Category: Statistics

Curr Probl Diagn Radiol. 2025 Oct 24:S0363-0188(25)00193-8. doi: 10.1067/j.cpradiol.2025.10.015. Online ahead of print.

ABSTRACT

Program directors (PDs) oversee training and generously provide their time to mentorship. Cultural competency and diverse mentorship may better prepare doctors while increasing student interest. This study examines PD demographic data in IR, noting changes from 2020 to 2023. A list of IR PDs for IR programs was obtained from the ACGME. Duplicates were removed. Public websites were searched to collect age, sex, ethnicity, training, and research metrics (RM). Descriptive statistics were made for demographic data and analyzed. There were 114 unique IR PDs. By sex, 18.4 % were female. Mean age was 42.7. Of the 114, 79 had ethnic data, the most common being non-Hispanic white (54.5 %) and the least common were Hispanic (2.5 %) and Black (3.5 %). Only 2.6 % held DO degrees. In 2020, 12 % of PDs were female. In 2019, 17.8 % of trainees were female and 11.3 % were ethnicities under-represented in medicine (3.1 % Black, 8.2 % Hispanic). From 2020 to 2023, the proportion of women PDs increased by 6.4 % surpassing 2019’s 17.8 % of female trainees. Strictly comparing URM, the 7.7 % PDs has not yet met 2019’s 11.3 % of URM IR trainees. However, diversity has increased as Asian and Middle Eastern PDs account for 37.2 %, a greater than 10 % increase from 2019’s trainees. PD diversity may reflect trends in overall IR diversity. The increase in diverse PDs thus far is promising. Increased PD diversity may garner diverse student interest and provide better trained physicians.

PMID:41162207 | DOI:10.1067/j.cpradiol.2025.10.015

Travel Med Infect Dis. 2025 Sep-Oct;67S:102826. doi: 10.1016/j.tmaid.2025.102826. Epub 2025 Oct 27.

ABSTRACT

BACKGROUND: Malaria remains a significant public health threat, particularly in vulnerable populations. Insecticide-treated mosquito nets (ITNs) have been a cornerstone of malaria prevention efforts for decades. ITNs have demonstrably reduced malaria morbidity and mortality. However, their widespread use has raised concerns about a potential unintended consequence: environmental pollution.

METHODS: To assess the potential environmental impact of ITNs in a real-world setting, a Knowledge, Attitudes and Practices (KAP) survey was conducted in Djougou, a high malaria burden in Northen Benin. The survey employed a two-stage stratified random sampling approach.

RESULTS: There is an average of 2.4 people per ITN. Half of the ITNs are less than 2 months old, indicating a recent distribution campaign. The reported ITNs used the night before the survey was 73 %. Over half of the households (52 %) reported losing at least one ITN in the past year, with an average of 2.53 nets lost per household. The most common ITN brand contains alpha-cypermethrin and chlorfenapyr insecticides. We can estimate that Djougou releases approximately 133 kg of insecticides and 57.6 tons of plastic waste annually from discarded ITNs. Extrapolations to Benin and to Sub-Saharan Africa suggest a large potential environmental impacts.

CONCLUSION: The study highlights a potential environmental challenge associated with large-scale ITN use – plastic and insecticide waste from discarded nets. Further research is needed to quantify the environmental impact of abandoned nets. ITNs distribution programs should be complemented by collection and potential recycling initiatives. A circular economy approach could transform waste into a resource for fuel generation.

PMID:41162134 | DOI:10.1016/j.tmaid.2025.102826

Travel Med Infect Dis. 2025 Sep-Oct;67S:102817. doi: 10.1016/j.tmaid.2025.102817.

ABSTRACT

BACKGROUND: Malaria elimination efforts are expensive and often challenging because they are usually located in the hard-to-reach areas. Malaria elimination efforts can be greatly enhanced through the involvement of village health workers (VHWs). This systematic review aimed to study the role of VHWs in malaria elimination programs in hard-to-reach areas.

METHODS: A systematic review was conducted in five life sciences databases including PubMed, Web of Sciences, Scopus, ProQuest, and Medline, and Google. They were searched from their inception to October 2024 for studies reporting the roles of VHW in malaria elimination activities.

