Lancet Public Health最新文献

{"title":"Effect of extending PrEP initiation to primary care settings: a nationwide cohort study in France","authors":"Sophie Bamouni, Sophie Billioti de Gage, David Desplas, Julie Valbousquet, Julie Lamant, Jean-Philippe Joseph, François Dabis, Agnès Viot, Mojgan Hessamfar, Salim Fakir, Rosemary Dray-Spira, Michel Carles","doi":"10.1016/s2468-2667(25)00062-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00062-3","url":null,"abstract":"<h3>Background</h3>Pre-exposure prophylaxis (PrEP) medicines are key to reducing HIV infection. Improving access, increasing initiation, and expanding the populations covered is therefore important. In June, 2021, in France, PrEP initiation was extended to primary care. The aim of this study was to describe the deployment and characteristics of PrEP initiation in primary care.<h3>Methods</h3>We did a nationwide cohort study using data obtained from the French National Health Data System (Système National des Données de Santé). We included all people aged 15 years or older, who initiated PrEP in primary care between June 1, 2021, and Dec 31, 2022. We estimated the number of PrEP initiations per month over the period, and the characteristics of people initiating PrEP and prescribers, and PrEP use.<h3>Findings</h3>13 500 individuals initiated PrEP in primary care during the study period. The mean number of PrEP initiations increased from 654 (SD 64) per month between July and December, 2021, to 783 (SD 86) per month between July and December, 2022. Individuals initiating PrEP were predominantly male (12 996 [96·3%] of 13 500 individuals) with a mean age of 36 years (SD 11·8), who lived in large urban areas (9581 [71·0%]). 1012 (7·5%) of 13 500 individuals were socioeconomically disadvantaged. Of the 5125 PrEP initiation prescribers, 4542 (88·6%) were general practitioners (GPs), and 4713 (44·7%) of 10 525 were the patient's family practitioner. In the 6 months after PrEP initiation, 6216 (70·8%) of 8783 PrEP initiators had at least one monthly renewal (mean 3·3 renewals [SD 1·7]). 11 961 (82·4%) of 14 507 renewals were made by the same practitioner who had initiated PrEP, and this proportion was higher when the prescriber who had initiated PrEP was the family practitioner (6225 [92·5%] of 7135 renewals).<h3>Interpretation</h3>Although the number of PrEP initiations in primary care steadily increased over the study period, the profile of users was unchanged when compared with before extension. The high proportion of PrEP initiations not prescribed by family practitioners highlights potential barriers to sharing sexual health concerns with the family practitioner. Extending PrEP to women, individuals who are socioeconomically disadvantaged, and all those who might benefit from it will require increased awareness among target audiences and practitioners.<h3>Funding</h3>French National Agency for Medicines and Health Products Safety.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"183 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806184","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":"Extending PrEP access and coverage in France","authors":"Leslie Grammatico-Guillon, Yazdan Yazdanpanah","doi":"10.1016/s2468-2667(25)00067-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00067-2","url":null,"abstract":"Pre-exposure prophylaxis (PrEP) has become a key strategy for HIV prevention worldwide.<span><span>1</span></span>, <span><span>2</span></span> Since 2016 in France, PrEP—in particular a fixed-dose combination of oral tenofovir disoproxil fumarate and emtricitabine—has been available and fully covered by the French Health Insurance for people considered at high-risk of HIV acquisition. Since its introduction, the number of PrEP initiations has steadily increased, with an estimated 103 407 individuals initiating PrEP up to June, 2024.<span><span>3</span></span>, <span><span>4</span></span> Nevertheless, barriers to uptake and adherence remain, and disparities in PrEP initiation are a concern. In 2023, fewer than 20% of eligible men who have sex with men (MSM) and 2–4% of women at high risk of HIV acquisition were estimated to have initiated PrEP.<span><span>5</span></span>, <span><span>6</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"18 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806242","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":"Could people live longer and healthier?","authors":"Qiushi Feng, Daisheng Tang","doi":"10.1016/s2468-2667(25)00072-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00072-6","url":null,"abstract":"Japan is an important case in ageing research, showing how the epidemiological transition progresses in a society with almost 30% of its population older than 65 years. The latest Global Burden of Disease (GBD) Study 2021, published in <em>The Lancet Public Health</em>, traced a 30-year transformation of morbidity and mortality in Japan.