Hypertension and diabetes commonly coexist, sharing mechanisms such as insulin resistance, obesity, and endothelial dysfunction, which together amplify cardiovascular, renal, and cerebrovascular risk. This dual burden is particularly pronounced in the Asia-Pacific region, where rapid demographic and lifestyle transitions have led to a surge in non-communicable diseases. The Asian-Pacific Society of Hypertension (APSH) and the Diabetes Asia Study Group (DASG) have jointly developed this consensus to provide region-specific, evidence-based recommendations for managing hypertension in individuals with diabetes. A multidisciplinary panel from 15 countries formulated these recommendations using a modified Delphi approach, incorporating evidence from randomized controlled trials, meta-analyses, and international and regional guidelines published between 2015 and 2025, graded according to the GRADE framework. The consensus underscores lifestyle modification as the cornerstone of therapy, emphasizing sodium restriction, weight control, regular physical activity, and avoidance of tobacco and alcohol. Pharmacologic management should be individualized, prioritizing renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, and thiazide-like diuretics as first-line options, with single-pill combinations preferred for adherence. Emerging therapies such as sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists offer added cardio-renal protection and are recommended where appropriate. A target blood pressure of <130/80 mmHg is advised for most, with ≤140/90 mmHg for older or frail individuals. Home blood pressure monitoring is preferred for ongoing management. This consensus offers a practical, patient-centered framework to optimize cardiovascular and renal outcomes in people with diabetes and hypertension across the Asia-Pacific region.
In May 2015, the World Health Organization (WHO) adopted the Global Technical Strategy 2016-2030 with the aim of reducing global malaria incidence and mortality by 90% between 2015 and 2030. To mark World Malaria Day 2026, themed “Driven to End Malaria: Now We Can. Now We Must”, we invited three researchers from three global regions to share their experiences of working towards this ambitious goal and the unique challenges and opportunities that remain. The experts involved are Dionicia Gamboa (an expert in molecular surveillance and vector genomics in the Peruvian Amazon region, Universidad Peruana Cayetano Heredia), Fitsum Girma Tadesse (an expert in malaria molecular epidemiology in Ethiopia and the Horn of Africa working at Armauer Hansen Research Institute in Addis Ababa and London School of Hygiene and Tropical Medicine), and Leanne Robinson (an expert on malaria epidemiology and implementation research in the Asian-Pacific region with a particular focus on Papua New Guinea, Burnet Institute).
Ulcerative colitis (UC) and Crohn's disease (CD) are increasingly prevalent in the Asia Pacific region, necessitating updated, region-specific guidance on advanced therapies. Targeted small molecule agents, such as filgotinib, tofacitinib, upadacitinib, etrasimod, and ozanimod; and the IL-23 p19 inhibitors (guselkumab, mirikizumab, risankizumab) are the newest advanced therapies in our armamentarium for the treatment of IBD. The aim of the Asia-Pacific consensus statements is to provide context-specific recommendations integrating real-world evidence specific to our region. The Asian-Pacific Association of Gastroenterology (APAGE) Committee on Inflammatory Bowel Disease, with the participation of Asian Education Network in Inflammatory Bowel Disease (AEN-IBD), convened a forum of 34 IBD experts from 12 countries to develop consensus guidelines on the best practices on the use of these new advanced therapies using the modified Delphi method. IL-23 p19 inhibitors have shown good efficacy in biologic-naïve and experienced patients in both UC and CD, with clinical and endoscopic superiority over ustekinumab and an excellent safety profile. JAK inhibitors (tofacitinib and filgotinib) are efficacious in UC, and upadacitinib is efficacious in both UC and CD. They have a rapid time to response, and emerging data on acute severe UC appears promising. However, careful screening and monitoring is needed for known side effects, and prophylactic vaccination for herpes zoster should be considered. S1P modulators (ozanimod, etrasimod) are efficacious in UC with a favorable side effect profile.