RESULTS: Of 14,884 articles screened, 44 articles met the inclusion criteria. Nearly 65.9 % (29) of the studies were from Africa and the rest were from Asia. Thirty-seven studies were from the hard-to-reach areas. The hard-to-reach areas included villages (18/44), hard-to-reach villages (2/44), rural areas (7/44), one study each on border areas, border forested areas, and refugee and conflict areas. VHWs were mostly involved in diagnosis and treatment of malaria (21/44), three studies on behaviour change communication and reactive case detection, four on prevention using long-lasting insecticidal nets and intermittent preventive treatment of children, two studies each on seasonal malaria chemoprevention, health education, and intermittent preventive treatment in children.

CONCLUSION: VHWs engaged in a number of malaria control activities in a hard-to-reach areas. They were primarily involved in routine control of malaria and were not regularly engaged in malaria elimination activities. As more countries are pursuing the national goal of malaria elimination, VHWs should be integrated into the elimination program.

PMID:41162133 | DOI:10.1016/j.tmaid.2025.102817

Lancet Public Health. 2025 Nov;10(11):e988-e1000. doi: 10.1016/S2468-2667(25)00222-1.

ABSTRACT

Life expectancy in the USA is considerably lower than in most high-income countries, with many deaths considered preventable. The extent by which poor performance on prevention measures and public health policies in the USA could be contributing to this issue is not well understood. To address this issue, we compared publicly available population-based indicators of health care across different levels of prevention in the USA and six high-income countries (ie, Australia, Canada, Germany, France, Sweden, and the UK) and Organisation for Economic Co-operation and Development countries between 2010 and 2023. Relative to comparator countries, the USA had a younger population and lower smoking rates, but it had higher obesity prevalence, calorie intake, illicit drug use, and gun and vehicle ownership. Regarding public health policies that lie largely outside the health-care system, the USA compared unfavourably to comparator countries. For measures dependent on the health-care system, the USA performed well across several measures of clinical prevention, including screening rates and diagnosis and control of chronic conditions. However, the USA was worse on measures of access to health care and coverage. While the USA performs well in prevention efforts within the health-care system compared with other countries for people with access to the system, it faces greater risk from external factors, generally worse dietary intake, and implements weaker public health prevention and regulation against harmful products that might exacerbate these issues. To improve population health, policy makers should prioritise multi-sectoral investments in prevention policies and improve access to health care.

PMID:41162132 | DOI:10.1016/S2468-2667(25)00222-1

Lancet Public Health. 2025 Nov;10(11):e979-e987. doi: 10.1016/S2468-2667(25)00226-9.

ABSTRACT

BACKGROUND: Premature mortality rates are higher in the USA than other peer nations. Few studies have assessed the association between cumulative unsecured debt and subsequent premature mortality. The aim of this study was to investigate the association between cumulatively accrued unsecured debt over 20 years of early adulthood and subsequent premature mortality in midlife (age 41-62 years).

METHODS: For this longitudinal analysis, we used data from 6954 participants included in the US National Longitudinal Survey of Youth 1979. Participants were followed up from 1985 to 2004 to assess debt trajectory, and from 2004 to 2018 to assess premature mortality. A group-based trajectory model was used to classify four groups of unsecured debt trajectories: no debt, constant low debt, constant medium debt, and increasing debt. Multivariable adjusted Cox proportional hazards models were used to assess associations between debt trajectory and mortality.

FINDINGS: Of the 6954 participants included in our analysis, 5670 (81·5%) individuals had constant low debt, 712 (10·2 %) had constant medium debt, 148 (2·1%) had increasing debt, and 424 (6·1%) had no debt. In adjusted models, the risk of mortality was 89% higher in the increasing debt group than the constant low debt group (hazard ratio 1·89 [95% CI 1·14-3·12]). In unadjusted models, individuals with no debt had a numerically higher risk of premature mortality compared with those with constant low debt; however, this difference was not statistically significant.

INTERPRETATION: Cumulative increasing unsecured debt in early adulthood was associated with increased risk of premature mortality in midlife. Interventions and policies targeting unsecured debt might reduce premature mortality.

FUNDING: National Institute of Health National Institute on Aging.

PMID:41162131 | DOI:10.1016/S2468-2667(25)00226-9

Lancet Public Health. 2025 Nov;10(11):e971-e978. doi: 10.1016/S2468-2667(25)00227-0.

ABSTRACT

BACKGROUND: Living in poverty increases the risk for mortality. Existing research that examines life course poverty typically relies on measures separated by decades of time. Here, we aimed to estimate the association of 20-year cumulative poverty exposure from emerging adulthood through to established adulthood with premature mortality assessed over the following 15 years.