<span><span>¹</span></span> The study suggests that Japan has seen a slowed or plateaued trend in the continuously extended life expectancy for the past three decades, and an even slower pace of healthy life expectancy. Additionally, and importantly, regional disparity continues to widen across prefectures.<span><span>¹</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"15 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766631","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":"Changes in incarceration and tuberculosis notifications from prisons during the COVID-19 pandemic in Europe and the Americas: a time-series analysis of national surveillance data","authors":"Amy Zheng, Lena Faust, Anthony D Harries, Pedro Avedillo, Michael Akodu, Miranda Galvan, Beatriz Barreto-Duarte, Bruno B Andrade, César Ugarte-Gil, Alberto L Garcia-Basteiro, Marcos Espinal, Joshua L Warren, Leonardo Martinez","doi":"10.1016/s2468-2667(24)00325-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00325-6","url":null,"abstract":"<h3>Background</h3>The COVID-19 pandemic disrupted tuberculosis control programmes globally; whether or not this disproportionately affected people who were incarcerated is unknown. We aimed to evaluate changes in incarceration and tuberculosis notifications in prisons in Europe and the Americas during the COVID-19 pandemic.<h3>Methods</h3>Data from WHO Pan American Health Organization (PAHO) and WHO Europe were used to conduct a joint hierarchical Bayesian negative binomial time-series. This approach accounted for world region, country-specific temporal trends, and country-specific autocorrelated random effects to simultaneously model and predict both annual prison population (ie, the offset) and prison tuberculosis cases (ie, the primary outcome). Results were used to calculate percentage differences between predicted and observed annual tuberculosis notifications and prison populations during the COVID-19 pandemic years (2020–22).<h3>Findings</h3>In total, 22 of 39 countries from PAHO and 25 of 53 countries from WHO Europe were included (representing 4·9 million people incarcerated annually), contributing 520 country-years of follow-up. Observed tuberculosis notifications in prisons were lower than predicted in 2020 (–26·2% [95% credible interval –66·3 to 7·8), 2021 (–46·4% [–108·8 to 3·9]), and 2022 (–48·9 [–124·4 to 10·3]). These decreasing trends were consistent across Europe and the Americas, but larger decreases were seen in low-burden settings in 2020 (–54·8% [–112·4 to –4·8]) and 2021 (–68·4% [–156·6 to –2·9]), high-burden settings in 2021 (–89·4% [–190·3 to –10·4]), and Central and North America in 2021 (–100·3% [–239·0 to –6·3]). Observed incarceration levels were similar to predicted levels (&lt;10% difference overall) during all COVID-19 pandemic years.<h3>Interpretation</h3>Tuberculosis notifications in prisons from 47 countries in Europe and the Americas were lower than expected (at times &gt;50% lower) during COVID-19 pandemic years, despite consistent incarceration levels. Reasons for this change in tuberculosis notifications might be multifactorial and include missed diagnoses and implementation of COVID-19 pandemic measures, reducing transmission. Greater prioritisation of people who are incarcerated is needed to ensure appropriate access to care in the face of future pandemics.<h3>Funding</h3>Canadian Institutes of Health Research, National Institutes of Health, and Oswaldo Cruz Foundation, Brazil.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"183 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745274","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":"Rates, causes, and risk factors for death among justice-involved young people in Australia: a retrospective, population-based data linkage study","authors":"Stuart A Kinner, Lucas Calais-Ferreira, Jesse T Young, Rohan Borschmann, Alan Clough, Ed Heffernan, Scott Harden, Matthew J Spittal, Susan M Sawyer","doi":"10.1016/s2468-2667(25)00042-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00042-8","url":null,"abstract":"<h3>Background</h3>Children and adolescents exposed to the youth justice system have poor health profiles, but little is known about their subsequent mortality. We aimed to examine mortality outcomes in a large, state-wide cohort of young people in Australia who had contact with the youth justice system.