PLoS Medicine最新文献

{"title":"Rapid diagnostic tests, laboratory-based immunoassay and nucleic acid testing strategies for long-acting injectable pre-exposure prophylaxis: A systematic review and meta-analysis.","authors":"Warittha Tieosapjaroen, Eloise Williams, Cheryl C Johnson, Carlota Baptista Da Silva, Magdalena Barr-DiChiara, Michelle Rodolph, Heather Leigh Ingold, Heather-Marie A Schmidt, Mateo Prochazka, Busi Msimanga, Celine Lastrucci, Hortensia Peralta, Lastone Chitembo, Precious Andifasi, Nandi Siegfried, Raphael J Landovitz, Jason J Ong","doi":"10.1371/journal.pmed.1005030","DOIUrl":"10.1371/journal.pmed.1005030","url":null,"abstract":"<p><strong>Background: </strong>Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is a highly effective biomedical intervention for the prevention of HIV acquisition. There is a strong interest among communities and policymakers for LAI-PrEP scale-up, accelerating the demand for clear guidance on testing approaches that balance accuracy with scalability. Unlike oral pre-exposure prophylaxis, LAI-PrEP may overcome adherence challenges, such as difficulty with frequent clinic visits. However, LAI-PrEP results in prolonged subtherapeutic drug levels after discontinuation, which can increase the risk of drug resistance among those who have an undetected HIV infection. This systematic review evaluates how different HIV testing strategies, including rapid diagnostic tests (RDTs), laboratory-based immunoassays and nucleic acid testing (NAT), affect clinical utility and programme delivery of LAI-PrEP.</p><p><strong>Methods and findings: </strong>We searched databases and retrieved studies up to April 8, 2025, and supplemented findings with data collected through a World Health Organization (WHO) survey among ongoing and completed LAI-PrEP implementation studies. We included publications reporting original or primary data on clinical, diagnostic and resource-use outcomes of HIV testing for LAI-PrEP. Meta-analyses were conducted using random-effects models. Chi-square tests were used to examine differences between related outcomes. Certainty of evidence was determined using the GRADE methodology (Prospero: CRD42024605562). Risk Of Bias In Non-randomised Studies of Interventions, Version 2 (ROBINS-I V2) assessment tool was used to assess bias for non-randomised comparative studies. Of 7,698 records identified, 38 reports representing 22 studies (cabotegravir: 20, lenacapavir: 2) across 15 countries were included. The overall certainty of evidence was low. Most were observational cohorts (n = 13) or non-randomised comparator studies (n = 7). Among 8,171 LAI-PrEP users in four randomised controlled trials, HIV detection rates were similar across strategies (9/8171 (RDT) versus 14/8171 (NAT) (Odds ratio (OR) 0.66 (95% confidence interval: 0.29-1.50; P = 0.87)), with no difference in adverse events. Compared with laboratory-based tests, RDTs enabled faster turnaround (same-day versus up to 7 days), more rapid treatment initiation (1 day versus 6-9 days), and lower test costs (US$4 versus US$22). All tests had similar negative predictive value (~100%) at LAI-PrEP initiation and comparable positive predictive value (~55%) at continuation. There was little difference in delayed HIV detection (11/8171 (RDT) versus 0/8171 (NAT)). In the HPTN 083 trial, NAT use was occasionally associated with false-positive results, leading to unnecessary PrEP holds or discontinuation (7/2483). NAT might have detected HIV before resistance emerged, though no prospective or modelling evidence showed clinical benefit at a population level. There was limited evidence of HIV se","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005030"},"PeriodicalIF":9.9,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of esketamine versus alternative treatment strategies for treatment-resistant depression in Hong Kong: A multi-armed modeling study.","authors":"Yifan Li, Vivien Kin Yi Chan, Mark Jit, Franco Wing Tak Cheng, Hei Hang Edmund Yiu, David Makram Bishai, Dawn Craig, Esther Wai Yin Chan, Sandra Sau Man Chan, Xue Li","doi":"10.1371/journal.pmed.1005047","DOIUrl":"10.1371/journal.pmed.1005047","url":null,"abstract":"<p><strong>Background: </strong>Treatment-resistant depression (TRD), defined as failure to respond to at least two adequately administered antidepressant (AD) regimens, imposes major clinical and economic burdens. Esketamine nasal spray offers rapid antidepressant clinical effects, yet previous evaluations compared it only with unrealistic comparators such as AD monotherapy. This study assessed the cost-effectiveness of esketamine versus multiple alternative third-line strategies for TRD from the Hong Kong healthcare payer's perspective.