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology-such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia-leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy (≥10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standardized major and minor histologic criteria were developed collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorporating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
Cancer remains a major global health burden, with 10 million deaths in 2020 and among the 35 million adults worldwide with psychoactive substance use disorders (SUDs), it is a major contributor to premature mortality. In the U.S., tobacco causes over 30% of cancer deaths and alcohol nearly 5%, highlighting the role of modifiable behaviors. Despite this clinical and economic burden, national long-term data on co-occurring SUDs and cancer mortality remain limited. We therefore analyzed 22 years (1999-2020) of U.S. mortality data from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) to evaluate temporal trends and demographic and geographic disparities in psychoactive substance-related mental disorder mortality in relation to cancer among adults aged ≥25 years. Mortality data for adults aged ≥25 were obtained from CDC WONDER using ICD-10 codes C00-D48 (cancer) and F10-F19 (psychoactive substance-related mental disorders). We calculated age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) by demographics and region. Subgroup analyses paired cancer deaths with alcohol, tobacco, and other psychoactive substance categories to assess substance-specific trends. From 1999-2020, 1,789,591 deaths involved both cancer and substance use (SU)-related mental disorders. Overall AAMR rose from 5.66 in 1999 to 43.26 in 2020, increasing sharply from 1999-2005 (APC: 41.67), more gradually through 2012 (APC: 4.36), and stabilizing thereafter (APC: -1.23; p>0.05). Rates were higher in males than females (51.57 vs. 25.8), highest in non-Hispanic (NH) American Indian/Alaska Native individuals, and lowest in NH Asian/Pacific Islanders. Regionally, AAMR was greatest in the Midwest (49.32) and lowest in the West (25.38) with Vermont and California representing the highest and lowest AAMR states, respectively. Nonmetropolitan areas had higher rates than metropolitan areas (49.6 vs. 34.26). By substance, alcohol-related AAMR declined until 2012 then rose, tobacco increased sharply early and later stabilized, and "psychoactive drug"-related mortality was stable until 2008 before increasing. Overall, AAMR plateaued after 2012, with the highest burden in NH American Indian/Alaska Natives, males, and rural Midwest residents, highlighting demographic and geographic disparities among individuals with concomitant cancer and psychoactive substance use-related mental disorders.
Despite the United States having a low overall gastric cancer incidence rate, there remain disparities by race/ethnicity. We examined the incidence of gastric cancer by stage at diagnosis among Hispanic, Asian/Pacific Islander (A/PI), American Indian/Alaska Native (AI/AN), and non-Hispanic Black (NHB) populations, compared with the non-Hispanic White (NHW) population, during 2009 to 2019. Using Surveillance, Epidemiology, and End Results data, age-adjusted gastric cancer incidence rates, rate ratios (RR), and 95% confidence intervals (CI) were calculated by stage and race/ethnicity. Stratified analyses were performed by sex, age, and anatomic site. Compared with NHW individuals, the incidence rates of regional and distant-stage gastric cancer diagnoses were nearly two times higher in Hispanic (RRregional, 1.87; 95% CI, 1.78-1.97; RRdistant, 1.92; 95% CI, 1.84-2), A/PI (RRregional, 2.17; 95% CI, 2.04-2.30; RRdistant, 1.58; 95% CI, 1.49-1.68), and NHB (RRregional, 1.78; 95% CI, 1.67-1.88; RRdistant, 1.80; 95% CI, 1.71-1.89) individuals. In stratified analyses, the increased rate of advanced-stage diagnosis for Hispanic, A/PI, and NHB individuals remained generally consistent by sex and age, although young AI/AN individuals also had a significantly higher rate of distant gastric cancer (RR, 2.38; 95% CI, 1.36-3.83). By site, the increased rates of advanced-stage diagnosis were limited to noncardia and overlapping/unspecified gastric cancer, whereas these populations had lower rates of cardia gastric cancer than NHW individuals. Hispanic, A/PI, and NHB individuals have disproportionately high advanced-stage noncardia gastric cancer rates compared with NHW individuals. This study has identified significant disparities in advanced-stage noncardia gastric cancer, suggesting the need to identify strategies to improve early detection in these populations.
