Lancet Regional Health-Americas最新文献

{"title":"Multilevel and multidimensional features of socioeconomic status and cognitive function in older adulthood: a cross-sectional analysis of the IGNITE study","authors":"Jermon A. Drake , Lu Wan , Chaeryon Kang , Peter J. Gianaros , Patricio Solis-Urra , Haiqing Huang , Rebecca Reed , Charles H. Hillman , Eric D. Vidoni , Jeffrey M. Burns , Arthur F. Kramer , Edward McAuley , George Grove , Kirk I. Erickson , Lauren E. Oberlin","doi":"10.1016/j.lana.2025.101206","DOIUrl":"10.1016/j.lana.2025.101206","url":null,"abstract":"<div><h3>Background</h3><div>Lower socioeconomic status (SES) is associated with increased risk of cognitive decline and dementia, yet reliance on singular indicators of SES limits understanding of these relationships. We examined multiple SES characteristics at the individual and area-levels simultaneously in association with diverse cognitive processes in a large, community-dwelling older adult sample.</div></div><div><h3>Methods</h3><div>Data collected at three United States sites (Boston, Pittsburgh, Kansas City) included a comprehensive cognitive assessment comprising measures of episodic memory, executive function, processing speed, working memory, and visuospatial abilities. Multiple SES measures were obtained including area-level (Area Deprivation Index), subjective, and objective SES. We generated a novel objective SES latent factor from measures of income, savings, debt-adjusted savings, and financial stability using full information maximum likelihood to address missing data, and examined cross–sectional associations of SES indicators with each cognitive domain as outcome variables in multivariable regression models.</div></div><div><h3>Findings</h3><div>This study included 648 cognitively unimpaired older adults (69.88 (3.75) years; 71% female). Individual-level objective SES (processing speed, <em>β</em> [95% confidence interval (CI)] = 0.225 [0.152–0.299]; executive function, 0.210 [0.137–0.283]; episodic memory, 0.113 [0.040–0.186]; working memory, 0.200 [0.129–0.271]; visuospatial processing, 0.165 [0.093–0.238]) and subjective SES (processing speed, <em>β</em> [95% CI] = 0.148 [0.077–0.219]; executive function, 0.138 [0.067–0.208]; episodic memory, 0.020 [−0.051 to 0.091]; working memory, 0.128 [0.059–0.197]; visuospatial processing, 0.094 [0.023–0.164]) outperformed area-level SES in detecting cognitive deficits, and demonstrated widespread associations with poorer performance across cognitive domains. On average, individuals categorized into the lowest objective SES quartile performed between 0.22 and 0.58 standard deviations lower than those in the highest quartile across domains (processing speed, pairwise adjusted mean difference [95% CI] = 0.580 [0.304–0.856]; executive function, 0.556 [0.282–0.829]; episodic memory, 0.223 [−0.054 to 0.499]; working memory, 0.516 [0.248–0.784]; visuospatial processing, 0.434 [0.161–0.706]). A novel objective SES composite showed robust associations with cognition above and beyond traditional SES measures. All findings are subject to missing at random assumptions.</div></div><div><h3>Interpretation</h3><div>Standard measures of objective SES may underestimate the broad cognitive burden of socioeconomic inequity. Integrating multiple financial indicators into future studies may improve estimation of the public health impact of socioeconomic conditions in older adulthood.</div></div><div><h3>Funding</h3><div><span>National Institutes of Health</span> (<span><span>R01AG053952</span></span>).</d","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101206"},"PeriodicalIF":7.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861042","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 “Effects of missed anti-tuberculosis therapy doses on treatment outcome: a multi-center cohort study”–The Lancet Regional Health—Americas 2025; Volume 48; 101162; August 2025","authors":"Isabella B.B. Ferreira , Rodrigo C. Menezes , Mariana Araújo-Pereira , Valeria C. Rolla , Afrânio L. Kritski , Marcelo Cordeiro-Santos , Timothy R. Sterling , Cody Staats , Gustavo Amorim , Anete Trajman , Bruno B. Andrade , RePORT-Brazil Consortium","doi":"10.1016/j.lana.2025.101212","DOIUrl":"10.1016/j.lana.2025.101212","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101212"},"PeriodicalIF":7.