeling, risk stratification, refinement of CNS screening guidelines, and patient counseling.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101213"},"PeriodicalIF":7.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912765","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 “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.”–The Lancet Regional Health—Americas 2025; Volume 46:101119; DOI: 10.1016/j.lana.2025.101119","authors":"Salvador Vargas-García ,&nbsp;Eduardo A. Undurraga ,&nbsp;Nadia Escobar ,&nbsp;Christian García ,&nbsp;Natalia Vergara ,&nbsp;María Elvira Balcells","doi":"10.1016/j.lana.2025.101219","DOIUrl":"10.1016/j.lana.2025.101219","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101219"},"PeriodicalIF":7.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904100","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":"Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)","authors":"Kevin Y. Xu ,&nbsp;Terri V. Newman ,&nbsp;Lakeya S. McGill ,&nbsp;Enrico M. Novelli ,&nbsp;Cheryl A. Hillery ,&nbsp;Joanna L. Buss ,&nbsp;Lisa Gong ,&nbsp;Ruizhi Huang ,&nbsp;Fanghong Dong ,&nbsp;Dustin Stwalley ,&nbsp;Joanne Salas ,&nbsp;Shiyuan A. Liu ,&nbsp;Jeffrey F. Scherrer ,&nbsp;Tashalee R. Brown ,&nbsp;Tae Woo Park ,&nbsp;Marc R. LaRochelle ,&nbsp;Richard A. Grucza ,&nbsp;Charles R. Jonassaint","doi":"10.1016/j.lana.2025.101214","DOIUrl":"10.1016/j.lana.2025.101214","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured individuals with SCD over a 10-year time period in the United States (US).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective cohort study of US administrative claims (2011–2022), analyzing 45,726 commercial and Medicaid beneficiaries with SCD. Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group (1–12, 13–17, 18–27, 28–45, 46–64 years). Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Among 45,726 individuals with SCD (mean age [SD] = 25.1 [16.2]; 39.7% female; 52.9% Medicaid, 47.1% commercial insurance), Medicaid beneficiaries had higher rates than commercial beneficiaries for monthly opioid prescribing (18.3 vs 14.0 per 100) and VOC encounters (16.6 vs 8.2 per 100). Monthly opioid prescribing per 100 people increased with age: 1–12 y = 5.1; 13–17 y = 11.3; 18–27 y = 22.5; 28–45 y = 24.6; 46–64 y = 20.6 per 100. Both Medicaid and commercial beneficiaries experienced declining opioid prescribing beginning in 2011 (commercial monthly percentage change [MPC] = −0.3% [95% CI: −0.3%, −0.2%]; Medicaid MPC = −0.5% [−0.6%, 0.5%]). Down-trending opioid prescribing was not consistently accompanied by up-trending VOCs until the COVID-19 pandemic's onset. Particularly among children and adolescents, VOC-related encounters increased significantly after 2020 across both commercial (MPC = 1.8% [1.5%, 2.2%]) and Medicaid (MPC = 0.6% [0.1%, 1.6%]) beneficiaries.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Opioid prescribing and VOC admissions vary by insurance and age. Opioid prescribing declined from 2011 but was not consistently accompanied by increased VOCs until after COVID-19.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Analyses of Merative MarketScan Commercial and Multi-State Medicaid Database were funded by grants &lt;span&gt;NIH&lt;/span&gt; K12 DA041449 (PI: KYX; data analysts: JLB, DS). Effort for some personnel was supported by P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX), the &lt;span&gt;American Psychiatric Association (APA)&lt;/span&gt; Psychiatric Research Fellowship (with funding by &lt;span&gt;NIDA&lt;/span&gt; and the &lt;span&gt;APA&lt;/span&gt;, KYX), &lt;span&gt;NIH&lt;/span&gt; K12NS130673 (LSM), &lt;span&gt;NIH&lt;/span&gt; L60HL170453 (LSM), and the &lt;span&gt;St. Louis University Research Institute&lt;","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101214"},"PeriodicalIF":7.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880080","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}