PLOS Medicine

BackgroundThe last two decades have seen substantial expansion of childhood vaccination programmes in low and middle income countries (LMICs). Here we quantify the health impact of these programmes by estimating the deaths and disability-adjusted life years (DALYs) averted by vaccination with ten antigens in 98 LMICs between 2000 and 2030. MethodsIndependent research groups provided model-based disease burden estimates under a range of vaccination coverage scenarios for ten pathogens: hepatitis...

BackgroundBacille Calmette-Guerin (BCG) is the most commonly-used vaccination globally, but multi-country cost-effectiveness analyses are outdated and have not considered sequelae in tuberculosis survivors. A rationale is lacking to guide the size of safety stocks. MethodsFor the 110 countries using universal neonatal BCG vaccination, we used a decision tree model to compare the costs and health benefits of status-quo BCG vaccination for children aged 0-4 years in 2023 to a counterfactual where...

BackgroundIndividuals who are obese in childhood have an elevated risk of cardiometabolic disease in adulthood. However, whether childhood adiposity directly impacts intermediate markers of this risk, independent of adult adiposity, is unclear. Methods and ResultsWe conducted a multivariable Mendelian randomization (MR) study to simultaneously evaluate the effects of childhood and adulthood body size on over 100 systemic molecular biomarkers representing multiple metabolic pathways. We first va...

BackgroundObesity is a modifiable risk factor for coronavirus(COVID-19)-related mortality. We estimated excess mortality in obesity, both "direct", through infection, and "indirect", through changes in healthcare, and also due to potential increasing obesity during lockdown. MethodsIn population-based electronic health records for 1 958 638 individuals in England, we estimated 1-year mortality risk("direct" and "indirect" effects) for obese individuals, incorporating: (i)pre-COVID-19 risk by ag...

AimsWe aimed to elicit preferences for weight and harm outcomes of glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment. We examined heterogeneity across key patient subgroups to support tailored treatment decisions to identify patients most likely to benefit with minimal risks. Material and MethodsWe conducted a best-worst scaling survey of adults with overweight or obesity in 15 European countries, assessing 21 GLP-1 RA outcomesincluding 5% and 10% weight gain (to align with harms) a...

BackgroundTreating asymptomatic tuberculosis (TB) infection prevents TB disease and is critical for TB elimination in the United States (U.S.). In the U.S., TB disease disproportionately affects those born outside of the U.S. The quality of TB preventive care in primary care settings for non-U.S.-born populations is poorly characterized. We aimed to measure gaps in TB preventive care among non-U.S.-born persons receiving primary care at community health clinics across the U.S. MethodsWe conduct...

BackgroundObesity remains a major public health concern in the UK, contributing towards increased disease risk and premature mortality. The Eatwell Guide - the UKs health eating model - is widely applied in policy and practice, yet evidence linking adherence to this dietary pattern with adiposity is limited. Similarly, understanding whether associations differ across population subgroups, including by level of genetic risk for obesity, is essential to inform equitable and effective dietary guida...

BackgroundType 2 diabetes (T2DM) incidence is increased after diagnosis of COVID-19. The impact of vaccination on this increase, for how long it persists, and the effect of COVID-19 on other types of diabetes remain unclear. MethodsWith NHS England approval, we studied diabetes incidence following COVID-19 diagnosis in pre-vaccination (N=15,211,471, January 2020-December 2021), vaccinated (N =11,822,640), and unvaccinated (N=2,851,183) cohorts (June-December 2021), using linked electronic healt...

BackgroundNorovirus vaccines are currently undergoing advanced clinical trials. Acute kidney injury (AKI) is a serious sequelae of norovirus infection. This study evaluated the health and economic impact of implementing a norovirus vaccination programme in England and assessed the contribution of AKI. MethodsWe constructed a deterministic age-stratified dynamic-transmission compartmental model. Three single-dose norovirus vaccination strategies were compared to a no-vaccination strategy: target...

BackgroundObesity is a risk factor for both cardiovascular disease (CVD) and cancer. The traditional body mass index (BMI)-based obesity definition (BMI [≥]30 kg/m{superscript 2}) has limitations across adulthood and ancestry. The Global Commission on Clinical Obesity in 2025 proposed a new definition incorporating central adiposity measures. The magnitude of increased disease risk among the newly classified obese persons remains undetermined. We compared the associations between obesity defi...