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852726","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":"Modifiable factors associated with cognitive health trajectories among Indigenous, Hispanic, Black, and White older adults: an exploratory longitudinal panel analysis of the health and retirement study with a focus on Indigenous peoples","authors":"Cliff Whetung ,&nbsp;Ernest Gonzales","doi":"10.1016/j.lana.2025.101207","DOIUrl":"10.1016/j.lana.2025.101207","url":null,"abstract":"<div><h3>Background</h3><div>Despite elevated dementia risk, cognitive health among Indigenous older adults remains understudied. This study explored how modifiable factors were associated with cognitive health among Indigenous, Black, Hispanic, and White older adults.</div></div><div><h3>Methods</h3><div>Using longitudinal panel data from the Health and Retirement Study (2006–2020, N = 27,327), we estimated mixed effect growth curve models to examine associations between modifiable factors and total cognitive function.</div></div><div><h3>Findings</h3><div>This diverse sample of Indigenous (1.65%), Black (11.43%), Hispanic (9.85%), and White (77.07%) older adults had a mean age of 61 (SD = 9.66) and was 52% female. Despite being younger on average (M = 59), 3% of Indigenous respondents reported memory-related diagnoses three times the overall sample rate. Linear mixed-effect growth curve analysis revealed that Indigenous and Black older adults had similar cognitive trajectories. A college education was a protective factor for initial cognitive function (<em>b</em>₀ = 3.09, 95% CI: 2.91, 3.27) and over time (<em>b</em> = 0.24, 95% CI: 0.15, 0.33) across ethnicity. Formal (<em>b</em> = 0.21, 95% CI: 0.15, 0.27) and informal (<em>b</em> = 0.26, 95% CI: 0.20, 0.32) volunteering were associated with slower rates of cognitive decline relative to non-volunteers, though these effects may partly reflect socioeconomic status. Among Indigenous older adults, higher education, volunteering, and fewer depressive symptoms were linked to better cognitive outcomes.</div></div><div><h3>Interpretation</h3><div>Despite high levels of resource deprivation, Indigenous older adults demonstrate resilience that supports cognitive health. Expanding access to education and volunteering in later life through targeted social policy may enhance cognitive outcomes in Indigenous communities for generations.</div></div><div><h3>Funding</h3><div>This research was supported by the <span>National Institute on Aging</span> (R36AG078781).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101207"},"PeriodicalIF":7.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826549","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":"Assessing the impact of a single qualitative fecal immunochemical test on colonoscopy prioritization and mortality in risk-stratified patients with suspected colorectal cancer: a retrospective cohort study","authors":"Felipe F. Quezada-Diaz ,&nbsp;Johanna Acevedo ,&nbsp;Maite González ,&nbsp;Andrea Tello ,&nbsp;Richard Castillo ,&nbsp;Carlos Morales ,&nbsp;Erik Manríquez ,&nbsp;Valentina Duran ,&nbsp;Felipe Mena ,&nbsp;Catherine Le-Bert ,&nbsp;Manuel Cabreras ,&nbsp;Ángelo Fulle ,&nbsp;Gonzalo Carvajal ,&nbsp;Pamela Briones ,&nbsp;Bruno Nervi ,&nbsp;Rodrigo Kusanovich","doi":"10.1016/j.lana.2025.101201","DOIUrl":"10.1016/j.lana.2025.101201","url":null,"abstract":"<div><h3>Background</h3><div>Performing fecal immunochemical tests in symptomatic individuals at low-or moderate risk for suspected colorectal cancer could help prioritize candidates for colonoscopies. The objective of this study was to assess the diagnostic accuracy of the fecal immunochemical test (FIT) in symptomatic individuals at low-or moderate risk of colorectal cancer and explore association with survival.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study between December 2016 and July 2024 from a single-center, public hospital in Chile. Adults (≥18 years-old) individuals were included, those with symptoms suggestive of colorectal cancer and set for evaluation via colonoscopy. Symptomatic individuals with suspected colorectal cancer were stratified as high risk or low/moderate risk by a trained nurse according to 2015 NICE guidelines. Subsequently, high risk patients were directly referred for colonoscopies, while low/moderate risk patients underwent a single qualitative FIT and prioritized to colonoscopy based on results. Main outcomes were FIT diagnostic accuracy for colorectal cancer, overall mortality, and colorectal cancer-specific mortality.</div></div><div><h3>Findings</h3><div>A total of 394 out of 1304 participants (30%) were classified as high risk. The remaining 910 (70%) were categorized as low/moderate risk and were referred for FIT. From these, 808 (89%) individuals were tested and had results for FIT. Regarding the diagnostic accuracy of the FIT, sensitivity was 96% and specificity reached 66.8%, with a negative value of 99.8%. Low/moderate risk positive FIT (FIT+) and high-risk participants had higher mortality rates vs. low/moderate risk negative FIT (FIT−) individuals. Time-to-event analysis confirmed a lower cumulative mortality in low/moderate risk FIT− patients. A multivariable Cox regression model showed a consistently lower risk of death in this group, while a non-significant trend towards increased mortality was observed in low/moderate risk FIT+ individuals after 30 months.