Lancet Public Health最新文献

{"title":"The public health risks of counterfeit pills","authors":"Joseph Friedman, Daniel Ciccarone","doi":"10.1016/s2468-2667(24)00273-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00273-1","url":null,"abstract":"Synthetic illicit drugs, such as nitazenes and fentanyls, are becoming commonplace in countries around the world, including in Europe, Australia, and Latin America, which raises concern for overdose crises like those seen in North America. An important dimension of the risk represented by synthetic drugs is the fact that they are increasingly packaged in counterfeit pill form. These pills—often indistinguishable from authentic pharmaceuticals—have substantially widened the scope of populations susceptible to synthetic drug overdose in North America (eg, among adolescents experimenting with pills or tourists from the USA seeking psychoactive medications from pharmacies in Mexico). The non-medical use of diverted prescription medications is relatively more common, and less stigmatised, than the use of powder drugs. Many consumers of counterfeit pills are unaware that they contain synthetic illicit drugs, believe them to be authentic pharmaceuticals, and would be unlikely to consume those drugs knowingly or if in powder form. Given these issues, we recommend the expansion of educational and awareness campaigns, pill testing programmes to help consumers shift demand to safer products, increased monitoring in routine clinical scenarios and overdose death toxicology, and expanding medically managed safer alternatives to counterfeit pill use.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"28 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924614","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 SARS-CoV-2 test scale-up in the USA: an analysis of the number of tests produced and used over time and their modelled impact on the COVID-19 pandemic","authors":"Steven Santos, Matthew Humbard, Anastasia S Lambrou, Gary Lin, Yamil Padilla, Jasmine Chaitram, Muktha S Natrajan, Hannah L Kirking, Sean Courtney, Kim Del Guercio, Seth Roberts, Fraser Gaspar, Michael F Iademarco, Joseph Hamel, Reynolds M Salerno","doi":"10.1016/s2468-2667(24)00279-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00279-2","url":null,"abstract":"<h3>Background</h3>Rapid, accessible, and accurate testing was paramount to an effective US COVID-19 response. Federal partners supported SARS-CoV-2 testing scale-up through an interagency-coordinated approach that focused on expanding supply chains, research and development, validation, and improving patient access. We aimed to provide an overview of the federal efforts to scale up the testing response and study the impact of scale-up.<h3>Methods</h3>In this descriptive analysis, we mapped federal partner activities and milestones using the US Government Testing and Diagnostics Working Group (TDWG) and participating agency and department data from Jan 1, 2020, to Dec 31, 2022. Tests produced (TDWG), reported test positivity (US Centers for Disease Control and Prevention [CDC]'s COVID-19 Electronic Laboratory Reporting system and the Federal Direct Report testing data), reported COVID-19 case counts (CDC), hospitalisations (Department of Health and Human Services Unified Hospital Data Surveillance System and the CDC's National Healthcare Safety Network), and deaths (CDC) were analysed over time. We then developed an agent-based model to evaluate the impact testing had on COVID-19 outcomes using different scenarios. The scenarios were (1) if efforts led to substantially fewer tests produced, (2) if scale-up was delayed, affecting test access, and (3) if efforts led to substantially more tests produced.<h3>Findings</h3>Approximately 6·7 billion SARS-CoV-2 tests, including over 1·5 billion laboratory-based, 1·9 billion point-of-care (POC), and 3·2 billion over-the-counter (OTC) tests, were produced, and approximately 2·7 billion tests were performed between Jan 1, 2020, and Dec 31, 2022. Testing capacity exhibited various expansion phases, with laboratory-based capacity growing from approximately 6 million tests per month in March, 2020 to approximately 34 million tests per month in July, 2020; POC increased to approximately 126 million tests per month by December, 2020, and OTC increased to approximately 986 million tests per month by February, 2022. Comparison between the baseline (actual) and delay-in-testing scenario suggests the increased testing capacity potentially saved upwards of 1·4 million lives and averted 7 million hospitalisations.<h3>Interpretation</h3>Our study suggests that early development, manufacturing, and distribution of tests had a great impact on reducing severe COVID-19 outcomes. These results highlight the importance of robust and rapid test development, production, and distribution when addressing future public health threats.