</p><p><strong>Methods and findings: </strong>A Markov cohort model simulated adults with TRD in Hong Kong over 5 years with 4-week cycles. The model compared esketamine plus AD with six alternative third-line treatment strategies: combination therapy (AD plus AD), augmentation therapy (AD plus antipsychotic or lithium), psychotherapy alone, psychotherapy plus AD, repetitive transcranial magnetic stimulation (rTMS) plus AD, and electroconvulsive therapy (ECT) plus AD. Primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) under a US$50,000/QALY willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted, focusing on alternative esketamine dosing, delivery strategies, and comparisons with other treatment options to assess the robustness of the results. In base-case analysis, esketamine was not cost-effective versus augmentation, combination, psychotherapy, or psychotherapy plus AD with ICERs ranging from US$134,127 to US$312,750 per QALY but was more cost-effective than rTMS (dominated) and ECT (ICER: US$322,407/QALY). Combination therapy was the most cost-effective among all strategies evaluated. The main limitation of this study is the reliance on indirect comparisons and assumptions derived from heterogeneous clinical trial populations, which may not fully reflect real-world patient characteristics and treatment pathways.</p><p><strong>Conclusions: </strong>Esketamine appeared more cost-effective than rTMS and ECT, but not cost-effective compared with other commonly used third-line treatment strategies for TRD. These findings suggest that cost-effectiveness evidence may help inform more context-sensitive treatment sequencing strategies beyond conventional line-of-therapy frameworks. Policy approaches such as price negotiation, optimized service delivery, and alternative dosing strategies may improve the value of esketamine for TRD management.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005047"},"PeriodicalIF":9.9,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting circulating microbiome-related metabolites in coronary heart disease.","authors":"Zhonghan Sun, Mengkun Shi, Yan Zheng","doi":"10.1371/journal.pmed.1005056","DOIUrl":"10.1371/journal.pmed.1005056","url":null,"abstract":"<p><p>Circulating microbiome-related metabolites have emerged as promising biomarkers for coronary heart disease. A recent multi-stage study in PLOS Medicine strengthens signal prioritization but highlights the persistent gap between association and causality.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005056"},"PeriodicalIF":9.9,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clostridioides difficile colonization amplification despite limited in-hospital transmission: A modeling study.","authors":"Daniel De-la-Rosa-Martinez, Travis C Porco, Ashley Hazel, Xinran Liu, Karim Khader, Seth Blumberg","doi":"10.1371/journal.pmed.1004712","DOIUrl":"10.1371/journal.pmed.1004712","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although healthcare-associated transmission of Clostridioides difficile is a recognized public health concern, community-onset infections represent an important component of the overall disease burden. This paradox likely reflects the underappreciated interplay between these settings. We aimed to quantify in-hospital transmission and the hospital's contribution to community colonization by estimating the intrinsic reproduction number (Ri) and introducing the colonization amplification index (Ai), defined as the ratio of colonized patients at discharge to those at admission. Given the potential contribution of external cases, we also evaluated interventions targeting asymptomatic carriers at admission to reduce disease burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;We developed a compartmental model informed by data from UCSF Medical Center to capture C. difficile transmission dynamics among symptomatic and asymptomatic patients. Across simulations, the median Ri was 0.61 (Q1-Q3: 0.53, 0.71), consistently indicating limited sustained in-hospital transmission (Ri &lt; 1). In contrast, Ai was 1.9 (Q1-Q3: 1.7, 2.1), suggesting substantial amplification of colonization during hospital stay. Amplification of colonization persisted in sensitivity analyses, with Ri exceeding 1 under boundary values of low colonization prevalence at admission, a low proportion of colonized patients progressing to symptomatic disease, and prolonged incubation periods. Redefining healthcare-associated C. difficile infection (CDI) using thresholds from ≥1-day post-admission instead of the standard threshold of &gt;3 days post-admission increased Ai and Ri by 11% and 21%, respectively. A threshold of ≥5 days post-admission reduced these metrics by 5% and 8%, respectively. Interventions targeting asymptomatic carriers through contact precautions and/or prophylactic treatment reduced both Ai and CDI incidence, with combined