Lancet Public Health最新文献

{"title":"Universal health coverage in the context of migration and displacement: a cosmopolitan perspective","authors":"Santino Severoni, Claudia Marotta, Josephine Borghi","doi":"10.1016/s2468-2667(25)00117-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00117-3","url":null,"abstract":"Migration and displacement are reshaping societies and economies with profound implications for health equity and universal health coverage (UHC). In this Viewpoint, we review the unique health challenges faced by migrants and displaced people, as well as the limitations of current UHC policies and financing arrangements. We propose a cosmopolitan approach to UHC, grounded in global solidarity and structured around four pillars: supranational financing, integrated cross-border care, harmonised legal frameworks, and long-term investment in inclusive health systems. We also explore what this approach could mean practically for regional or global financing mechanisms and sources of funding, including progressive contributions and the integration of health into climate finance. Achieving equitable and effective UHC in a world shaped by mobility and crisis requires global thinking and collective action. We call for a reimagining of UHC via a cosmopolitan approach, which offers a pathway to reframe health and wellbeing as a shared right and responsibility, transcending national borders.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"43 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144305453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health outcomes and psychosocial determinants in young carers: a systematic review","authors":"Aoife Bowman Grangel, Jennifer McMahon, Nikki Dunne, Fay O'Donoghue, Stephen Gallagher","doi":"10.1016/s2468-2667(25)00099-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00099-4","url":null,"abstract":"Evidence suggests that young carers (age <25 years) can have worse health outcomes than their peers, yet the long-term effects of caregiving remain unclear. While psychosocial factors influence adult carers' health, their role in young carers' health is understudied. The aim of our Review is to synthesise longitudinal evidence examining young carers' physical and mental health and summarise psychosocial determinants. Databases were searched for eligible studies (eg, longitudinal and health-focused studies, those that included a non-carer comparison group, and studies of carers age <25 years) until Dec 31, 2024. After screening 4362 records, 18 studies met the inclusion criteria with 17 retained for narrative synthesis. All studies were conducted in high-income countries. 17 studies contributed 26 associations between caregiving and health, with 20 for mental health and six for physical health. Three studies identified links between psychosocial factors and mental health. Despite some notable inconsistencies, our findings suggest a small-to-moderate risk of poorer mental health among young carers, with stronger effects for subgroups (eg, high-intensity carers). Evidence on physical health was inconclusive. Social connections appear to play a key part in young carers' mental health. Further large-scale longitudinal studies are needed to clarify inconsistent findings. Unequal conditions of care relating to individual and situational factors could affect health in young carers.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"6 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health conditions among women in prisons: a systematic review","authors":"Katherine E McLeod, Kevin A Wong, Sumner Rajaratnam, Paige Guyatt, Stephanie Di Pelino, Naveera Zaki, Hanaya Akbari, Carolyne Kerrigan, Reilly Jones, Emily Norris, Jessica Liauw, Amanda Butler, Nyki Kish, Emma Plugge, Paula Harriott, Fiona G Kouyoumdjian","doi":"10.1016/s2468-2667(25)00092-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00092-1","url":null,"abstract":"Despite rapidly rising incarceration rates, the health needs of women in custody are overlooked. This Review aims to summarise the current evidence on the health of women in prisons around the world. In this systematic review, we searched peer-reviewed and grey literature databases for quantitative studies published between Jan 1, 2003, and Jan 29, 2025. Our population of interest was people detained in carceral spaces designated for women as part of the criminal-legal system worldwide. We included studies that reported the prevalence of health conditions (based on the Global Burden of Disease Study, or in the International Classification of Disease 11th revision) among women in custody. We assessed risk of bias using the JBI <em>Critical Appraisal Checklist for Studies Reporting Prevalence