</div></div><div><h3>Interpretation</h3><div>In symptomatic individuals at low or moderate risk, a single qualitative FIT was associated with high sensitivity and moderate specificity for colorectal cancer detection. FIT may help prioritize colonoscopy in low-resource settings, but further prospective validation is warranted.</div></div><div><h3>Funding</h3><div>This research was partially funded by <span>ANID</span> <span>FONDAP</span> <span><span>152220002</span></span> (CECAN).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"50 ","pages":"Article 101201"},"PeriodicalIF":7.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826548","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":"Sports gambling in the Americas: the rise of invisible risks.","authors":"The Lancet Regional Health-Americas","doi":"10.1016/j.lana.2025.101211","DOIUrl":"10.1016/j.lana.2025.101211","url":null,"abstract":"","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"101211"},"PeriodicalIF":7.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971959","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":"The potential for dementia prevention in Brazil: a population attributable fraction calculation for 14 modifiable risk factors.","authors":"Claudia K Suemoto, Wyllians V Borelli, Ismael L Calandri, Laiss Bertola, Raphael M Castilhos, Paulo Caramelli, Ricardo Nitrini, Sonia M D Brucki, Jerson Laks, Naaheed Mukadam, Gill Livingston, Cleusa P Ferri","doi":"10.1016/j.lana.2025.101209","DOIUrl":"10.1016/j.lana.2025.101209","url":null,"abstract":"<p><strong>Background: </strong>The Lancet Commission on dementia prevention, intervention, and care 2024 updated the list of modifiable risk factors to include 14 factors. The potential for dementia prevention seems to be greater in low- and middle-income countries (LMIC) due to the higher prevalence of these factors. This study aims to provide the first LMIC figure for the potential for dementia prevention in Brazil attributed to 14 modifiable risk factors.</p><p><strong>Methods: </strong>Data was retrieved from 9949 participants aged 50 years or older from the nationally representative second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted between 2019 and 2021. The prevalence of modifiable risk factors was estimated, and principal component analysis was used to account for factor communalities. Overall and individual population attributable fractions (PAF) were calculated using relative risks from the 2024 Lancet Commission report. Stratified analyses by sex, race, and Brazilian macro regions were performed to assess disparities in dementia risk.</p><p><strong>Findings: </strong>The overall PAF for the 14 modifiable risk factors was 59.5% (95% CI = 58.5-60.5). The three risk factors with the highest PAFs were less education (9.5%, 95% CI = 8.9-10.1), untreated visual loss (9.2%, 95% CI = 8.6-9.8), and midlife depression (6.3%, 95% CI = 5.8-6.8). The overall PAF was similar across race and region but was higher among women (61.1%, 95% CI = 59.9-62.4) compared to men (58.2%, 95% CI = 56.7-59.8).</p><p><strong>Interpretation: </strong>Almost 60% of dementia cases in Brazil could potentially be prevented by addressing 14 modifiable risk factors. Public health strategies could further reduce the dementia burden in Brazil.</p><p><strong>Funding: </strong>CKS, PC, and CPF received productivity fellowships from the National Council for Scientific and Technological Development (CNPq). ELSI-Brazil was supported by the Brazilian Ministry of Health: DECIT/SCTIE (Grants: 404965/2012-1 and TED 28/2017); COPID/DECIV/SAPS (Grants: 20836, 22566, 23700, 25560, 25552, and 27510).</p>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"101209"},"PeriodicalIF":7.