interventions yielding the greatest reductions, followed by contact precautions alone. Our main limitation stems from uncertainty in some parameters describing the disease's natural history, particularly colonization prevalence at admission, progression to symptomatic disease, and the incubation period, which may affect the precision of our estimates despite sensitivity analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings indicate that in most potential scenarios, in-hospital transmission of C. difficile is limited (Ri &lt; 1) and likely sustained by continuous importation of cases from the community. Nevertheless, hospitalization amplifies colonization (Ai &gt; 1), which potentially contributes to community transmission. These results underscore the importance of interventions addressing asymptomatic carriers, a currently overlooked source of spread. Our study highlights the need to broaden metrics beyond Ri to capture hospitals' contribution to the C. difficile burden. Future infection control strategies should address colon","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1004712"},"PeriodicalIF":9.9,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13120704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Quantify unmet medical need across the disease landscape - A large language model-based methodology.","authors":"Elliott W Sharp, Nicholas Fragola, Charlotte Blewitt, Matthew Goddeeris, Lee Lancashire, Charlie Hempstead, David C Fajgenbaum","doi":"10.1371/journal.pmed.1005048","DOIUrl":"10.1371/journal.pmed.1005048","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1371/journal.pmed.1004798.].</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005048"},"PeriodicalIF":9.9,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) and incidence of asthma and wheeze in childhood: A register-based cohort study in Ronneby, Sweden.","authors":"Annelise J Blomberg, Christel Nielsen, Beata Borgström Bolmsjö, Marie-Abèle Bind, Linda Hartman, Anna Saxne Jöud","doi":"10.1371/journal.pmed.1004659","DOIUrl":"10.1371/journal.pmed.1004659","url":null,"abstract":"<p><strong>Background: </strong>Early-life exposure to per- and polyfluoroalkyl substances (PFAS) may impact the developing lungs and immune system and increase the risk of childhood asthma, but no studies have been conducted in a high-exposed population. The objective of this study was to estimate associations between prenatal PFAS exposure and childhood incidence of asthma and wheeze in Blekinge County, Sweden, where a subset of residents in the city of Ronneby was exposed to PFAS from drinking water contaminated by aqueous film-forming foam (AFFF).</p><p><strong>Methods and findings: </strong>We constructed a register-based open cohort of 11,488 children born in Blekinge county between 2006 and 2013 and followed each individual from birth until age 12 or December 31, 2022. Maternal address history was linked to water distribution records to create a categorical proxy variable for prenatal PFAS exposure from drinking water. We identified incident cases of wheeze and asthma from administrative health records and estimated hazard ratios (HRs) using Cox proportional hazards models adjusted for individual-level confounders, including maternal smoking in early pregnancy, maternal age at delivery, parity, child sex, parental asthma, and socioeconomic factors. As a secondary analysis, we applied a Rubin Causal Model (RCM) analysis to estimate the average marginal effect of prenatal PFAS exposure on wheeze and asthma among the very highly-exposed population, using a matched dataset of very-high and background-exposed individuals balanced on measured confounders. Overall, 18% of children were diagnosed with wheeze and 17% with asthma during follow-up. Very high prenatal PFAS exposure was associated with incidence of asthma (HR: 1.44, 95% CI [1.08, 1.92]), whereas no associations were observed for the high or intermediate exposure groups or for wheeze. In the RCM analysis, the estimated cumulative incidence of asthma was 16.1% in the background-exposed group and 26.7% in the very highly exposed group (Fisherian p < 0.001). Study limitations include reliance on an address-based categorical proxy for prenatal PFAS exposure, which likely results in non-differential exposure misclassification and limits the ability to distinguish prenatal from early-childhood exposure effects.</p><p><strong>Conclusions: </strong>In this study, very high prenatal PFAS exposure was associated with a higher incidence of childhood asthma. Although these results should be replicated, they suggest an important public health impact of AFFF-associated PFAS contamination.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1004659"},"PeriodicalIF":9.