Data</em>. We identified 18 008 unique records, 247 studies (including more than 452 261 women) were included for analysis. Nearly all studies had a high risk of bias in at least one domain. Communicable diseases and mental health conditions were the most frequently described topics. Prevalence of many conditions varied widely between studies and across geographical regions. We identified gaps in the literature, particularly around non-communicable conditions and in the geographical representation of data. Globally, women in custody experience a high burden of health conditions but there are substantial gaps in current evidence and a need for improved data collection and reporting. Additionally, limitations found in some studies included the exclusion of people with complex health-care needs and the use of measures such as self-reporting, which depend on previous access to health care, and it is likely that the true burden of health conditions among incarcerated women is even greater. The findings of this Review call the correctional, health, and research communities to act to reduce the health inequities faced by women in prison.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"25 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144269146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health dividend of cash transfer programmes","authors":"Aaron Richterman, Brendan Maughan-Brown, Harsha Thirumurthy","doi":"10.1016/s2468-2667(25)00116-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00116-1","url":null,"abstract":"Cash transfer programmes have expanded rapidly across low-income and middle-income countries (LMICs), from eight countries with programmes in 1960 to 134 countries in 2019, and have demonstrated effectiveness in improving a range of human capital outcomes.<span><span>1</span></span>, <span><span>2</span></span> However, despite their proliferation, progress against poverty has stalled—or even reversed—since the COVID-19 pandemic.<span><span>³</span></span> Many programmes now stand at a crossroads, as policy makers decide whether to scale them back due to fiscal constraints or expand them.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"171 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health effects of the Brazilian Conditional Cash Transfer programme over 20 years and projections to 2030: a retrospective analysis and modelling study","authors":"Daniella Medeiros Cavalcanti, José Alejandro Ordoñez, Andrea Ferreira da Silva, Elisa Landin Basterra, Ana L Moncayo, Carlos Chivardi, Philipp Hessel, Alberto Pietro Sironi, Rômulo Paes de Sousa, Tereza Campello, Luis Eugênio Souza, Davide Rasella","doi":"10.1016/s2468-2667(25)00091-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00091-x","url":null,"abstract":"<h3>Background</h3>In 2024, Brazil celebrated the 20th anniversary of the Bolsa Família Program (BFP), one of the world's oldest and largest conditional cash transfer (CCT) programmes, covering more than 50 million Brazilians. This study aimed to evaluate the effect of the BFP on overall mortality and hospitalisation rates over the past two decades, and to forecast the potential effects of expanding this programme until 2030.<h3>Methods</h3>This study combined retrospective impact evaluations in Brazil from 2000–19 with microsimulation models up to 2030. First, the effect of the BFP on overall mortality and hospitalisation rates was estimated across different age groups, adjusting for all relevant demographic, socioeconomic, and health-care factors. Fixed-effect multivariable Poisson models were then applied to 3671 municipalities with adequate quality vital statistics data. The three exposure variables of BFP were target coverage, benefits adequacy (average transfer per family), and the interaction of coverage and adequacy. Several sensitivity and triangulation analyses were conducted, including difference-in-difference models with propensity-score matching. Previous longitudinal datasets were then integrated with validated dynamic microsimulation models to project trends up to 2030.<h3>Findings</h3>High coverage of BFP was associated with a significant reduction in overall age-standardised mortality rates (rate ratio [RR] 0·824 [95% CI 0·807–0·842]). High adequacy of BFP was associated with a reduction in overall age-standardised mortality (0·849 [0·833–0·866]). Our models estimated that the BFP prevented 8 225 390 (95% CI 8 192 730–8 257 014) hospitalisations and 713 083 (702 949–723 310) deaths in 2000–19. Stronger effects were found in BFP high coverage and high adequacy scenario, resulting in large reductions in under-5 mortality (RR 0·67 [95% CI 0·65–0·69]) and hospitalisation of individuals older than 70 years (0·52 [0·50–0·53]). Expanding BFP coverage could avert an additional 8 046 079 (95% CI 8 023 306–8 068 416) hospitalisations and 683 721 (676 494–690 843) deaths by 2030, compared with scenarios of reduced coverage.