PurposeTo examine disparities in receipt of the first course of treatment modality used among individuals diagnosed with early-onset colorectal cancer, focusing on sex, race/ethnicity, and rurality differences.MethodsWe conducted a cross-sectional analysis utilizing national data from the 2006-2020 Surveillance, Epidemiology, and End Results Program among adults aged 20-49. Key factors included sex, race/ethnicity, and rurality. Our main outcomes were whether patients started treatment, and which types they received. Multivariable logistic regression models were performed.ResultsOf total 82,427 patients, males (54.9%, p=0.097), racial minorities (0.8%-23.3%, p<0.001), and patients in all urban areas (70.7%; p<0.001) had higher rates of no treatment. Adjusted analysis showed that male patients had16%-19% lower odds of receiving surgery regardless of rurality (p<0.05) compared with female patients. In all/mostly urban areas, Black patients were found to had 17%-41% lower odds of receiving any treatment modalities (p<0.05); Hispanic patients had 11%-24% lower odds of receiving any treatment modalities (mostly urban: OR, 0.76; 95% CI, 0.60-0.95) or surgery alone (all urban: OR, 0.89; 95% CI, 0.84-0.95) compared with White patients. In rural areas, 33% and 34% lower odds of receiving radiation treatment were found among American Indian (AI)/Alaska Native (AN) (OR, 0.67; 95% CI, 0.46-0.98) and Asian/Pacific Islander (PI) patients (OR, 0.66; 95% CI, 0.44-0.99) compared with White patients, respectively.ConclusionsDisparities in receipt of surgery treatment were observed in males regardless of rurality. Black and Hispanic patients in urban areas had lower treatment use, while AI/AN and Asian/PI patients in rural areas were less likely to start radiation. Targeted approaches for specific groups are needed. Younger adults with colorectal cancer often experience diagnostic delays and are more frequently diagnosed at later stages than those diagnosed at age 50 or older, likely reflecting challenges in accessing timely and appropriate care. Evaluating whether patients receive treatment after diagnosis is therefore critical for understanding access to care in this population. In our study, we observed several disparities in receipt of treatment. Male patients were consistently less likely to receive surgery, regardless of whether they lived in urban or rural areas. Black and Hispanic patients in all or mostly urban settings had lower odds of receiving treatment, while American Indian/Alaska Native (AI/AN) and Asian/Pacific Islander (PI) patients in rural areas showed reduced receipt of radiation therapy. These patterns underscore the need for targeted interventions that improve provider awareness and strengthen cultural competency. Addressing barriers faced by Black and Hispanic patients in urban areas and enhancing patient navigation and referral pathways for AI/AN and Asian/PI patients in rural communities are essential steps toward equitable treatment access.
Objectives. To investigate the impact of evolving antiencampment policies on encampment closures after the US Supreme Court decision in City of Grants Pass v Johnson. Methods. We used descriptive statistics and geospatial analysis to compare encampment closure activity in Oakland, California, before (January 2021‒June 2024) and after (July 2024‒December 2024) the Grants Pass decision. Results. After Grants Pass, monthly closure counts significantly increased and their spatial distribution expanded. Many sites were closed repeatedly. Closures shifted to census tracts with lower household incomes, increased poverty rates, larger shares of Hispanic and Black residents, and smaller shares of White and Asian/Pacific Islander residents. Conclusions. These patterns suggest expanded enforcement activity enabled by the decision, homeless population dispersion because of intensified closure activity, or both. The frequency of repeated closures indicates that this intervention does not effectively resolve encampments. Public Health Implications. To minimize resource-intensive repeat closures and prevent the redistribution of homelessness to more vulnerable communities, jurisdictions should reallocate resources toward expanding adequate shelter and housing. Local governments should also publicly report health, economic, and displacement outcomes of encampment closures. (Am J Public Health. Published online ahead of print May 28, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308473).
Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6-11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.