METHODS: We included National Longitudinal Survey of Youth 1979 study participants with three or more family income measures between 1985 and 2004. Participants were, on average, aged 23 years at the start and aged 42 years at the end of this period. Follow-up for premature mortality began in 2004 and ended in 2019, at which time participants were aged 53-62 years. We defined cumulative poverty by the proportion of family size-adjusted income measures less than 200% of the Federal Poverty Level: never in poverty, sometimes in poverty (>0 and less than a third of measures), often in poverty (a third or more but not all measures), and always in poverty. Primary analyses used confounder-adjusted Cox proportional hazards regression models. Our outcome was mortality between 2004 and 2019.

FINDINGS: Our sample included 5653 participants, with 1484 (26·2%) never in poverty, 1867 (33·0%) sometimes in poverty, 1852 (32·8%) often in poverty, and 450 (8·0%) always in poverty. 363 (6·4%) participants were reported deceased over follow-up. Compared with participants never in poverty, those sometimes, often, and always in poverty had 1·10 (95% CI 0·79-1·53), 1·53 (1·09-2·14), and 2·53 (1·61-3·96) times higher rates of premature mortality, respectively.

INTERPRETATION: Greater cumulative exposure to poverty across emerging and established adulthood is associated with a greater risk for premature mortality. To inform public health action and policy, future research should evaluate the effects of providing support to individuals who are experiencing financial hardships during these important life stages on health and longevity.

FUNDING: National Institute of Health’s National Institute on Aging.

PMID:41162130 | DOI:10.1016/S2468-2667(25)00227-0

Lancet Public Health. 2025 Nov;10(11):e943-e954. doi: 10.1016/S2468-2667(25)00163-X.

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to substantial health services disruption in England. Health-care policy makers need reliable national-level information on disease burden to plan services. Whole-population individual-level data, which are routinely collected and linked across multiple sources, provide comprehensive estimates that can be regularly updated at low cost. We aimed to measure the burden of cardiovascular diseases in the whole population of England from 2020 to 2024.

METHODS: Using linked National Health Service England hospital, primary care, death, and specialist registers between Jan 1, 2020, and May 31, 2024, we defined 79 common and rare cardiovascular diseases, and estimated incidence, prevalence, 30-day case fatality, and post-diagnosis rates of myocardial infarction and ischaemic stroke, focusing on five common conditions (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, and peripheral vascular disease), as well as pulmonary embolism, myocarditis, and intracranial venous thrombosis. We conducted subgroup analyses based on and adjusted for age, sex, ethnicity, long-term conditions, deprivation, and geographical area.

FINDINGS: Analysis of data for 57 406 990 people in England between 2020 and 2024 revealed changes in cardiovascular disease burden. Although incidences after the pandemic were generally stable for the five common diagnoses, myocardial infarction (events per 100 000 person-years: 245·2 vs 216·9; -12%, 95% CI -17 to -6; p=0·0003) and peripheral vascular disease (97·9 vs 86·5; -12%, -21 to -1; p=0·032) showed decreases compared with January to February, 2020. Prevalence increased for ischaemic stroke (1·5% vs 1·8%; +16%, 10 to 21; p<0·0001), heart failure (0·9% vs 1·2%; +25%, 17 to 34; p<0·0001), and atrial fibrillation (2·8% vs 2·9%; +3%; 2 to 5; p=0·0001). There was little change in 30-day case fatality for most common diagnoses before and after the pandemic. Post-diagnosis myocardial infarction and stroke rates from 30 days to 1 year increased for myocardial infarction (events per 100 000 person-years: 18 850 vs 21 289; +13%, 5 to 22; p=0·0023), ischaemic stroke (11 849 vs 13 574; +15%, 7 to 23; p=0·0008), and heart failure (5821 vs 6393; +10%, 1 to 19; p=0·031) after the pandemic. Subgroup analyses indicated higher burdens among older adults, males, deprived populations, people with multiple long-term conditions, and Asian or Black ethnicities. There were clear regional variations in the incidence of stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral vascular disease.

INTERPRETATION: Our study offers new insights into recent cardiovascular disease patterns and reveals important health inequalities at a whole-population scale for multiple cardiovascular diseases, during and after the COVID-19 pandemic. These inequalities are targets for the improvement of cardiovascular health.

FUNDING: British Heart Foundation Data Science Centre (Health Data Research UK).