<h3>Methods</h3>We linked youth justice records in the state of Queensland, Australia from July 1, 1993, to June 30, 2014, with adult correctional records and the National Death Index, for records up to Jan 31, 2017. We calculated all-cause and cause-specific crude mortality rates per 100 000 person-years, and age-standardised and sex-standardised mortality ratios with 95% CIs. Calculations were performed for the whole cohort and in subgroups defined by sex, Indigenous status, and youth justice history. We used survival analysis to identify demographic and criminal justice factors associated with all-cause mortality.<h3>Findings</h3>Of 49 011 individuals in the study sample, 321 were excluded due to data linkage or data quality issues and 20 were excluded as they did not have an age or date of birth recorded, which resulted in 48 670 (99·3%) participants. 11 897 (24·4%) participants were female, 36 773 (75·6%) were male, and 13 250 (27·2%) were Indigenous. During a median of 13·5 years (IQR 8·4–18·4) of follow-up, we observed 1431 (2·9%) deaths among the 48 670 participants. Median age at end of follow-up was 28·6 years (IQR 23·6–33·6). The most common causes of death were suicide (495 [34·6%]), transport accidents (244 [17·1%]), and accidental drug poisoning (209 [14·6%]). The all-cause crude mortality rate was 218·9 deaths (95% CI 207·9–230·6) and the all-cause standard mortality ratio was 4·2 (3·9–4·4). In multivariable analyses, mortality rates were higher for males (adjusted hazard ratio [aHR] 1·5 [95% CI 1·3–1·7]); those who had been subject to community supervision (aHR 1·3 [1·1–1·5]), or detention (aHR 2·1 [1·8–2·4]) versus charge only; and those under adult correctional supervision in the community (aHR 1·9 [1·5–2·4]) versus unsupervised. More than half of the observed deaths occurred before 25 years of age, and very few (1·6%) occurred in custody.<h3>Interpretation</h3>Justice-involved young people are at markedly increased risk of premature death from largely preventable causes. Reducing the burden of preventable death among these young people will require coordinated, multi-sectoral responses that extend beyond the criminal justice system.<h3>Funding</h3>National Health and Medical Research Council, Australia.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"53 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745178","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 care universalism in Italy: a debunked myth","authors":"Anna Odone, Riccardo Vecchio","doi":"10.1016/s2468-2667(25)00064-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00064-7","url":null,"abstract":"Almost 50 years ago the Italian National Health Service (NHS) was established under the principles of health care universalism, equity, and solidarity. Where do we stand today? In an ageing society, where there is a struggle to balance increasing health needs with available resources to sustain health care, answering this question is imperative. In <em>The Lancet Public Health</em>, The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) Italian Collaborators have taken up the challenge again,<span><span>¹</span></span> after a previous attempt in 2019.<span><span>²</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"42 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745154","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":"A new perspective on the health of people experiencing homelessness","authors":"Maurizio Marceca, Giulia Civitelli, Serafina Torchiaro, Giuseppinanna Merlino, Salvatore Geraci","doi":"10.1016/s2468-2667(25)00063-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00063-5","url":null,"abstract":"As noted by Di Simone and colleagues in their Correspondence,<span><span>¹</span></span> the change in Italian law introducing the right to public primary health care for people experiencing homelessness through registration with a general practitioner (GP) represents an important first step against inequities in health care.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"58 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745177","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":"Effective interventions for active workplaces: time to get evidence into practice","authors":"Elizabeth Goyder, Kelly Mackenzie","doi":"10.1016/s2468-2667(25)00046-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00046-5","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"56 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745176","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":"Effect of the COVID-19 pandemic on incarceration and tuberculosis","authors":"Emma H Plugge, Nicola Cocco","doi":"10.1016/s2468-2667(25)00012-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00012-x","url":null,"abstract":"Although preventable and curable, 10·8 million people were diagnosed with tuberculosis and 1·25 million people died from tuberculosis in 2023.