Les maladies du cœur et les maladies du cerveau partagent divers facteurs de risque et elles coexistent souvent; pourtant, les guides de pratique clinique en cardiologie et en neurologie sont le plus souvent produits en silos disciplinaires. Élaboré par un groupe de personnes expertes du projet C-CHANGE (Canadian Cardiovascular Harmonized National Guideline Endeavour), le présent guide de pratique clinique vise à élargir les recommandations actuelles sur les affections cardiovasculaires pour y intégrer des données probantes provenant de la documentation en neurologie et en santé mentale, ainsi que des recommandations spécifiquement destinées aux prestataires de soins qui prennent en charge des affections concomitantes du cœur et du cerveau. MÉTHODES: Le comité de rédaction qui a élaboré le présent guide de pratique clinique comprenait un comité directeur; 10 sous-comités de personnes expertes chargées de formuler des questions de recherche et de rédiger une première version des recommandations portant sur des affections cœur–cerveau particulières; une équipe d’analyse des données probantes pour garantir la rigueur de la méthodologie et son application cohérente; et un comité de mise en œuvre pour faciliter l’adoption des recommandations du guide par les cliniciennes et cliniciens ainsi que l’intégration de ces recommandations aux dossiers médicaux électroniques. La McMaster Evidence Review and Synthesis Team a apporté son soutien aux recherches documentaires et à l’évaluation critique de la documentation. Un groupe de personnes qui ont une expérience vécue (PEV) des affections concernées, y compris des personnes proches aidantes, a apporté son éclairage sur les valeurs et les points de vue de la patientèle durant tout le processus d’élaboration du présent guide. Notre processus d’atteinte du consensus a respecté les principes de l’outil Appraisal of Guidelines for Research and Evaluation II. Nous avons utilisé une méthode reconnue d’évaluation des données probantes pour déterminer le degré de certitude des données probantes et la force de chaque recommandation. Enfin, nous avons adopté les principes du Guidelines International Network pour la gestion des intérêts concurrents. Nous avons formulé 11 recommandations sur la prise en charge de diverses maladies cœur–cerveau concomitantes. Les principales recommandations comprennent le dépistage du déclin cognitif en cas de fibrillation auriculaire et de la dépression en cas de coronaropathie; le traitement de la dépression en cas de coronaropathie, de troubles cognitifs en cas d’hypertension et de la dyslipidémie en cas d’accident vasculaire cérébral (AVC); ainsi que la vaccination pour prévenir l’AVC, l’infarctus du myocarde et la démence. Nous recommandons également la prise de décision partagée, ce qui comprend le recours à des outils d’aide à la décision fondés sur des données probantes, afin de soutenir la patientèle aux prises avec des maladies cœur–cerveau. INTERPRÉTATION: Nous avons cherché à produire un guide de pratique clinique applicable et pratique pour le dépistage et la prise en charge de la patientèle aux prises avec des maladies cœur–cerveau. Notre guide s’adresse principalement aux prestataires de soins primaires, mais il est également pertinent pour faciliter la prestation et l’individualisation des soins de surspécialités et pour aider les équipes interprofessionnelles qui prennent en charge des personnes atteintes de maladies cœur–cerveau concomitantes.
To assess trends in births by maternal race and ethnicity following the Dobbs v. Jackson Women's Health Organization (Dobbs) decision. Retrospective analysis of the Centers for Disease Control and Prevention Natality Live Birth database with detailed geographical data available (2018-2023). States were classified by abortion policy environment based on the Center for Reproductive Rights' five-tier framework. For this analysis, states classified as hostile or illegal were grouped as restrictive, while those classified as expanded access or protected access were grouped as protective. We compared rates of births in restrictive vs. protective states before and after the Dobbs ruling on June 24, 2022, stratified by maternal race and ethnicity. The period from July to December 2022 was considered transitional and excluded from the analysis. The proportion of births among Hispanic patients in restrictive states increased by 12.8 %, while the proportion in protective states increased by 7.6 % (p<0.01). Rates of births among non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients in restrictive states decreased by 3.8 and 5.6 %, respectively (p<0.001). Rates of births among NHW and NHB patients in protective states also decreased by 2.4 and 6.4 %, respectively (p<0.001). Changes for Asian/Pacific Islander and other racial groups were small (<1 % relative change). Following the Dobbs decision, birth rates in restrictive states increased most among Hispanic individuals, while non-Hispanic White and Black populations saw declines. These trends highlight racial and ethnic disparities in the impact of abortion restrictions.