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875560","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":"Effectiveness of nirsevimab among infants in their first RSV season in the United States, October 2023–March 2024: a test-negative design analysis","authors":"Amanda B. Payne ,&nbsp;Steph Battan-Wraith ,&nbsp;Elizabeth A.K. Rowley ,&nbsp;Melissa S. Stockwell ,&nbsp;Sara Y. Tartof ,&nbsp;Kristin Dascomb ,&nbsp;Stephanie A. Irving ,&nbsp;Brian Dixon ,&nbsp;Sarah W. Ball ,&nbsp;Mark W. Tenforde ,&nbsp;Gabriela Vazquez-Benitez ,&nbsp;Ashley B. Stephens ,&nbsp;Jungmi Han ,&nbsp;Karthik Natarajan ,&nbsp;S. Bianca Salas ,&nbsp;Cassandra Bezi ,&nbsp;Lina S. Sy ,&nbsp;Bruno Lewin ,&nbsp;Tamara Sheffield ,&nbsp;Julie Arndorfer ,&nbsp;Ruth Link-Gelles","doi":"10.1016/j.lana.2025.101196","DOIUrl":"10.1016/j.lana.2025.101196","url":null,"abstract":"<div><h3>Background</h3><div>In August 2023, the Centers for Disease Control and Prevention recommended nirsevimab, a long-acting monoclonal antibody, for all U.S. infants aged &lt;8 months entering or born during their first respiratory syncytial virus (RSV) season. Our aim was to estimate nirsevimab effectiveness against RSV-associated emergency department (ED) encounters and hospitalisation among U.S. infants during the 2023–2024 RSV season.</div></div><div><h3>Methods</h3><div>We conducted a test-negative analysis using electronic health record (EHR) data from 6 healthcare systems, including ED encounters and hospitalizations with a diagnosis of RSV-like illness (RLI) during October 8, 2023–March 31, 2024, among infants aged &lt;8 months as of October 1, 2023, or born during the study period. Nirsevimab effectiveness was estimated by comparing children who received nirsevimab with those who did not among RSV-positive and RSV-negative encounters, adjusting for age, race and ethnicity, sex, calendar day, and geographic region and excluding infants whose mother received RSV vaccination during pregnancy.</div></div><div><h3>Findings</h3><div>Among 5039 ED encounters with RLI among infants in their first RSV season, 2045 (41%) were RSV-positive and 446 (9%) received nirsevimab, with a median time since dose of 52 days (interquartile range [IQR]: 27–84 days). Among 1025 hospitalizations with RLI among infants in their first RSV season, 605 (59%) were RSV-positive and 95 (9%) received nirsevimab, with a median time since dose of 48 days (IQR: 24–82 days). Nirsevimab effectiveness was 77% (95% CI: 69%–83%) against RSV-associated ED encounters and 98% (95% CI: 95%–99%) against RSV-associated hospitalisation.</div></div><div><h3>Interpretation</h3><div>Nirsevimab was effective in preventing RSV-associated ED encounters and hospitalisation among infants in their first RSV season, with greatest protection against hospitalisation. However, these estimates reflect a short interval from nirsevimab administration to RLI onset. Since nirsevimab is a passive immunization and concentration is expected to wane over time, it is important to continue monitoring effectiveness to assess effectiveness with increased time since dose.</div></div><div><h3>Funding</h3><div>This work was supported by the <span>Centers for Disease Control and Prevention</span> (contracts <span><span>75D30121D12779</span></span> to Westat and <span><span>75D30123C18039</span></span> to Kaiser Foundation Hospitals).</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101196"},"PeriodicalIF":7.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781683","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":"Environmental justice index and prevalence of asthma and COPD in US neighborhoods- a population-based study","authors":"Sumanth Khadke ,&nbsp;Vidhatri Khadke ,&nbsp;Ashish Kumar ,&nbsp;Bhargav Makwana ,&nbsp;Sourbha S. Dani ,&nbsp;Sadeer Al-Kindi ,&nbsp;Sanjay Rajagopalan ,&nbsp;Yixin Kong ,&nbsp;Khurram Nasir ,&nbsp;Gary Adamkiewicz ,&nbsp;Anju Nohria ,&nbsp;Timothy N. Liesching ,&nbsp;Sarju Ganatra ,&nbsp;Victor Pinto-Plata","doi":"10.1016/j.lana.2025.101195","DOIUrl":"10.1016/j.lana.2025.101195","url":null,"abstract":"<div><h3>Background</h3><div>The independent effects of social and environmental factors on asthma and chronic obstructive pulmonary disease (COPD) are well-documented, but less is known about their combined impact across US neighborhoods. This study aimed to determine the combined and individual associations of neighborhood-level social vulnerability and environmental burden with the prevalence of asthma and COPD.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed 71,677 US census tracts, linking the 2022 CDC Environmental Justice Index (EJI) rankings and its subcomponents (environmental burden module [EBM] and social vulnerability module [SVM]) to the 2023 CDC PLACES dataset. Multivariable quasi-Poisson regression with an offset function was used to compare covariate-adjusted risk ratios of health indicators across quartiles of neighborhood socio-environmental burden.