<h3>Funding</h3>US Administration for Strategic Preparedness and Response and US Centers for Disease Control and Prevention.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"116 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924609","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":"Mortality in survivors of adolescent and young adult cancer: progress and opportunities","authors":"Michael E Roth, Amy M Berkman","doi":"10.1016/s2468-2667(24)00277-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00277-9","url":null,"abstract":"Survivors of adolescent and young adult (AYA) cancer (ie, those aged 15 to 39 years at diagnosis) are a large and growing population. There are more than 2 million survivors of AYA cancer in the USA alone,<span><span>¹</span></span> and efforts targeted at reducing late morbidity and mortality are urgently needed. In <em>The Lancet Public Health</em>, Taylor Hughes and colleagues<span><span>²</span></span> evaluate the risk of mortality after a diagnosis of cancer as an AYA over a median of 9 years from diagnosis. Including 24 459 individuals with primary AYA cancer in the Alberta AYA Cancer Survivor Study, they found that all-cause cumulative morality was 35·6% (95% CI 34·6–36·7) at 30 years from diagnosis. This translated to an 11-fold increased risk of mortality in the overall cohort and a 4-fold increased risk of mortality among those who reached 5 years of survival compared with expected mortality in the general population. Cancer recurrence or progression was the main driver of excess mortality, whereas beyond 10-years from diagnosis, subsequent primary neoplasms (SPN) and non-cancer causes of death became more prevalent. Encouragingly, the authors found reductions in mortality for AYAs diagnosed with cancer in more recent decades, largely the result of decreased deaths due to cancer recurrence or progression. These results are similar to those of previous population-based survival analyses using data from the Surveillance, Epidemiology, and End Results database and California Cancer Registry, which found improvements in primary cancer mortality over time, as well as persistently elevated long-term risks of non-cancer and SPN mortality among survivors of AYA cancer.<span><span>3</span></span>, <span><span>4</span></span>, <span><span>5</span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"66 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924613","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":"Overall and late mortality among 24 459 survivors of adolescent and young adult cancer in Alberta, Canada: a population-based cohort study","authors":"Taylor Hughes, Ruth L Diaz, Sarah McKillop, Paul C Nathan, Miranda M Fidler-Benaoudia","doi":"10.1016/s2468-2667(24)00268-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00268-8","url":null,"abstract":"<h3>Background</h3>Adolescent and young adult (AYA) cancer survivors are at an increased risk of premature mortality due to their cancer and its treatment. Herein, we aimed to quantify the excess risks of mortality among AYA cancer survivors and identify target populations for intervention.<h3>Methods</h3>The Alberta AYA Cancer Survivor Study is a retrospective, population-based cohort of individuals diagnosed with a first primary neoplasm at age 15–39 years in Alberta, Canada, between 1983 and 2017. We assessed cancer survivors (ie, all individuals included in the cohort) overall and for 2-year and 5-year survivorship subpopulations. We calculated standardised mortality ratios and absolute excess risks (AERs; per 10 000 person-years) compared with the general population, and cumulative mortality probability. Causes of death were categorised as deaths due to recurrence or progression (of the first primary neoplasm), deaths due to a subsequent primary neoplasm (SPN), and deaths due to non-neoplastic causes.<h3>Findings</h3>Among the 24 459 individuals included in the cohort, 5916 deaths were observed, which was 11·4 times (95% CI 11·1–11·7) that expected for the general population, equating to 191·6 (186·2–196·9) excess deaths; correspondingly, 5-year survivors had 4·2 times (4·0–4·4) more deaths than expected, equating to 74·3 (69·8–78·8) excess deaths. Increased age at diagnosis, poorer neighbourhood income quintile at diagnosis, first primary neoplasm type, and initial treatment plan were identified as important risk factors for mortality. While recurrence or progression was the main cause of excess mortality (AER 172·2 [167·4–177·1]), the majority of deaths beyond 10 years from diagnosis were due to SPNs and non-neoplastic causes among survivors of endometrial cancer, testicular cancer, and Hodgkin lymphoma. The cumulative mortality probability significantly decreased among more recently diagnosed survivors for all-cause mortality (p&lt;0·0001) as well as recurrence or progression deaths (p&lt;0·0001) and SPN deaths (p=0·0070), suggesting that long-term survival is improving.