ObjectiveTo evaluate the impact of isoniazid on incident tuberculosis in household contacts of MDR tuberculosis cases. DesignSystematic review and individual-participant meta-analysis. Data sourcesMEDLINE, Web of Science, BIOSIS, and Embase without language restrictions for case-contact cohort studies of tuberculosis contacts. Eligibility criteria and data analysisHousehold contact tracing studies that investigated the development of tuberculosis in persons closely exposed to individuals with...

Structured AbstractO_ST_ABSImportanceC_ST_ABSType 2 diabetes and obesity drive substantial morbidity and spending. Rigorous evidence on the impacts of digitally delivered lifestyle interventions on healthcare cost and utilization are critical to assessing their value. ObjectiveDetermine the impact of a telehealth-delivered individualized nutrition therapy (INT) program on per-member-per-month (PMPM) total cost of care and utilization over one and two years. DesignRetrospective propensity score...

BackgroundUndernutrition is the leading cause of tuberculosis (TB) globally, but nutritional interventions are often considered cost prohibitive. The RATIONS study demonstrated that nutritional support provided to household contacts of persons with TB can reduce TB incidence. However, the long-term cost-effectiveness of this intervention is unclear. MethodsWe assessed the cost-effectiveness of a RATIONS-style intervention (daily 750 kcal dietary supplementation and multi-micronutrient tablet). ...

BackgroundHigher body-mass index (BMI) and waist-to-hip ratio (WHR) increase the risk of cardiovascular disease, but the extent to which this is mediated by blood pressure, diabetes, lipid traits and smoking is not fully understood. MethodsUsing consortia and UK Biobank genetic association summary data from 140,595 to 898,130 participants predominantly of European ancestry, MR mediation analysis was performed to investigate the degree to which genetically predicted systolic blood pressure (SBP)...

ObjectivesTo examine associations between cardiometabolic conditions and health-related quality of life (HRQoL) and to evaluate whether condition-associated HRQoL changed from 2001 to 2022. MethodsWe analyzed nationally representative data from U.S. adults aged [≥]18 years in the Medical Expenditure Panel Survey, 2001-2022. Survey years without BMI data (2017, 2019, 2021) were excluded. EQ-5D utilities were mapped from SF-12 scores using a validated algorithm. For each survey year, survey-we...

BackgroundIn 2018, Scotland introduced a Minimum Unit Pricing (MUP) policy to remove very-low-cost alcoholic drinks from the market and reduce adverse social and health-related impacts of excessive alcohol consumption. Any increased spending on alcohol may reduce spending on food, and adversely impact diet quality. ObjectivesTo estimate the effect of MUP on dietary energy, nutrients and diet quality. MethodsAnalyses were conducted on household level purchase data, collected by Kantar Worldpane...

BackgroundCardiovascular diseases (CVD) are the leading cause of mortality and disability globally. An ongoing reform of the Irish healthcare system is underway with a focus on preventing avoidable CVD and lessening its burden to society. However, the high rates of healthcare service use attributable to CVD and the associated costs have not been adequately quantified in Ireland. We examined the difference in health service utilisation and costs for populations with and without CVD in Ireland for...

IntroductionRandomised trials comparing new vaccines against tuberculosis for use in neonates and infants, for whom Bacille Calmette-Guerin (BCG) vaccination is established practice, are using tuberculosis infection as the primary endpoint in a non-inferiority design. Markers of tuberculosis infection have imperfect sensitivity and specificity. Flaws in the non-inferiority trial design typically bias towards the null, which may result in falsely declaring non-inferiority. MethodsWe conducted a ...

ObjectiveAdults typically overestimate height and underestimate weight compared with directly measured values, and such misreporting varies by sociodemographic and health-related factors. Using self-reported and interviewer-measured height and weight, collected from the same participants, we aimed to develop a set of prediction equations to correct bias in self-reported height and weight, and assess whether this adjustment improved the accuracy of obesity prevalence estimates relative to those b...

BackgroundThe high cost and widespread use of glucagon-like peptide 1 receptor agonists (GLP-1RAs) are a concern for healthcare budgets. Whether GLP-1RA use reduces other health care spending is unclear. MethodsWe conducted a cohort study using insurance claims data for United States adults aged 18-64 from 2016-2024, matching GLP-1RA treated members with untreated members (controls) on baseline demographics, clinical conditions, hospitalization, and medication use. Primary outcomes were per mem...