Lancet Regional Health-Europe最新文献

{"title":"Short-term effects of cannabis legalisation in Germany on driving under the influence of cannabis: a difference-in-differences analysis using Austria as a control","authors":"Anna Schranz ,&nbsp;Anja Knoche-Becker ,&nbsp;Moritz Rosenkranz ,&nbsp;Uwe Verthein ,&nbsp;Jakob Manthey","doi":"10.1016/j.lanepe.2026.101593","DOIUrl":"10.1016/j.lanepe.2026.101593","url":null,"abstract":"<div><h3>Background</h3><div>In April 2024, Germany legalised adult cannabis possession and cultivation, and in August 2024 established legal THC-limits for driving. This study aimed to examine short-term impacts on (1) cannabis use and (2) driving under the influence of cannabis (DUIC), and (3) investigates the extent of DUIC involving cannabis combined with alcohol or other drugs (DUIC(+)).</div></div><div><h3>Methods</h3><div>Data came from two cross-sectional population surveys in Germany and Austria (control) before (t₀: Nov–Dec 2023) and after legalisation (t₁: Nov 2024–Jan 2025). We assessed 12-month cannabis use among adults aged 18–64 (Germany: n_t0 = 6670, n_t1 = 9692; Austria: n_t0 = 2132, n_t1 = 2102) and DUIC among at least monthly cannabis users (excluding medical use; Germany: n_t0 = 393, n_t1 = 589; Austria: n_t0 = 86, n_t1 = 92) using a difference-in-differences (DiD) approach. For t₁, we compared the proportion of DUIC(+) and cannabis-only DUIC(−) episodes among all DUIC episodes by use frequency.</div></div><div><h3>Findings</h3><div>In Germany, cannabis use rose from 12·1% to 14·4%, but this trend did not significantly differ from Austria (DiD-effect: <em>OR</em> = 1·18, 95% CI 0·95–1·48, <em>p</em> = 0·141, weighted). Among at least monthly users, DUIC decreased slightly from 28·5% to 26·8% (unweighted), with no significant difference compared with Austria (DiD-effect: <em>aOR</em> = 0·68, 95% <em>CI</em> 0·27–1·68, <em>p</em> = 0·408). Results held across sensitivity analyses including additional confounders and negative controls. At t₁, DUIC(+) accounted for 21·5% of episodes. DUIC(−) was most common among daily users, DUIC(+) among weekly users.</div></div><div><h3>Interpretation</h3><div>Eight months after legalisation, no significant short-term effects on cannabis use or DUIC were observed. DUIC(+), associated with higher traffic risk, was most common among weekly users. A comprehensive evaluation of the cannabis reform requires further monitoring of DUIC and traffic data.</div></div><div><h3>Funding</h3><div><span>Federal Highway</span> and <span>Transport Research Institute</span> (FE 82.0816/2023).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101593"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023191","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":"Stigma from healthcare professionals and care-limiting behaviors in individuals with substance use disorders: a mixed-methods study","authors":"Mathias Luderer ,&nbsp;Dorothea Stockreiter ,&nbsp;Annette Binder ,&nbsp;Laura Müller ,&nbsp;Franca Burger ,&nbsp;Nathalie Stüben ,&nbsp;Andreas Reif","doi":"10.1016/j.lanepe.2025.101587","DOIUrl":"10.1016/j.lanepe.2025.101587","url":null,"abstract":"<div><h3>Background</h3><div>Stigmatization of individuals with substance use disorders (SUDs) by healthcare professionals (HCPs) is a recognized problem, but its direct impact on patient treatment choices has not been systematically quantified. We aimed to provide first robust, quantitative metrics of non-disclosure, treatment avoidance, and treatment discontinuation for any medical treatment directly attributable to HCP stigma and to explore the lived experiences underpinning these behaviors.</div></div><div><h3>Methods</h3><div>We conducted a prospective mixed-methods study with 119 adult inpatients with SUDs at a German university hospital (2021–2024). A self-developed questionnaire assessed stigma-related behaviors and their association with self-stigmatization. Qualitative data were analyzed using reflexive thematic analysis (RTA). A person with lived experiences contributed to writing up the manuscript.