</div></div><div><h3>Findings</h3><div>Among the 71,677 neighborhoods studied, the median proportion of females was 50.90%. The median proportions of individuals aged 18 to 44, 45 to 64, and ≥65 were 30.6%, 26.7%, and 15.3%, respectively, with 22.6% of the Hispanic population. Asthma and COPD prevalence rates increased with increasing EJI and EBM quartiles. Neighborhoods with the highest socio-environmental burden (Q4 EJI) had significantly higher rates of asthma (RR:1.102, 95% CI: 1.087–1.117, p &lt; 0.001) and COPD (RR:1.156, 95% CI:1.141–1.172, p &lt; 0.001) compared to neighborhoods with the lowest burden (Q1 EJI), after adjusting for covariates. Similarly, neighborhoods with the highest environmental burden (Q4 EBM) had higher rates of asthma (RR: 1.091, 95% CI: 1.064–1.118, p &lt; 0.001) and COPD (RR:1.099, 95% CI: 1.070–1.129, p &lt; 0.001) compared with Q1 EBM, after adjusting for SVM and other covariates.</div></div><div><h3>Interpretation</h3><div>A higher prevalence of obstructive lung disease is associated with neighborhoods experiencing high cumulative socio-environmental burden. Environmental burden showed an independent association with asthma and COPD prevalence, even after adjusting for social vulnerability and other factors.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101195"},"PeriodicalIF":7.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772004","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 call to action to include disability in intersectional health equity research and policy","authors":"Susan M. Havercamp ,&nbsp;Gloria L. Krahn ,&nbsp;Alexa J. Murray ,&nbsp;Ilhom Akobirshoev ,&nbsp;Chyrell D. Bellamy ,&nbsp;Alexandra Bonardi ,&nbsp;Mary Lou Breslin ,&nbsp;Ly Xīnzhèn Zhǎngsūn Brown ,&nbsp;Mark Costa ,&nbsp;Robert S. Dembo ,&nbsp;David Ellsworth ,&nbsp;Jean P. Hall ,&nbsp;Willi Horner-Johnson ,&nbsp;David Hughes ,&nbsp;Marjorie McGee ,&nbsp;Nancy R. Mudrick ,&nbsp;Elayne Otstot ,&nbsp;Germán Parodi ,&nbsp;Shaylin Sluzalis ,&nbsp;Silvia Yee","doi":"10.1016/j.lana.2025.101199","DOIUrl":"10.1016/j.lana.2025.101199","url":null,"abstract":"<div><div>Disability status is rarely included in health research and policy, including intersectional research, perpetuating health inequities for this population. This paper calls on researchers and policymakers to take concrete steps to advance health equity for disabled people, including those at the intersections of disability, race, ethnicity, poverty, and other marginalized identities. We propose four strategies with recommendations to promote: a) meaningful engagement of disabled and multiply marginalized people in research and policy planning; b) cohesive, systemic disability data collection and analyses; c) use of intersectional approaches to examine structural drivers of health inequities; and d) leveraging of administrative data to improve disability healthcare policies and practices.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"49 ","pages":"Article 101199"},"PeriodicalIF":7.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766752","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":"Strengthening healthcare system resilience: a comprehensive framework for tropical cyclone preparedness and response","authors":"Attila J. Hertelendy ,&nbsp;Caleb Dresser ,&nbsp;Sophia Gorgens ,&nbsp;Arabella P. Hertelendy ,&nbsp;Paul D. Biddinger ,&nbsp;Gregory Ciottone","doi":"10.1016/j.lana.2025.101205","DOIUrl":"10.1016/j.lana.2025.101205","url":null,"abstract":"<div><div>This review examines healthcare system resilience to tropical cyclones through complementary frameworks of temporal phases (Before-During-After) and geographic contexts (Inside-Outside Impact Zone). The paper highlights how climate change is intensifying cyclone threats while demographic transitions create increasingly vulnerable patient populations dependent on continuous healthcare. Despite decreasing immediate mortality from cyclones, research reveals concerning increases in delayed morbidity and mortality due to disrupted healthcare access. Seven critical dimensions of healthcare resilience are identified: maintaining continuity of care for vulnerable populations, transitioning from reactive response to proactive resilience, strategic resource prioritization, adapting to climate change, integrating efforts across phases and zones, ensuring health equity, and addressing research gaps. A tiered approach to strengthening resilience is proposed, from immediate low-resource actions to long-term structural investments. The review emphasizes that healthcare systems must transform from reactive disaster response to proactive resilience strategies to protect vulnerable populations in an increasingly turbulent future climate.</div></div>","PeriodicalId":29783,"journal":{"name":"Lancet Regional Health-Americas","volume":"48 ","pages":"Article 101205"},"PeriodicalIF":7.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723283","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}