<h3>Interpretation</h3>CCT programmes have strongly contributed to the reduction of morbidity and mortality in Brazil, having prevented millions of hospitalisations and deaths in the past two decades. During the current period of polycrisis, the expansion of CCTs in terms of coverage and benefits could prevent a large number of hospitalisations and deaths worldwide, and should be considered a crucial strategy for achieving the UN health-related Sustainable Development Goal 3.<h3>Funding</h3>UK Foreign, Commonwealth and Development Office, UK Medical Research Council, and the Wellcome Trust (grant number MC_PC_MR/T023678/1).<h3>Translation</h3>For the Portuguese translation of the summary see Supplementary Materials section.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"1 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology and burden of injury in countries of the Association of Southeast Asian Nations (ASEAN), 1990–2021: findings from the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s2468-2667(25)00069-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00069-6","url":null,"abstract":"<h3>Background</h3>Injuries are among the top causes of mortality and disability in southeast Asia. Although injury prevention is a key health priority in the Post-2015 Health Development Agenda of the Association of Southeast Asian Nations (ASEAN), the focus was placed solely on road injuries. The absence of a broader recognition of injury burden and trends hinders future intervention efforts. This study aims to provide a comprehensive analysis of the burden and epidemiological trends of all injuries across ASEAN countries.<h3>Methods</h3>In this analysis of the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021, we estimated incidence, cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age, sex, location, and year for ten ASEAN member states (Brunei, Cambodia, Indonesia, Myanmar, Laos, Malaysia, the Philippines, Singapore, Thailand, and Viet Nam) from 1990 to 2021. Incidence and non-fatal disease burden were estimated using disease model Bayesian meta-regression (DisMod-MR) 2.1. Mortality was derived from the GBD Cause of Death Ensemble model. Estimates include 95% uncertainty intervals where appropriate.<h3>Findings</h3>In 2021, an estimated 35·5 million (95% UI 33·5–37·7) injury incident cases were reported in ASEAN, resulting in approximately 317 000 deaths (286 000–350 000). Substantial variation was observed across the region, with the age-standardised mortality ranging from 13·4 per 100 000 people (12·7–14·1) in Singapore to 68·5 per 100 000 (54·4–81·9) in Viet Nam. Road injury was the leading cause of mortality and morbidity in most ASEAN countries, with the highest age-standardised DALY rates in Thailand and Malaysia. Self-harm was the leading cause of mortality in Singapore, whereas interpersonal violence was the leading cause of injury deaths in the Philippines. From 1990 to 2021, the region's age-standardised injury incidence rate declined by 23·0% (21·8–24·1). Age-standardised DALY rates decreased substantially for drowning (60·6% [53·2–66·7]) and road injuries (39·6% [32·1–46·4]), whereas falls saw a smaller and more heterogeneous decline of 12·3% (2·6–21·0) over the past 31 years.<h3>Interpretation</h3>The injury epidemiological landscape in ASEAN is complex, with substantial geographical variations and emerging challenges triggered by the rapid sociodemographic transition in the region. Progress has been uneven. Effective burden reduction across different causes of injury requires strategies addressing the wide range of socioenvironmental determinants and system shortfalls. Prevention programmes need to be customised to each country's unique context and development.<h3>Funding</h3>Bill &amp; Melinda Gates Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"43 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The epidemiology and burden of cardiovascular diseases in countries of the Association of Southeast Asian Nations (ASEAN), 1990–2021: findings from the Global Burden of Disease Study 2021","authors":"","doi":"10.1016/s2468-2667(25)00087-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00087-8","url":null,"abstract":"<h3>Background</h3>The Association of Southeast Asian Nations (ASEAN) has undergone substantial epidemiological changes over the past three decades, characterised by a growing burden of cardiovascular disease. This study provides an epidemiological overview of cardiovascular diseases across ASEAN.