</div></div><div><h3>Findings</h3><div>49.6% (95% CI 40.3–58.9; n = 59/119) reported non-disclosure of substance use, 36.1% (95% CI 27.5–45.5; n = 43/119) avoided necessary medical treatment, and 29.4% (95% CI 21.4–38.5; n = 35/119) discontinued treatment due to stigma. Internalized stigma significantly predicted all three outcomes (aORs 1.055–1.075, p ≤ .001). RTA identified “Institutional Stigma” (addiction as a “moral failing”), “Barriers to Care” (obstacles to respectful treatment), and “Cost of Disclosure” (negative consequences such as hostility after revealing substance use).</div></div><div><h3>Interpretation</h3><div>Stigma from HCPs is a quantifiable contributor of treatment disengagement, representing a direct threat to patient safety and a major contributor to the SUD treatment gap. These findings underscore the urgent need for evidence-based interventions, including training HCPs across all specialties in non-stigmatizing communication, to improve healthcare engagement for this vulnerable population and narrow the substantial treatment gap.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101587"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978785","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":"Comorbidities, medication use, and overall survival in eight cancers: a multinational cohort study of 1.7 million patients across Europe","authors":"Irene López-Sánchez ,&nbsp;Anna Palomar-Cros ,&nbsp;Ravinder Claire ,&nbsp;Laura Pérez-Crespo ,&nbsp;Agustina Giuliodori ,&nbsp;Ian Koblbauer ,&nbsp;Jeremy Dietz ,&nbsp;Jamie Elvidge ,&nbsp;James Koh ,&nbsp;Asieh Golozar ,&nbsp;Juan Manuel Ramirez-Anguita ,&nbsp;Angela Leis ,&nbsp;Miguel-Angel Mayer ,&nbsp;Nicola Symmers ,&nbsp;Mahéva Vallet ,&nbsp;Colin McLean ,&nbsp;Peter S. Hall ,&nbsp;Mees Mosseveld ,&nbsp;Katia Verhamme ,&nbsp;Espen Enerly ,&nbsp;Danielle Newby","doi":"10.1016/j.lanepe.2025.101585","DOIUrl":"10.1016/j.lanepe.2025.101585","url":null,"abstract":"<div><h3>Background</h3><div>Real-world evidence provides valuable insights into cancer burden, presentation, and care variations. Through a large-scale federated approach, this study aims to explore patient characteristics and overall survival for eight cancers using data from 11 electronic health records and cancer registries from eight European countries, mapped to the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM).</div></div><div><h3>Methods</h3><div>Patients aged 18 years or older with a primary cancer diagnosis between 2000 and 2019 were included. Patients were followed from cancer diagnosis until death, database exit, or study end. Mortality data was sourced from linked national or subnational death registries for most databases. Patient characteristics, including comorbidities, and medication use, were summarised. Age-standardised overall survival (OS) at one, five, and ten years were calculated using the Kaplan–Meier method and stratified by cancer type, age group and sex.</div></div><div><h3>Findings</h3><div>There were 1,796,278 eligible cancer patients included with most diagnoses in individuals aged 60–79 years. Top comorbidities and medications were relatively consistent across databases, with certain variations observed by cancer type, possibly indicative of early cancer signs and risk factors. For instance, anaemia was frequent in colorectal (9% [HUS]–23% [IMASIS]; 791/8395–730/3141 individuals) and stomach cancers (10% [HUS]–34% [IMASIS]; 130/1277–225/670), while chronic obstructive pulmonary disease (18% [SIDIAP]–34% [HUVM], 5310/29,009–1039/3063) and pneumonia (5% [CPRD GOLD]–33% [UTARTU], 1904/34,990–1001/3063) were common in lung cancer patients. Breast and prostate cancers had the highest one, five and ten-year overall survival, with 5-year OS ranging from 76% [ECi]–85% [IMASIS] and 75% [HUVM]–83% [SIDIAP], respectively. Pancreatic cancer showed the lowest survival ranging from 3% [NCR]–25% [IMASIS] 5-year OS. Variations in cancer survival estimates were observed across data sources and countries.