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between early methadone dose titration and treatment discontinuation and opioid toxicity: A retrospective cohort study.","authors":"Ria Garg, Jin Luo, Nikki Bozinoff, Beth Sproule, Tony Antoniou, Jennifer Wyman, Pamela Leece, Charlotte Munro, Jes Besharh, Tara Gomes","doi":"10.1371/journal.pmed.1004748","DOIUrl":"10.1371/journal.pmed.1004748","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Clinical guidance in Canada and the United States recommends faster methadone dose titration for individuals using fentanyl. An initial dose increase is recommended between days 4 and 6, but the impact on patient outcomes remains unclear, particularly when provided in an outpatient setting. Therefore, we evaluated the association between early methadone dose titration (i.e., within treatment days 4-6) and treatment discontinuation and opioid toxicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and findings: &lt;/strong&gt;We conducted a retrospective propensity-score weighted cohort study of Ontario residents who initiated methadone in an outpatient setting between January 2017 and December 2022. Exposure was defined as provision of a dose titration between treatment days 4-6, with the index date defined as the first date of dose increase. For unexposed individuals, the index date was randomly assigned and followed the same distribution as those exposed. Individuals were followed for up to 181 days following index date for study outcomes. Primary outcomes included methadone discontinuation and opioid toxicity, using an intention-to-treat approach. Secondary outcomes included methadone versus non-methadone-related toxicity while on treatment. We fit a propensity-score model to estimate the probability of dose titration, conditional on baseline demographic and clinical (e.g., comorbidities, past medication use) variables. Propensity score weighted Cox proportional hazard models were then estimated to determine the association between early dose titration and study outcomes. Among 13,560 incident methadone recipients (61.4% [N = 8,322] provided early dose titration), the mean age was 36.5 years old, and approximately one-third were female. Individuals who received an early dose titration had a lower weighted hazard of discontinuation, which was most pronounced during the first seven days of follow-up (weighted hazard ratio [wHR]: 0.55; 95% confidence interval [CI]: 0.51, 0.60), with attenuation towards the null over time. The observed weighted rate of opioid toxicity was lower among those exposed versus unexposed (10.1 versus 12.3 per 100 person-years; wHR: 0.82; [95% CI: 0.69, 0.97]). Early dose titration was not associated with opioid toxicity while on treatment. Most toxicities were attributed to non-methadone opioids (exposed: 3.89 per 100 person-years versus unexposed: 4.06 per 100 person-years; wHR: 1.00; [95% CI: 0.70, 1.44]). Methadone-related toxicity while on treatment remained low and comparable between exposed and unexposed groups (2.02 versus 2.65 per 100 person-years; wHR: 0.80; [95% CI: 0.46, 1.41]). The main study limitation is the lack of information on drug use history and time-varying clinical factors that may influence both dose titration and subsequent outcomes, introducing the potential for residual confounding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This population-based analysis demonstrated that early methadone dose titrat","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1004748"},"PeriodicalIF":9.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial omics and AI for clinically actionable cancer biomarkers.","authors":"Nic G Reitsam","doi":"10.1371/journal.pmed.1005049","DOIUrl":"10.1371/journal.pmed.1005049","url":null,"abstract":"<p><p>Integrating spatial omics with artificial intelligence is likely to advance biomarker research and diagnostics, with the potential to pair mechanistic insight into spatial target biology. By developing scalable, reproducible quantification in routine pathology, it can help bridge discovery, validation, and real-world clinical implementation.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005049"},"PeriodicalIF":9.9,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The benefits of investments to combat HIV, tuberculosis, and malaria for primary healthcare from 2000 to 2023: An economic modeling analysis.","authors":"Jiaying Stephanie Su, John Stover, Carel Pretorius, Peter Winskill, Sedona Sweeney, Timothy B Hallett, Nicolas A Menzies","doi":"10.1371/journal.pmed.1005036","DOIUrl":"10.1371/journal.pmed.1005036","url":null,"abstract":"<p><strong>Background: </strong>Global investments to combat HIV, tuberculosis, and malaria (HTM) have delivered substantial health gains and may have reduced the burden placed by these diseases on the routine health system. We estimated the reduction in primary healthcare (PHC) utilization resulting from the scale-up of HTM services over 2000-2023 in 108 low- and middle-income countries.