<h3>Methods</h3>As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we assessed the prevalence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) of 12 cardiovascular diseases, stratified by age, sex, and location, for ten ASEAN member states (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Viet Nam) from 1990 to 2021. We examined the contribution of major risk factors associated with cardiovascular disease. Diverse data sources and meta-analytical modelling techniques were used to synthesise data and generate consistent estimates for each metric.<h3>Findings</h3>In 2021, there were 36·8 million (95% uncertainty interval 34·4–38·8) prevalent cases of cardiovascular disease and 1·66 million (1·51–1·80) cardiovascular disease deaths across ASEAN. The total number of DALYs was 42·4 million (38·4–46·2), making cardiovascular disease the leading cause of disease burden in the region. Compared with 1990, the number of individuals with cardiovascular disease has increased by 148·1% (144·0–152·5), whereas the age-standardised prevalence rate rose by 2·5% (1·4–3·6). The highest age-standardised prevalence rate was in Malaysia, followed by Indonesia. The top three leading cardiovascular diseases with the highest age-standardised prevalence rates were ischaemic heart disease (2070·6 [1831·3–2358·2] per 100 000 people), lower extremity peripheral arterial disease (1380·8 [1189·8–1598·7] per 100 000 people), and stroke (1300·6 [1230·5–1375·4] per 100 000 people). The age-standardised mortality rate was highest in Laos (410·9 deaths [337·2–485·9] per 100 000 people). Most cardiovascular disease burden was attributed to high systolic blood pressure, dietary risks, air pollution, high low-density lipoprotein cholesterol, and tobacco use, with high BMI and high fasting plasma glucose rapidly rising as attributive factors.<h3>Interpretation</h3>Cardiovascular disease remained the leading cause of mortality and morbidity in ASEAN in 2021. The number of individuals with cardiovascular disease is expected to rise with an ageing population and socioeconomic advancement. Given the disparities across ASEAN, interventions must be tailored at all levels to address the needs in prevention, treatment, and management.<h3>Funding</h3>The Gates Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"49 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safer opioid supply and health outcomes – Authors' reply","authors":"Tara Gomes, Gillian Kolla, Samantha Young, Ahmed Bayoumi, Tony Antoniou","doi":"10.1016/s2468-2667(25)00119-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00119-7","url":null,"abstract":"We thank Robert Tanguay and Nickie Mathew for their comments and welcome the opportunity to clarify key aspects of our study.<span><span>¹</span></span> The authors raise concerns about higher opioid toxicity rates among safer opioid supply (SOS) recipients compared with those initiating methadone. We believe it is important to emphasise our finding that opioid toxicity events declined markedly following both SOS and methadone initiation.<span><span>¹</span></span> The smaller decline among SOS recipients might reflect higher baseline risk and greater ongoing exposure to the unregulated drug supply early in treatment. Importantly, opioid-related and all-cause mortality was exceedingly low in both groups throughout follow-up, highlighting the protective effect of treatment engagement. The authors contrast our findings with those of Hai Nguyen and colleagues, who evaluated population-level trends following policy changes. However, these studies did not examine outcomes among SOS recipients, did not compare SOS with methadone, and were prone to ecological fallacy due to design.<span><span>2</span></span>, <span><span>3</span></span> Thus, these studies are more likely to be biased than our individual-level, matched cohort analysis.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"10 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of workplace interventions for health promotion","authors":"Marianna Virtanen, Tea Lallukka, Marko Elovainio, Andrew Steptoe, Mika Kivimäki","doi":"10.1016/s2468-2667(25)00095-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00095-7","url":null,"abstract":"Workplaces are an important setting for health promotion, offering established infrastructure, daily access to large populations, and opportunities to engage groups that are often under-represented in such initiatives. Although the effectiveness of workplace health promotion has been evaluated in reviews focusing on specific interventions, a comprehensive overview is needed. To address this gap, we present a quality-informed horizontal analysis encompassing 88 reviews and 339 meta-analysed effect