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Healthcare disparities in colorectal cancer, driven by insurance status and socioeconomic factors, lead to delayed diagnoses and poor surgical outcomes. We sought to examine the impact of insurance status on presentation, treatment, and in-hospital mortality among CRC patients undergoing colectomy using the Nationwide Inpatient Sample (NIS) database. We included patients aged 18-65 years diagnosed with colon cancer and undergoing colectomy, as identified by ICD-9-CM codes. We classified them as those with private insurance, Medicaid, or no insurance during the period January 1, 2005, through December 31, 2014. The primary independent variable was insurance status, and the primary outcome was in-hospital postoperative death. Associations between this outcome and insurance status were analyzed using the Cox proportional hazard model, both in the full cohort as well as in a subset of patients with low comorbidity, with models stratified by hospitals to account for clustering effects from variations in access to care. The study cohort included 301,304 patients, of whom 238,158 (79.0%) were privately insured, 40,417 (13.4%) on Medicaid, and 22,729 (7.6%) were uninsured. Most patients were White (71.6%), followed by African American (12.6%), Hispanic (8.4%), Asian/Pacific Islander (3.8%), and Native American (0.5%). A total of 55.4% of cases took place in teaching hospitals. In the unadjusted analysis, the mortality rate for privately insured patients was 0.7% (95% CI 0.6-0.7%) compared with 2.1% for uninsured patients (95% CI 1.7-2.5%) and 1.5% for Medicaid recipients (95% CI 1.2-1.8%; p = 0.001). After adjusting for patient characteristics and stratifying by hospital in patients with low comorbidity, uninsured patients still had a higher risk of experiencing in-hospital death (HR, 1.60; 95% CI 1.24-2.07) compared with privately insured patients, while no significant disparity was found in Medicaid recipients (HR, 0.95; 95% CI 0.75-1.22). Uninsured patients undergoing colectomy for colon cancer experienced the highest in-hospital mortality, a disparity not fully explained by overall health differences. These findings underscore the critical role of insurance coverage in improving surgical outcomes and highlight the need for policy interventions to reduce mortality disparities.
Severe asthma (SA) is associated with frequent exacerbations and high treatment costs. To develop and validate an individualized risk calculator for severe exacerbations in SA, and evaluate its clinical utility for guiding personalized clinical decisions. Patients with SA were identified from combined data from the International Severe Asthma Registry (2015-2022) and NOVEL observational longiTudinal studY (2016-2023) across 30 countries and regions. The prediction end point was the 12-month risk of 1 or more or 2 or more severe exacerbations. Using expert input and Bayesian network analysis, 11 routinely measured predictors were identified, measured within the past 12 months. A mixed-effects, zero-inflated negative binomial model was developed, adjusting for between-country variability and biologic drop-in effects. Internal-external cross-validation was performed using the natural clustering by country settings. Data from 9911 patients with SA were used. Essential predictors included age, sex, past 12-month severe exacerbations, asthma control, chronic rhinosinusitis, FEV1 to forced vital capacity ratio, percent predicted FEV1, blood eosinophils, fractional exhaled nitric oxide, and long-term oral corticosteroid and macrolide use. The model also adapted setting-specific baseline risks. In the internal-external cross-validation, across broad geographical and health care variability, the model showed excellent calibration and informative, generalizable discrimination (pooled area under the time-dependent receiver-operating characteristics curve of 0.63 [95% CI, 0.60-0.66] for ≥1 and 0.68 [95% CI, 0.64-0.72] for ≥2 exacerbations). Decision curve analysis showed clear net benefit across risk thresholds. The Risk of Exacerbation in Severe Asthma model quantifies SA exacerbation risk using routinely available predictors and demonstrates potential clinical utility.