<h3>Interpretation</h3>AYA cancer survivors have substantial excess mortality. Given the high burden of late SPN and non-neoplastic deaths, survivors of endometrial cancer, testicular cancer, and Hodgkin lymphoma are notable populations that might benefit from primary, secondary, and tertiary prevention strategies.<h3>Funding</h3>None.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"370 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924611","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":"Anyone can drown. No one should.","authors":"","doi":"10.1016/s2468-2667(24)00305-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00305-0","url":null,"abstract":"“Anyone can drown. No one should.” notes WHO Director General Tedros Adhanom Ghebreyesus, in his foreword to the first WHO <span><span>Global status report on drowning prevention</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, released on Dec 13, 2024. Following on from the recommendations of the UN resolution on drowning prevention, championed by the Governments of Bangladesh and Ireland and the 2023 World Health Assembly resolution on accelerating action on global drowning prevention, this landmark report dissects the drowning burden globally, at the country level, and the trends since 2000, presents an overview of the key strategies to prevent drowning, and provides a benchmark for tracking prevention efforts in the future. Importantly, this report sheds light on a tragic, neglected, mostly preventable public health issue.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"34 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924608","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":"Improving implementation of needle and syringe programmes to expand, scale up, and sustain evidence-based prevention interventions for HIV and hepatitis C in prisons","authors":"Nadine Kronfli, Daniel J Bromberg, Hans Wolff, Linda Montanari, Serheii Vasyliev, Frederick L Altice","doi":"10.1016/s2468-2667(24)00275-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00275-5","url":null,"abstract":"The 1990 resolution by the UN General Assembly committed member states to provide health-care equity for people in prison, who are included in the global goals to control HIV and eliminate hepatitis C virus (HCV) by 2030. WHO has set ambitious HCV elimination targets by including people who inject drugs (PWID), yet has not prioritised PWID who are incarcerated, a substantial population who have or are at risk for HCV infection. Human rights principles of health-care equity stipulate that “prisoners should enjoy the same standards of health care that are available in the community, without discrimination on the grounds of their legal status”. Globally, only nine countries provide prison-based needle and syringe programmes (PNSPs), essential evidence-based interventions to holistically reduce the harms from drug use, of which only three countries extend reach to all prisons. Even where available, these services are accessed by few participants. PNSPs are recommended as an essential element of an effective HIV and HCV prevention strategy in prisons, and studies have shown that they are key to achieving HCV elimination in carceral settings. This Viewpoint, based primarily on unpublished data from key country-level stakeholders and expert opinion, highlights our perspective that implementation factors related to PNSP delivery in diverse settings likely contribute to low adoption and use of these services by PWID in prisons compared with in the community. However, successful expansion of these evidence-based interventions will depend on political commitment, national surveillance and monitoring programmes, and state-of-the-art implementation science methods, where inputs from multilevel stakeholders should guide improved implementation. Policy makers are urged to create and support opportunities to scale up PNSPs within countries where they exist and expand them to other countries where they are needed to solidify years of commitment towards the 2030 HCV elimination goals.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"17 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831977","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":"Early childhood adversity associated with high-intensity public service use","authors":"Nicole Racine, Andrea Evans","doi":"10.1016/s2468-2667(24)00269-x","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00269-x","url":null,"abstract":"Experiences of early childhood adversity are common, with 1 in 6 children having high levels of adversity in their childhood.