</div></div><div><h3>Interpretation</h3><div>Federated analysis of diverse European real-world databases, standardised to OMOP-CDM, offer a valuable benchmark for future cancer research, particularly in understanding prodromes and risk factors, often recorded in routinely collected healthcare data prior to cancer onset.</div></div><div><h3>Funding</h3><div>The <span>European Health Data &amp; Evidence Network</span> has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 806968. The JU receives support from the <span>European Union’s Horizon 2020</span> research and innovation programme and the European Federation of Pharmaceutical Industries and Associations partners.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101585"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023190","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":"Humanity first, not country first","authors":"The Lancet Regional Health – Europe","doi":"10.1016/j.lanepe.2026.101664","DOIUrl":"10.1016/j.lanepe.2026.101664","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101664"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147650001","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":"SARS-CoV-2 reinfections and subsequent risk of hospital-diagnosed post-acute sequelae in Denmark (2020–2022): a nationwide cohort study","authors":"Mark P. Khurana ,&nbsp;Mathilde Marie Brünnich Sloth ,&nbsp;Neil Scheidwasser ,&nbsp;Jacob Curran-Sebastian ,&nbsp;Christian Morgenstern ,&nbsp;Nicolas Banholzer ,&nbsp;David Thein ,&nbsp;Laust H. Mortensen ,&nbsp;Morten Rasmussen ,&nbsp;Pikka Jokelainen ,&nbsp;Frederik Trier Møller ,&nbsp;Marc Stegger ,&nbsp;Tyra G. Krause ,&nbsp;Ewan Cameron ,&nbsp;David A. Duchêne ,&nbsp;Alexandros Katsiferis ,&nbsp;Samir Bhatt","doi":"10.1016/j.lanepe.2026.101601","DOIUrl":"10.1016/j.lanepe.2026.101601","url":null,"abstract":"<div><h3>Background</h3><div>Post-acute sequelae of COVID-19 (PASC), or long COVID, are a public health concern. While most recover from SARS-CoV-2 infections within weeks, some experience persistent symptoms. Here, we quantified the association between repeated SARS-CoV-2 infections and the risk of hospital-diagnosed PASC.</div></div><div><h3>Methods</h3><div>We conducted a nationwide register-based cohort study of all adults in Denmark (≥18 years) with at least one SARS-CoV-2 PCR or antigen test between April 1, 2020, and December 31, 2022. Participants were followed from first test until long COVID diagnosis (ICD-10: B948A), death, emigration, three SARS-CoV-2 infections, or end of study. Risk of long COVID diagnosis was estimated at three timepoints after study entry (180 days, 1 year, 2 years) and the outcomes were assessed during the 180 days after each timepoint. Cause-specific Cox models treated death as a competing risk, with number of infections and vaccination status as time-varying covariates. Absolute risks and differences were estimated using G-computation. Analyses were stratified by sex, income, and vaccination status. Secondary analyses assessed fatigue and headache (ICD-10), excluding individuals with prior diagnoses.</div></div><div><h3>Findings</h3><div>Of 4,418,544 individuals, 6942 (0.16%) were diagnosed with long COVID. The absolute risk of a diagnosis increased following reinfection (0.73% [95% CI 0.69–0.77] after one infection vs. 1.16% [1.05–1.30] after two infections at 180 days), but differences were small and decreased over time. Risks following reinfection were similar across sex and income strata. Absolute risk decreased with prior vaccinations. Secondary analyses showed no increased risk of fatigue or headache after primary infection. A small increase in fatigue risk was observed after reinfection at 1 year (RD 0.03% [0.01–0.05]), but not for headache.</div></div><div><h3>Interpretation</h3><div>Reinfection increases long COVID risk; however, the absolute increase after reinfection is smaller than that observed after a primary infection. Vaccination offers substantial protection against long COVID.</div></div><div><h3>Funding</h3><div><span>Danish National Research Foundation</span> (DNRF).