Adverse Childhood Experiences (ACEs) increase risk for maternal depression and anxiety, with cascading effects on the entire family. This study investigated associations between ACEs and maternal mental health in a racially diverse US sample, considering individual (self-efficacy, loneliness) and contextual (parenting stress, partner support, family strength, discrimination, neighborhood safety) factors. Mothers of toddlers (N = 334; 23% Black/African-American, 18% Hispanic/Latino, 24% Asian/Pacific-Islander, 35% multiracial/other) completed self-report measures. Hierarchical regressions controlled for demographics and COVID-19-related resource worries. ACEs, loneliness, and discrimination predicted higher depression and anxiety (p < 0.001); partner support and family strength predicted lower depression (p < 0.05). Loneliness exacerbated the ACEs-depression association (p = 0.029). By innovatively applying a developmental-ecological lens to adulthood, findings highlight the importance of developmentally and culturally responsive interventions that address both past and present adversity, in order to promote maternal and family well-being and to prevent the intergenerational transmission of trauma.
Colon cancer incidence is increasing globally, yet its spatial and temporal dynamics in Central Asia remain insufficiently studied. This study aimed to assess regional disparities and temporal trends of colon cancer incidence in Kazakhstan from 2005 to 2024 using geospatial and age-period-cohort analyses. A nationwide population-based study was conducted using data from the Unified Nationwide Electronic Health System of Kazakhstan. Crude incidence rates (CR) and age-standardized incidence rates (ASR) were calculated per 100,000 population using the WHO world standard population. Spatial patterns were assessed based on the administrative division of 2005, and clustering was evaluated using the Getis-Ord Gi* statistic. Temporal trends were analyzed using Joinpoint regression and Age-Period-Cohort analysis modeling, including estimation of net drift, local drift, and period and cohort rate ratios. The national CR was 9.64 per 100,000, and the ASR was 9.44 per 100,000. A persistent north-south gradient was observed, with higher incidence in northern and central regions (Pavlodar, Kostanay, Karaganda, North Kazakhstan, Astana) and lower rates in southern regions. Spatial clustering analysis identified significant hotspots in northern regions and coldspots in the south. Age-Period-Cohort analysis demonstrated a strong age effect across all models. The net drift was +0.57% per year (95% CI 0.23-0.91; p=0.001), with the highest increases observed in older age groups (65-84 years). Period and cohort effects were also significant, indicating the influence of demographic aging, healthcare changes, and generational risk factors. Colon cancer incidence in Kazakhstan is characterized by pronounced spatial disparities and is primarily driven by population aging. The combined geospatial and Age-Period-Cohort analysis approach provides a comprehensive framework for understanding disease dynamics and supports the development of targeted cancer control strategies.