PMID:41162129 | DOI:10.1016/S2468-2667(25)00163-X

Lancet Public Health. 2025 Nov;10(11):e923-e932. doi: 10.1016/S2468-2667(25)00225-7.

ABSTRACT

BACKGROUND: Prospective data on the natural history of alcohol-use disorders (AUD) from adolescence into middle adulthood are scarce. This study aims to describe the prevalence, incidence, and remission of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 AUD from adolescence into middle adulthood and thereafter characterise those who do and do not develop AUD symptoms or experience remission.

METHODS: In this prospective cohort study, data were drawn from the Australian 11-wave population-based Victorian Adolescent Health Cohort Study (N=1943; 1000 female and 943 male participants). Between wave 7 (1998) and wave 11 (2019-21), we assessed 12-month DSM-5 AUD symptoms at age 21 years and 24 years (late adolescence), age 29 years and 35 years (young adulthood), and age 42 years (early middle adulthood) using the Composite International Diagnostic Interview (CIDI). The CIDI was administered by a trained interviewer, with AUD symptoms scored to align with DSM-5 AUD clinical diagnosis. We estimated incidence and incidence rate using flexible parametric survival models, and symptom prevalence and remission from symptoms using proportions, with and without cessation of heavy drinking. We used risk ratios and relative risk ratios from univariable generalised linear regression models to describe participant characteristics associated with symptoms of AUD and remission. Multiple imputation was used to address missing data.

FINDINGS: At any wave between ages 21 years and 42 years, estimated cumulative incidence of AUD symptoms using multiply imputed data was 58·0% (95% CI 52·3-63·8), and highest in male individuals (71·6% [65·1-78·1]). Incidence and prevalence increased markedly from age 21 years to 24 years, peaking at age 24 years, then decreased and stabilised across the subsequent assessment waves at age 29 years, 35 years, and 42 years. By age 42 years, 25·0% (95% CI 21·2-28·8) of the population had either ongoing or middle-adulthood-onset AUD, 11-13% had persistent AUD symptoms from late adolescence (age 21-24 years), and most experienced remission from AUD (67·0% [61·1-73·0]), with a majority also reporting cessation from heavy drinking (63·6% [58·6-65·5]). Remission from AUD was most common between the assessment waves at age 29 years and age 35 years (43·9% [95% CI 34·5-53·3]), and in female individuals (55·3% [42·6-67·9]), with a distinct reduction in remission for male individuals between the assessment waves at age 35 years and age 42 years (32·4% [24·8-39·9]). In both male and female individuals, remission from AUD was more common in those with higher education, in stable relationships, or without long-term other substance use.

INTERPRETATION: Cumulative incidence of AUD from late adolescence to middle adulthood is high. Although most individuals with AUD remit by age 42 years, greater investment in public health prevention and health service responses is needed for those with persistent AUD, particularly in male individuals.

FUNDING: National Health and Medical Research Council of Australia.

PMID:41162127 | DOI:10.1016/S2468-2667(25)00225-7

Lancet Public Health. 2025 Nov;10(11):e901. doi: 10.1016/S2468-2667(25)00247-6.

NO ABSTRACT

PMID:41162124 | DOI:10.1016/S2468-2667(25)00247-6

Lancet Public Health. 2025 Nov;10(11):e1001-e1005. doi: 10.1016/S2468-2667(25)00245-2.

ABSTRACT

Assisted dying (encompassing euthanasia and assisted suicide) has emerged as a legally sanctioned option for end-of-life care in an increasing number of countries. Over 200 million people now live in jurisdictions permitting some form of assisted dying, with at least 12 countries having implemented national or subnational legislation as of May, 2025. Legal frameworks, terminology, and procedures remain highly heterogeneous, affecting how assisted dying is perceived, delivered, and monitored. Terminological variation and the absence of specific ICD codes impede international data comparability, limiting public health surveillance and cross-country learning. In jurisdictions permitting both euthanasia and assisted suicide, euthanasia accounts for most assisted deaths, suggesting that system-level factors, such as integration into hospital-based care, procedural routines, and access barriers, might shape uptake alongside individual preferences. Socioeconomic inequalities further influence access to assisted dying and broader end-of-life care, highlighting persistent equity challenges. This Viewpoint emphasises the need for harmonised terminology, transparent and comparable data, and clear standards of care to support ethical, equitable, and patient-centred implementation. Strengthening these foundations is essential for evidence-based policy and the responsible integration of assisted dying into public health systems.

PMID:41162116 | DOI:10.1016/S2468-2667(25)00245-2