<span><span>¹</span></span> It is a disease that disproportionately affects marginalised groups—for instance, it has been clearly shown that there is a high tuberculosis incidence and low case detection rate in prison populations globally.<span><span>²</span></span> Indeed, WHO has identified incarcerated people as an important population who should be prioritised for tuberculosis control efforts.<span><span>³</span></span> However, although data show an adverse effect of the COVID-19 pandemic on the years of progress tackling tuberculosis at global, regional, and country levels,<span><span>⁴</span></span> there has been a paucity of data investigating the effect on specific marginalised populations. Amy Zheng and colleagues’ study,<span><span>⁴</span></span> which examined annual trends in incarceration rates and tuberculosis notifications among incarcerated people in Europe and the Americas before (pre-2020) and during (2020–22) the COVID-19 pandemic, is therefore an important contribution to the understanding of disease control in prisons during the pandemic.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"38 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745179","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":"State of health and inequalities among Italian regions from 2000 to 2021: a systematic analysis based on the Global Burden of Disease Study 2021","authors":"Mohsen Naghavi","doi":"10.1016/s2468-2667(25)00045-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00045-3","url":null,"abstract":"<h3>Background</h3>Over the past two decades, the Italian National Health Service has been gradually decentralised, with Italy's 21 regional governments now responsible for managing their health services. This change, coupled with austerity measures and a steadily ageing population, has adversely affected universal health coverage and equity, exacerbating inequalities and regional disparities. This study aimed to analyse time trends and subnational differences in the burden of disease from 2000 to 2019, and from 2019 to 2021 to capture the effects of the COVID-19 pandemic.<h3>Methods</h3>This study uses estimates for Italy from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We analyse trends and geographical differences in disease burden from 2000 to 2021. Metrics include life expectancy, health-adjusted life expectancy (HALE), years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) observed at national, macroregional, and subnational levels. Percent changes in rates, with both all-age and age-standardised rates, and 95% uncertainty intervals (95% UIs) are reported.<h3>Findings</h3>Life expectancy at birth in Italy increased from 79·6 years in 2000 to 83·4 years in 2019, dropped to 82·2 years in 2020 due to COVID-19, and recovered slightly to 82·7 years in 2021. HALE was 70·9 years (95% UI 67·4–73·8) in 2021. Substantial regional disparities were observed: in general, despite higher YLD rates, northern regions had better health outcomes, with higher life expectancy and HALE and lower YLL rates compared with southern regions. Overall, the top causes of YLDs were low back pain (1556·5 [1098·5–2080·2]), falls (926·2 [638·8–1253·8]), and headache disorders (858·0 [173·7–1808·2]). Anxiety and depressive disorders both had substantial increases in the period from 2019 to 2021 (19·8% and 17·3%, respectively). YLDs for Alzheimer's disease and diabetes increased substantially from 2000 to 2019 and 2019 to 2021 (70·6% and 3·0% for Alzheimer's disease and 46·8% and 7·9%, respectively for each timepoint). YLL rates declined for ischaemic heart disease from 2000 (–29·9% in 2019), but increased for Alzheimer's disease and other dementias (54·5%). DALY rates decreased overall from 2000 to 2019, but rose again in 2021 due to the COVID-19 pandemic.<h3>Interpretation</h3>The study highlights considerable regional disparities in Italy's health outcomes, driven by demography, heterogeneous health service quality, and economic inequalities. Addressing the increasing burden of Alzheimer's disease, diabetes, and mental health disorders, as well as regional disparities, requires strengthened preventive measures, equitable health service access, and socioeconomic policies, both at the national and regional levels.<h3>Funding</h3>Bill &amp; Melinda Gates Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"33 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143745196","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}