Chronic pancreatitis (CP) imposes substantial clinical and economic burden, yet contemporary nationwide trends and disparities are incompletely characterized. We quantified national trends in CP hospitalizations, examined sociodemographic disparities, and evaluated clinical outcomes and resource utilization using the National Inpatient Sample (NIS) 2016-2022. We conducted a retrospective cohort study of adults (≥18 years) with chronic pancreatitis (CP) identified by ICD-10-CM codes (primary or secondary diagnosis) in the National Inpatient Sample (NIS), 2016-2022. We described patient and hospital characteristics and modeled temporal trends in CP-associated hospitalizations using survey-weighted logistic regression with year as a continuous variable. To contextualize temporal changes during the COVID-19 pandemic, we additionally calculated annual CP-associated hospitalization rates per 100,000 all-cause hospitalizations. estimated adjusted odds ratios (aORs) for hospitalization by race/ethnicity and key risk factors (alcohol use disorder [AUD], non-alcohol substance use disorder [SUD], psychiatric disorders, homelessness), adjusting for age, sex, Elixhauser comorbidity index, hospital characteristics, and region. We summarized in-hospital outcomes, complications, and resource utilization. We identified 15,732 CP hospitalizations (mean age 49.9 ± 14.0 years; 52.8% male). Most were White (63.7%), followed by Black (21.4%) and Hispanic (10.1%). Mean length of stay (LOS) was 4.5 ± 5.3 days, and mean total hospital charges were $48,068 ± 73904.35 . In adjusted models treating year as a continuous variable, the odds of CP-associated hospitalization decreased by approximately 8% annually (adjusted odds ratio [aOR] 0.92; 95% CI 0.90-0.94; p<0.001). Although absolute weighted counts transiently increased in 2020, rates normalized to all-cause hospitalizations continued to decline overall, decreasing from 41.9 per 100,000 hospitalizations in 2016 to 27.5 per 100,000 in 2022. After adjustment, Black patients had significantly higher odds of CP hospitalization than White patients (aOR 1.15; 95% CI 1.09,1.21; p < 0.001). Hispanic (aOR 0.75; 95% CI 0.70,0.80; p = 0.0195) and Asian/Pacific Islander patients (aOR 0.48; 95% CI 0.40,0.58; p < 0.001) had substantially lower odds. Behavioral and social risk factors demonstrated strong association with CP hospitalization: AUD (aOR 5.76; 95% CI 5.48,6.064; p < 0.001), non-alcohol SUD (aOR 2.67; 95% CI 2.55,2.79; p < 0.001) and psychiatric comorbidity (aOR 1.57; 95% CI 1.50,1.65; p < 0.001) were independently associated with higher hospitalization risk. Homelessness was associated with lower odds after adjustment (aOR 0.76; 95% CI 0.64,0.90; p = 0.002). Overall in-hospital mortality was low (0.3%). Complications included acute kidney injury (9.2%), venous thrombosis (2.6%), portal vein thrombosis (1.7%), and sepsis (0.7%). From 2016-2022, CP-associated hospitalization rates declined overall, although absolute hospitalization counts demonstrated a transient increase during the first pandemic year. Marked disparities persist-higher odds among Black patients and strong associations with AUD/SUD and psychiatric comorbidity. Despite low inpatient mortality, CP continues to generate significant resource use. These findings support targeted prevention (alcohol/substance use), integrated behavioral health, and equity-focused strategies to reduce avoidable hospitalizations.
Introduction: Hypertension contributes to cardiovascular mortality, yet its role as an underlying cause with intracerebral hemorrhage (ICH) as a contributing cause is underexplored. Understanding demographic and geographic patterns can guide prevention. Aim: To analyze mortality trends and demographic disparities in deaths with hypertension as the underlying cause and ICH as a contributing cause, using the CDC Multiple Cause of Death (MCD) database from 1999-2020. Methods: Retrospective observational analysis of the CDC MCD database for adults aged ≥25 years in the United States from 1999-2020. Deaths were included if hypertension (I10-I15) was the underlying cause and intracerebral hemorrhage (ICH I61) a contributing cause. Data were stratified by gender, race, geographic region, and place of death. Crude and age-adjusted mortality rates per 1,000,000 and annual percentage change (APC) were calculated. Temporal trends were assessed using Joinpoint software. Results: Among 14,613 deaths (crude rate 3.3 per million), most decedents were male (56.5%) and White (62.8%); Black/African American individuals accounted for 31.2%, Asian/Pacific Islander 5.3%, and American Indian/Alaska Native 0.7%. Most deaths occurred in metropolitan areas (89.4%) and in medical facilities (61.0%), while 25.2% occurred at home. Age-adjusted rates were stable from 1999-2007, declined 2007-2013, then rose 2013-2020. Females showed larger early declines followed by a modest rise, whereas males experienced a later sharper increase. Black/African American decedents had early declines with a subsequent plateau, while White decedents showed smaller early change, followed by decline and later increase. Conclusion: Deaths with hypertension as the underlying cause and ICH as a contributing cause were concentrated among males, White and Black populations, and metropolitan residents, with most deaths in medical facilities. Notably, after a period of decline, mortality rates increased again after 2013, particularly among males and White individuals, underscoring the urgency of renewed prevention efforts.
Cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) combined with endocrine therapy are the standard of care for metastatic hormone receptor-positive, HER2-negative breast cancer (HR+ MBC). However, systemic therapy options and outcomes after progression on CDK4/6is remain poorly defined. We analyzed real-world treatment patterns and outcomes in patients with advanced HR+ MBC who received systemic therapy following CDK4/6i progression. We identified all patients with HR+ MBC treated at MD Anderson Cancer Center between January 1, 1997, and December 31, 2024. Kaplan-Meier and log-rank tests compared PFS and OS across post-CDK4/6i therapies, and a multivariable Cox model assessed prognostic factors. Among 1826 patients (99% female; median follow-up, 32.4 months), the median age at metastatic diagnosis was 56 years, and most were White (72%),with 10% Black, 9% Hispanic, 6% Asian/Pacific Islander, and <1% Native American. Following progression on CDK4/6is, 43% received chemotherapy, 38% targeted therapy, 12% endocrine therapy alone, and 7% investigational agents. Nearly half (48%) had visceral progression. Median PFS on subsequent therapy was 4.73 months (95% CI, 4.40-4.96), with no significant difference by therapy type. CDK4/6i duration ≥12 months was independently associated with improved PFS (HR 0.86; p = 0.021). Following CDK4/6i progression, most patients received chemotherapy, but PFS did not differ significantly across post-CDK4/6i treatment types. As CDK4/6is remain frontline therapy, further studies are needed to optimize treatment sequencing and improve post-CDK4/6i outcomes. Department of Defense grant (HT9425-24-1-0991) and the National Cancer Institute MDACC Support Grant (P30 CA016672).
Background Finite nucleos(t)ide analogue (NUC) therapy is an emerging treatment strategy in selected patients with chronic hepatitis B (CHB). We evaluated the feasibility, efficacy, and safety of NUC discontinuation in non-cirrhotic patients fulfilling the Asian Pacific Association for the Study of the Liver (APASL) stopping criteria. Methods We retrospectively analysed data from a tertiary gastroenterology clinic (January 2021-December 2024). Consecutive non-cirrhotic CHB patients meeting APASL criteria were included: hepatitis B e-antigen (HBeAg)-positive with stable HBeAg seroconversion and undetectable hepatitis B virus (HBV) DNA ≥12 months (preferably ≥3 years), or HBeAg-negative with ≥2 years of therapy and undetectable HBV DNA on three occasions, six months apart. Exclusion criteria were significant alcohol intake, viral coinfections, extrahepatic HBV disease, personal or family hepatocellular carcinoma (HCC) history, cirrhosis by imaging or elastography, or unwillingness to discontinue therapy. Patients were monitored for two years with clinical assessment, alanine aminotransferase (ALT), and HBV DNA. Retreatment was predefined upon virological or biochemical relapse. Results Twenty-nine patients were included (HBeAg-positive, 15; HBeAg-negative, 14). At three months, virological relapse occurred in 14/29 (48.3%) patients, more frequently in HBeAg-positive than in HBeAg-negative patients (10/15 (66.7%) vs 4/14 (28.6%); p = 0.047). No significant difference in virological relapse was observed between patients receiving tenofovir and those receiving entecavir (ETV) (5/15 (33.28%) vs 9/14 (64.28%); p = 0.09). All relapsed patients restarted the same NUC and achieved complete viral suppression within two years. Sustained off-therapy remission was observed in 15/29 (51.7%), more common in HBeAg-negative than HBeAg-positive patients (10/14 (71.4%) vs 5/15 (33.3%); p = 0.049). No flare, hepatic decompensation, antiviral non-response, or deaths occurred. Conclusions Finite NUC therapy was feasible and safe in non-cirrhotic CHB patients meeting APASL criteria. Sustained remission was maintained in half of the patients, supporting finite therapy with early monitoring and clear retreatment thresholds. However, larger multicentre studies are needed to validate these findings.