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101601"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078393","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 temperature and all-cause emergency hospital admissions in people with and without diabetes in Germany (2005–2022): a time-series analysis","authors":"Thaddäus Tönnies ,&nbsp;Marielle Wirth ,&nbsp;Katharina Piedboeuf-Potyka ,&nbsp;Oliver Kuss","doi":"10.1016/j.lanepe.2026.101591","DOIUrl":"10.1016/j.lanepe.2026.101591","url":null,"abstract":"<div><h3>Background</h3><div>People with diabetes may be more vulnerable to temperature extremes due to impaired thermoregulation and higher prevalence of comorbidities, but evidence is limited. We aimed to compare short-term effects of extreme heat and cold on all-cause emergency hospital admissions in Germany among people with and without diabetes.</div></div><div><h3>Methods</h3><div>We applied space- and time-stratified conditional quasi-Poisson regression with distributed lag non-linear models (up to 21 days) to estimate short-term effects of daily average temperature. We chose the reference temperature (20 °C) such that it approximates the minimum morbidity temperature in most subgroups. Analyses were stratified by sex, age, and diabetes status using data from all emergency hospital admissions in Germany, 2005–2022 (N = 132,243,083) at the level of 400 administrative districts, enabling an ecological study.</div></div><div><h3>Findings</h3><div>Both heat and cold increased hospital admissions. Heat-related relative risks (RR) were broadly similar between people with and without diabetes. Considering all ages, heat-related RRs (95% confidence interval) were 1.03 (1.03–1.04), 1.07 (1.00–1.13), and 1.02 (1.01–1.03) in males without, with type 1, and with type 2 diabetes. Age-specific RRs for heat and cold were similar between people without and with type 2 diabetes but higher for type 1 diabetes in some subgroups; e.g. cold-related RRs were 1.13 (1.12–1.15) and 1.51 (1.14–2.01) in men aged ≥80 years without and with type 1 diabetes.</div></div><div><h3>Interpretation</h3><div>Contrary to prior hypotheses, diabetes was not associated with greater vulnerability. This may reflect good healthcare access and increased awareness of heat and cold-related risks among people with diabetes. Nevertheless, given the higher baseline risk of hospital admission in diabetes, similar RR may still translate into larger absolute effects of extreme temperatures. Hence, clinical practice and policies aimed at mitigating temperature-related effects should continue to consider diabetes as a potential vulnerability factor.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101591"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023192","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":"Prenatal maternal depression and child behavioural and developmental outcomes: an individual participant data meta-analysis in 76,514 children from the EU Child Cohort Network","authors":"Adriana P.C. Hermans ,&nbsp;Demetris Avraam ,&nbsp;Isabel K. Schuurmans ,&nbsp;Ana G. Soares ,&nbsp;Marius Lahti-Pulkkinen ,&nbsp;Polina Girchenko ,&nbsp;Tanja G.M. Vrijkotte ,&nbsp;Susanne R. de Rooij ,&nbsp;Ahmed Elhakeem ,&nbsp;Judith van der Waerden ,&nbsp;Barbara Heude ,&nbsp;Chloé Vainqueur ,&nbsp;Tiffany C. Yang ,&nbsp;Rachael W. Cheung ,&nbsp;Dan Lewer ,&nbsp;Katrine Strandberg-Larsen ,&nbsp;Tim Cadman ,&nbsp;Maja Popovic ,&nbsp;Francesca Candelora ,&nbsp;Jari Lahti ,&nbsp;Hanan El Marroun","doi":"10.1016/j.lanepe.2026.101595","DOIUrl":"10.1016/j.lanepe.2026.101595","url":null,"abstract":"<div><h3>Background</h3><div>Prenatal maternal depression affects an estimated one in five women, with implications not only for the mother but also for the child, associating negatively with offspring mental health and cognition. This study aimed to investigate multiple outcomes within the same set of participants from multiple cohorts, explore sex-specific differences in associations, and examine of the role of timing of maternal depression.