<span><span>¹</span></span> These exposures have detrimental effects on children's health and developmental trajectories and are associated with poor physical and mental health outcomes across the life course.<span><span>²</span></span> Individuals exposed to high levels of childhood adversity might require increased support and services. Research exploring health service use among individuals exposed to childhood adversity has been fragmented. Understanding how exposure to childhood adversity can affect future service use across different domains and sectors is crucial.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"248 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820619","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":"Association between childhood adversity and use of the health, social, and justice systems in Denmark (DANLIFE): a nationwide cohort study","authors":"Bertina Kreshpaj, Leonie K Elsenburg, Signe Hald Andersen, Tjeerd Rudmer De Vries, Karsten Thielen, Naja Hulvej Rod","doi":"10.1016/s2468-2667(24)00242-1","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00242-1","url":null,"abstract":"<h3>Background</h3>Childhood adversities can negatively affect health and social outcomes. We aimed to assess the association between adversity in childhood and use of public services in early adulthood across three systems: health, social welfare, and justice.<h3>Methods</h3>We used Danish nationwide registry data on individuals born between 1980 and 1991 and followed up between 1998 and 2021. We evaluated annual exposure to adversity during childhood (age 0–16 years) across three dimensions—material deprivation, loss or threat of loss within the family, and family dynamics—and used this to divide individuals into five trajectory groups: low adversity, early-life material deprivation, persistent material deprivation, loss or threat of loss, and high adversity. We defined high-intensity users of each public service system as those above the 90th percentile in terms of hospital visits (health system) and weeks of social welfare use (social welfare system), and whether or not they were convicted for a crime (justice system) during early adulthood (age 18–40 years). We analysed the proportion of high-intensity users of each public service system across the childhood adversity trajectory groups. Logistic regression was used to assess whether the risk of becoming a high-intensity user differed by trajectory group relative to the low-adversity group, with adjustment for sex, parental education, parental origin, and maternal age at time of birth.<h3>Findings</h3>Of the 567 035 individuals in the cohort, 273 616 (48·3%) were in the low-adversity group, 128 238 (22·6%) were in the early-life material deprivation group, 100 959 (17·8%) were in the persistent material deprivation group, 43 826 (7·7%) were in the loss or threat of loss group, and 20 396 (3·6%) were in the high-adversity group. Childhood adversity was associated with a markedly higher risk of belonging to the high-intensity user group across all three public service systems. Specifically, low proportions of the low-adversity group became high-intensity users of the health system (19 675 [7·2%]), social welfare system (13 681 [5·0%]), and justice system (38 198 [14·0%]). By comparison, those in the high-adversity group were significantly more likely to become high-intensity users of the health system (4685 [23·0%]; adjusted odds ratio 2·81 [95% CI 2·71–2·93]), social welfare system (8158 [40·0%]; 8·88 [8·50–9·27]), and justice system (8681 [42·6%]; 3·62 [3·50–3·75]).<h3>Interpretation</h3>There were long-term effects of childhood adversities across three public service systems, with an association of high-intensity users among individuals who experienced childhood adversity. Systemic inequalities already present in childhood need to be addressed, with prioritisation of equitable resource allocation for those most in need of assistance.<h3>Funding</h3>Rockwool Foundation.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"21 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820781","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":"Inequities in access to assistive technology: a call for action","authors":"Luc de Witte, Rosalie van der Vaart","doi":"10.1016/s2468-2667(24)00270-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00270-6","url":null,"abstract":"Based on existing cross-sectional studies, case studies, and policy-related reports, experts in the field of assistive technology have long suspected that even in high-income countries such as England not everyone who could benefit from assistive technology has access to it, and that there are inequities in access. However, there was little concrete data on the extent of these gaps. Those data have been provided in the study by Danemayer and colleagues.