Lancet

Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.

A 57-year-old woman with a 3-day history of abdominal pain, vomiting, diffuse myalgia, and a temperature peaking at 39°C presented to her local hospital. The patient had a medical history of hypertension and type 2 diabetes and was prescribed losartan and metformin.

In The Lancet, we have published the findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 in a series of six Articles.1–6 GBD began in 1991 and has continued over the past three decades to provide a comprehensive empirical assessment of health around the world.7 With each iteration GBD has become more detailed, including more causes, risks, and locations, improving granularity of age group analyses, and has enabled the completion of extension studies, such as forecasting studies and estimations of the burden of antimicrobial resistance.

This week, The Lancet published the findings from COMMEND, the largest clinical trial to date of a psychological intervention for people with motor neuron disease (MND). This devastating, incurable neurodegenerative disease results from the loss of motor neurons in the motor cortex and spinal cord, causing progressive paralysis and eventual death. More than half of people with MND die within 2 years of a diagnosis. Rates of depression and anxiety in patients are high. Given the dire prognosis, interventions that can improve the quality of remaining life for patients are vital.

“Everything I thought was wrong.” With those powerful yet disarming words, Linda Villarosa begins her study of America's most intractable pathology—racism. Under the Skin: Racism, Inequality, and the Health of Our Nation was published in 2022 and its messages should be central to the political debates emerging today, in advance of the US Presidential election later this year. Racism, she argues, “is the American problem in need of an American solution”. But racism is, of course, more than an American problem.

Medics are preparing as best they can despite shortages of personnel and equipment. Clotilde Bigot reports.

Global health organisations are competing for influence over financing for pandemic preparedness and response in the new pandemic accord. By Ann Danaiya Usher.

Machine digital eyes can glean far more information from a scan than human experts can readily detect or accurately decipher. It may not be long before a chest x-ray report comes back with your risk of heart attack and stroke over the next decade, your coronary calcium score, your heart ejection fraction, the presence of leaky valve, and whether you have type 2 diabetes (figure). Developments in artificial intelligence (AI) make this scenario likely in the coming years. This advance is an unanticipated, opportunistic output of deep learning AI.

In her 2013 essay collection, Meaty, the comedian and writer Samantha Irby quips that, “as autoimmune diseases go”, her diagnosis of Crohn's disease “is one of the least glamorous of the bunch”. As a patient with Crohn's disease myself, I can see why. Those who experience this chronic inflammatory disease of the gastrointestinal tract know all too well the stigmas and shame that can accompany its symptoms. Unsurprisingly, Crohn's disease rarely appears in literature not tinged with a self-help ethos.

At the beginning of this decade, tremors rumbling within the inherited conventions of global health research erupted. Questions about the location, cultural backgrounds, and race and ethnicities of researchers, editors, and funders came under the spotlight. It seemed possible to imagine a world where new voices could be taken seriously and afforded the same attention and generosity routinely offered to white experts on public health in low-income and middle-income countries. Works of fiction can act as a reminder that these concerns are not unique to global health and bring fresh perspectives on representation, lived experiences, history, and hierarchies of knowledge.

Infectious diseases physician and renowned antimicrobial trialist. Born in Fortrose, Scotland, on May 14, 1934, he died in Birmingham, UK, on April 9, 2024, aged 89 years.

Sudan is facing its most severe humanitarian crisis since gaining independence in 1956. The history of conflicts in Sudan is long and heterogeneous, moving from foreign colonisation to internal ethnic and religious disputes, including almost 20 military coups interspersed with shorts periods of democracy.

WHO has proposed new terminology for “pathogens that transmit through the air”.1 The stated rationale is that “[d]uring the pandemic, the terms ‘airborne’, ‘airborne transmission’, ‘droplets’ and ‘aerosols’ were used in different ways, by different stakeholders, which contributed to confusion in communicating how this pathogen was transmitted”.1 The report proposes that use of the unqualified terms airborne and airborne transmission in the context of infectious disease transmission should be avoided.

Addressing the harms associated with drug use, illicit transnational drug trade, and the policies tied to them is one of the greatest policy challenges of our time—with intersectionalities to health, economics, and security. Restrictive interpretations by many Member States of the International Drug Control Conventions over the last 60 years have led to mass incarceration, lack of due process and fair trial, disproportionate sentencing, corporal punishment, ineffective compulsory drug treatment centres, extra-judicial killings, and iniquitous death penalty.

We read with interest Nickil R Agni and colleagues’ Article on the WHiTE 8 trial.1 This study has substantial implications for doctors concerned about antibiotic resistance and its effect on patient care. Given the high expectations for the potential of high-dose dual-antibiotic loaded cement in reducing the rate of deep surgical site infections following hip hemiarthroplasty, the WHiTE 8 trial's findings were surprising. The statistically insignificant difference in the rate of deep surgical site infections at 90 days post-randomisation between the high-dose dual-antibiotic loaded cement group and the standard care single-antibiotic loaded cement group raises questions about the current approach to preventing infections in such surgical procedures.

Nickil R Agni and colleagues’ Article1 reports results for the use of high-dose dual-antibiotic loaded cement for hip hemiarthroplasty in a UK clinical trial, providing important insights into the management of surgical site infections. We would like to highlight a potential limitation in the criteria for participant enrolment in the trial, which did not mention participants’ medical histories, medications, or lifestyles. Considering underlying conditions that are associated with infection risk (such as for diabetes, malignancies, lupus, etc) is essential,2 as these can weaken the immune system (making it more difficult for the body to fight off infections) and impair the body's ability to recover effectively.

In contradiction to results from previous studies, Nickil R Agni and colleagues’ Article1 on the WHiTE 8 randomised controlled trial showed that high-dose dual-antibiotic loaded bone cement resulted in a similar risk of deep surgical site infection at 90 days post-operation compared with standard care single-antibiotic loaded bone cement for patients aged 60 years or older with intracapsular hip fractures treated with hip hemiarthroplasties. Although the authors presented several baseline characteristics associated with increasing incidence of surgical site infection following hip hemiarthroplasties, such as cigarette use, alcohol consumption, diabetes, and renal failures, in table 1,1 they conducted subgroup analyses merely according to the included participants’ age and sex (as noted in figure 2),1 which warrants further clarification.

We would like to thank Yi Liu and colleagues, Yang Liu and Hua Fa, and Po-Jui Chu and colleagues for their Correspondences about our WHiTE 8 trial.1 Regarding long-term follow-up, Liu and colleagues raise an important point. Nearly all the literature pertaining to long-term outcomes following deep surgical site infection around a hip arthroplasty comes from planned surgery, most commonly hip replacement for arthritis.2 These reports show that deep surgical site infection has implications for patients in the long term.

Li X, Ge Z, Kan J et al. Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndromes (IVUS-ACS): a two-stage, multicentre, randomised trial. Lancet 2024; 403: 1855–65—In this Article, the major bleeding (BARC types 3 or 5) values in table 2 should have read “18 (1·0%)” for intravascular ultrasound-guided percutaneous coronary intervention; “35 (1·9%)” for angiography-guided percutaneous coronary intervention; “0·58 (0·33–1·02)” for the hazard ratio (95% CI); and “0·06” for the p value.

Ge Z, Kan J, Gao X, et al. Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo-controlled, double-blind clinical trial. Lancet 2024; 403: 1866–78—In this Article, the number needed-to-treat to prevent one clinically relevant bleeding event in the third paragraph of the Results should have read “40”. This correction has been made to the online version as of May 9, 2024, and the printed version is correct.