</div></div><div><h3>Methods</h3><div>We performed large-scale individual participant data analyses with a sample size of up to 76,514 participants to investigate prospective associations between prenatal maternal depression and eight offspring behavioural and developmental outcomes, leveraging harmonised data from seven European birth cohorts. Cohort-specific estimates were combined using random-effects meta-analysis. Potential sex differences and the role of pre-pregnancy and postnatal depression in the associations were examined.</div></div><div><h3>Findings</h3><div>Prenatal maternal depression was associated with higher internalising, externalising, attention deficit hyperactivity disorder, and autism spectrum disorder symptoms (6.61–10.90 increased percentile scores). Associations were similar between males and females, largely independent of pre-pregnancy depression, and partially mediated by postnatal maternal depression. Continuous prenatal depressive symptoms were associated with all eight offspring outcomes.</div></div><div><h3>Interpretation</h3><div>These findings emphasise the importance of prenatal maternal depression as a key developmental risk factor. Future work should consider how best to support mental health during pregnancy and children exposed to prenatal depression. Our results contribute to the growing evidence underscoring the need for early intervention and tailored support for those experiencing depression during pregnancy.</div></div><div><h3>Funding</h3><div>HappyMums Project, funded by the <span>European Union</span> (Grant Agreement n.101057390).</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101595"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078395","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":"European medicines agency approvals of new medicines in January and February 2026","authors":"Bruno Sepodes ,&nbsp;Juan Garcia Burgos ,&nbsp;Steffen Thirstrup","doi":"10.1016/j.lanepe.2026.101657","DOIUrl":"10.1016/j.lanepe.2026.101657","url":null,"abstract":"","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101657"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147650000","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 of vaccine hesitancy in Italy: a cross-sectional study","authors":"Giuseppina Lo Moro ,&nbsp;Fabrizio Bert ,&nbsp;Giovanna Elisa Calabrò ,&nbsp;Mauro Giovanni Carta ,&nbsp;Giulia Cossu ,&nbsp;Corrado De Vito ,&nbsp;Manuela Martella ,&nbsp;Azzurra Massimi ,&nbsp;Anna Odone ,&nbsp;Paolo Ragusa ,&nbsp;Giacomo Pietro Vigezzi ,&nbsp;Walter Ricciardi ,&nbsp;Roberta Siliquini","doi":"10.1016/j.lanepe.2026.101603","DOIUrl":"10.1016/j.lanepe.2026.101603","url":null,"abstract":"<div><h3>Background</h3><div>Vaccine hesitancy (VH) remains a global threat, exacerbated by socio-political uncertainty. We aimed primarily to estimate VH prevalence in Italy, identifying the most susceptible subgroups, and secondarily to assess whether these patterns varied across VH dimensions.</div></div><div><h3>Methods</h3><div>Cross-sectional survey (web/telephone) among adults in Italy (September 2024–March 2025). The sample (n = 52,094) was nationally representative by age, gender, education, area, municipality size. The primary outcome was VH (score ≥25, adult Vaccine Hesitancy Scale, aVHS). The secondary outcomes were aVHS subscales “Lack of trust” and “Risk perception”. Post-stratification weighting for age, area, and municipality size was applied.</div></div><div><h3>Findings</h3><div>VH prevalence was 46.09% (95% CI: 45.65–46.53%). Multivariable models showed several associations with VH, e.g., gender, sexual orientation, ethnicity, health literacy, political and religious orientation, personal experiences, and vaccination support from community figures. Among many subgroups significant after multiple-comparison correction, the strongest differences in VH predicted probability (PP) were estimated among individuals using complementary/alternative medicine (PP = 58.5%), right-aligned (PP = 47.0%) or politically unaffiliated participants (PP = 48.4%), individuals with middle school education (PP = 48.3%), people aged 60–74 (PP = 49.0%), and participants uncertain about healthcare workers' pro-vaccination support (PP = 52.8%). While some groups, e.g., individuals with chronic conditions, inadequate health literacy, or religious participants reported higher perceived risk, others, e.g., non-binary respondents, showed higher lack of trust.