</p><p><strong>Methods and findings: </strong>For each disease, we applied established mathematical models to quantify PHC utilization (outpatient visits and inpatient bed-days provided outside of HTM programs) by individuals with symptomatic HIV, tuberculosis, or malaria unable to access HTM-specific services. For each country, we estimated averted PHC utilization by comparing a scenario describing the actual scale-up of HTM services to a counterfactual scenario holding HTM service coverage constant at year 2000 levels. We applied published unit costs to estimate the averted costs resulting from reduced PHC utilization. Over 2000-2023, scale-up of HTM services averted an estimated 6.9 (95% uncertainty interval (UI) [4.4, 10.5]) billion outpatient PHC visits and 3.9 (95% UI [2.5, 5.9]) billion inpatient bed-days, representing US$135 (95% UI [71, 250]) billion in averted costs. These reductions were greatest in sub-Saharan Africa and East Asia and Pacific regions. Across study countries, these reductions represented a median of 4.4% of hospital bed capacity and 1.6% of government health spending in 2023. These percentages were 22.9% and 5.1%, respectively, for low-income countries. Our analysis did not consider changes in PHC services beyond utilization. Also, several inputs were missing in some countries, with missing values estimated using regression imputation.</p><p><strong>Conclusions: </strong>Over recent decades, sustained investments in HTM services in high-burden settings have averted substantial PHC utilization and associated costs. These benefits should be considered when assessing investment impact.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1005036"},"PeriodicalIF":9.9,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of abdominal obesity prevalence trends on dementia, cardiovascular disease, functional impairment, and mortality in older Chinese adults: A Markov scenario simulation, 2020-2050.","authors":"Yujing Zhou, Minrui Zeng, Yuntao Chen, Piotr Bandosz, Eric Brunner, Jing Liao","doi":"10.1371/journal.pmed.1004970","DOIUrl":"10.1371/journal.pmed.1004970","url":null,"abstract":"<p><strong>Background: </strong>Dementia, cardiovascular disease (CVD), and functional impairment (FI) often co-occur in aging populations, with abdominal obesity as a shared modifiable risk factor. The long-term impact of abdominal obesity on these comorbidities is unclear. We projected the 30-year burden of dementia, FI, and CVD in China under different trajectories of abdominal obesity prevalence.</p><p><strong>Methods and findings: </strong>We modeled three trajectories of abdominal obesity prevalence from 2020 to 2050 using data from the China Health and Nutrition Survey (2000-2015): continuation of the observed growth prevalence trend (persistent), stabilization at 2015 levels (optimal), and a 50% reduction in the growth rate (improved). Abdominal obesity was defined as a waist circumference of ≥90 cm for men and ≥85 cm for women. A Markov model was used to estimate occurrence of dementia, CVD, FI, and mortality among adults aged ≥65 years by sex and year. Under the persistent scenario, dementia cases were projected to rise to 37.8 million (95% uncertainty interval (UI) [36.7, 38.9]) by 2050, alongside 68.1 million (95% UI [66.7, 69.5]) cases of FI, 198.3 million (95% UI [196.5, 200.4]) CVD cases, and 17.6 million (95% UI [16.5, 18.7]) deaths. Compared with the persistent scenario, dementia and FI burdens increased under the optimal and improved scenarios by 2050, by 1396.0 thousand (95% UI [589.1, 2293.9]) and 711.4 thousand (95% UI [294.4, 1150.3]) for dementia, and by 2570.6 thousand (95% UI [1081.0, 4024.9]) and 1289.5 thousand (95% UI [569.5, 2034.2]) for FI, mainly due to reduced CVD mortality expanding the population at risk. These shifts are most pronounced among adults aged ≥80 years and women. For CVD, reductions in the number of cases were projected in the short term (by 2030), but these changes remain uncertain by 2050. Main limitations include the assumption that other risk factors remain unchanged, and the lack of modeling of multiple co-occurring dementia's risk factors.</p><p><strong>Conclusions: </strong>Abdominal obesity control may reduce CVD incidence and mortality, thereby shifting the disease burden toward dementia and FI due to increased longevity, highlighting the need for integrated, life-course public health strategies responsive to the patterns of dementia and its comorbidity in older people.</p>","PeriodicalId":49008,"journal":{"name":"PLoS Medicine","volume":"23 4","pages":"e1004970"},"PeriodicalIF":9.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}