<span><span>¹</span></span> Elegantly using longitudinal data from the English Longitudinal Study of Ageing, the authors show that in a population of 12 080 participants, 2480 (20·5%) had an unmet need for mobility assistive products at baseline and 5102 (42·2%) had an unmet need at least once during the follow-up period, which had a median duration of 4 years. The data further revealed that there are important inequities in access: women, older adults, and people with low education levels, less wealth, or disabilities have higher chances of transitioning from no need to unmet need, with women additionally being less likely than men to transition from unmet need to use. This study is important because it not only provides directions for further research, but it also particularly underscores the need for improving policy and practice. These findings align closely with those from the large, global cross-sectional study into assistive technology needs and access, published by WHO and UNICEF in their Global Report on Assistive Technology.<span><span>²</span></span> In that study, it was estimated that in countries with a very high human development index a median of 20·7% (range 16·5–59·8) of people with a need for assistive technology do not have access to it.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"22 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816145","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":"Demographic, socioeconomic, and social barriers to use of mobility assistive products: a multistate analysis of the English Longitudinal Study of Ageing","authors":"Jamie Danemayer, Mikaela Bloomberg, Adam Mills, Cathy Holloway, Shereen Hussein","doi":"10.1016/s2468-2667(24)00243-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00243-3","url":null,"abstract":"<h3>Background</h3>Cross-sectional evidence suggests that access to essential mobility assistive products (MAPs) might be dependent on non-clinical factors. However, MAP use is better understood as a dynamic process wherein individuals pass through different states of MAP need and use. We aimed to test associations of demographic, socioeconomic, and social factors with transitions between MAP need and use states.<h3>Methods</h3>For this multistate modelling study, data were drawn from 13 years (May, 2006, to July, 2019) of the English Longitudinal Study of Ageing, a prospective cohort study. We included respondents aged 50–89 years who participated in at least two waves of data collection. We used multistate models to examine associations of demographic, socioeconomic, and social factors, including age, sex, education, employment, wealth, marital status, and help with activities of daily living (ADL), with transitions between three main states: no need for MAPs, unmet need for MAPs, and use of MAPs.<h3>Findings</h3>We used data collected from 12 080 respondents (6586 women and 5494 men). During follow-up, 5102 (42·2%) of participants had unmet MAP need and 3330 (27·6%) used MAPs. Women were more likely than men to transition from no need to unmet need (hazard ratio [HR] 1·49, 95% CI 1·38–1·60) and less likely to transition from unmet need to use (0·79, 0·72–0·86). We found an increase in risk of transitioning from no need to unmet need for each 1-year increase in age (1·06, 1·06–1·07), for those with low education level (1·34, 1·23–1·45), those with help with ADL (1·32, 1·16–1·49), and who were not employed (1·22, 1·07–1·40) or disabled (3·83, 2·98–4·93). Similarly, we found an increase in risk of transitioning unmet need to use for each 1-year increase in age (1·06, 1·05–1·06), for those with low education level (1·20, 1·10–1·31), and those with help with ADL (1·25, 1·13–1·38). Increasing wealth was associated with a reduced risk of transitioning from no need to unmet need (0·78, 0·74–0·81) and from unmet need to use (0·94, 0·89–0·99). Single people were more likely to transition from unmet need to use than partnered people (HR 1·21, 95% CI 1·10–1·33).<h3>Interpretation</h3>Women might be disproportionately likely to have unmet MAP needs, whereas other demographic, socioeconomic, and social factors are associated with high MAP need overall. Our findings directly support efforts towards expanding access to assistive products and identifying groups that could particularly benefit. As the first study of its kind to our knowledge, replication with other longitudinal datasets is needed.<h3>Funding</h3>UK Aid.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"233 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816146","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}