</div></div><div><h3>Interpretation</h3><div>This study highlighted the importance of granular data to inform inclusive strategies. Key figures and politics emerged as relevant, deserving further exploration. Future research should evaluate tailored interventions for identified at-risk groups.</div></div><div><h3>Funding</h3><div>NextGenerationEU funding within the Italian <span>Ministry of University and Research</span> PNRR Extended Partnership initiative on <span>Emerging Infectious Diseases</span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101603"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078394","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 role of welfare regimes on socioeconomic inequalities in edentulism: a cross-national analysis of 40 countries","authors":"Roger Keller Celeste ,&nbsp;Carol Guarnizo-Herreño ,&nbsp;Johan Fritzell ,&nbsp;Francine S. Costa ,&nbsp;Olalekan Ayo-Yusuf ,&nbsp;Aluisio J. Barros ,&nbsp;Huihua Li ,&nbsp;Ninuk Hariyani ,&nbsp;Donna M. Hackley ,&nbsp;Silvana Blanco ,&nbsp;Jorge A. Gamonal ,&nbsp;Gerardo Maupome ,&nbsp;Richard G. Watt ,&nbsp;Marco Aurelio Peres","doi":"10.1016/j.lanepe.2025.101578","DOIUrl":"10.1016/j.lanepe.2025.101578","url":null,"abstract":"<div><h3>Background</h3><div>We aim to evaluate the association between welfare regimes and edentulism (total tooth loss) and to investigate whether welfare regimes modify the magnitude of socioeconomic inequalities in edentulism.</div></div><div><h3>Methods</h3><div>The Lancet Commission on Oral Health gathered and analysed nationally representative available data from 40 high, middle- and low-income countries, collected between 2007 and 2018. The study included 117,397 individuals 20 years or older. The outcome was edentulism, defined as the absence of all natural teeth. We categorised countries into seven welfare regimes, which served as both the primary exposure and an effect modifier. Individual-level variables included sex, age and a composite measure of socioeconomic position: “wealth” measured in quintiles. Inverse probability of treatment weight and multilevel logistic regression were employed to estimate the odds of being edentulous, and cross–level interaction terms between wealth and country factors.</div></div><div><h3>Findings</h3><div>Individuals at the lowest wealth quintile had the highest prevalence of edentulism in all regimes. The highest age-sex standardised prevalence was found in Eastern European countries (8.4%, 95% Confidence Interval: 7.6–9.3), followed by Corporative (8.1%, 95% CI: 7.0–9.3), while the lowest was among the Insecurity regime (0.8%, 95% CI: 0.4–1.5), followed by the Scandinavian regime (4.7%, 95% CI: 3.5–6.1). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 20.6 (95% CI: 15.3–27.8) times higher likelihood of being edentulous and 17.3 percentage points (pp) higher prevalence. Low-income countries in the Insecurity regime presented the lowest level of inequality. Among high- and upper-middle income countries, the Scandinavian regime had the lowest absolute inequalities (5.5 pp difference between highest and lowest quintiles). The Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 2.20, 95% CI: 1.06–4.59).</div></div><div><h3>Interpretation</h3><div>Our findings indicate that some welfare regime policies may enhance oral health while decreasing socioeconomic inequalities. Higher prevalence and inequalities among industrialised countries may reflect higher levels of oral health hazards.</div></div><div><h3>Funding</h3><div>This was partially supported by a <span>National Institute for Health and Care Research</span> (UK) grant number <span><span>132731</span></span>.</div></div>","PeriodicalId":53223,"journal":{"name":"Lancet Regional Health-Europe","volume":"63 ","pages":"Article 101578"},"PeriodicalIF":13.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847659","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}