estimates published between 2011 and 2024, covering a broad range of workplace health interventions. Mental health and stress reduction were the most frequently studied targets (36%), followed by weight management and cardiometabolic health (25%), health-related behaviours (22%), and musculoskeletal disorders and pain (17%). According to the GRADE assessment, 71 (21%) of the 339 meta-analysed effect estimates provided evidence of moderate quality, and the remainder were categorised as low or very low quality, with none classified as high quality. Mindfulness showed effectiveness across multiple stress and mental health outcomes, and cognitive behavioural techniques, stress management, physically oriented methods, and e-health interventions also showed some effectiveness. Multicomponent interventions had small but measurable effects on weight loss, glucose levels, fruit intake, and seasonal influenza vaccination uptake. A variety of behavioural, physical activity, environmental, multicomponent, and e-health interventions influenced physical activity and sedentary time at work. Consistent with findings found in non-occupational settings, effects at the individual level were generally modest but could be meaningful at both the workplace and population levels. In this Review we also discuss the broader public health implications of workplace health promotion, and highlight the strengths and limitations of the existing evidence and propose directions for future research.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"58 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of hearing intervention on falls in older adults: findings from a secondary analysis of the ACHIEVE randomised controlled trial","authors":"Adele M Goman, Nasya Tan, James Russell Pike, Sarah Y Bessen, Ziheng (Sally) Chen, Alison R Huang, Michelle L Arnold, Sheila Burgard, Theresa H Chisolm, David Couper, Jennifer A Deal, Nancy W Glynn, Theresa Gmelin, Lisa Gravens-Mueller, Kathleen M Hayden, Pablo Martinez-Amezcua, Christine M Mitchell, James S Pankow, Nicholas S Reed, Victoria A Sanchez, Frank R Lin","doi":"10.1016/s2468-2667(25)00088-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00088-x","url":null,"abstract":"<h3>Background</h3>Hearing loss is highly prevalent among older adults and has been associated with an increased likelihood of falling. We aimed to examine the effect of a hearing intervention on falls over 3 years among older adults in a secondary analysis of the ACHIEVE study.<h3>Methods</h3>The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study was a 3-year, unmasked, randomised controlled trial of adults aged 70–84 years at enrolment with untreated hearing loss and without substantial cognitive impairment. Participants were recruited at four US community-based field sites from two study populations: (1) an ongoing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) de novo from the community. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a health education control (didactic education and enrichment activities covering chronic disease prevention topics). A prespecified exploratory outcome was falls. Self-reported falls in the past 12 months were assessed at baseline and annually for 3 years, and analysed by intention to treat with covariate adjustment. The study was registered with ClinicalTrials.gov, NCT03243422, and is completed.<h3>Findings</h3>Between Nov 9, 2017, and Oct 25, 2019, 3004 individuals were screened for eligibility and 977 (238 [24%] from the ARIC study and 739 [76%] de novo) were randomly assigned, with 490 (50%) in the hearing intervention group and 487 (50%) in the health education control group. Overall mean age was 76·8 years (SD 4·0), 523 (54%) participants were female and 454 (46%) were male, and 112 (11%) were Black, 858 (88%) were White, and seven (1%) were other race. In adjusted analyses, the intervention group had a 27% reduction in the mean number of falls over 3 years compared with the control group (intervention group: 1·45 [95% CI 1·28 to 1·61]; control group: 1·98 [1·82 to 2·15]; mean difference: –0·54 [95% CI –0·77 to –0·31]). This 3-year effect of hearing intervention was consistent across both the ARIC and de novo study populations.<h3>Interpretation</h3>Hearing intervention versus a health education control was associated with a reduction in the mean number of falls over 3 years in older adults. Ongoing follow-up of ACHIEVE participants in a separate follow-up study (NCT05532657) will enable examination of the longer term effects of hearing intervention on falls.<h3>Funding</h3>US National Institutes of Health.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"83 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}