Geographic inequalities in cancer outcomes are reported internationally, but little is known about associations between geography and head and neck cancer (HNC) in Scotland. We explored how travelling times to health services influences clinical characteristics, stage at diagnosis, treatment, and one-year mortality for HNC in Scotland. We conducted a national, population-based, retrospective cohort study using linked administrative and clinical data covering all individuals diagnosed with HNC in Scotland between 2014 and 2019. We calculated and categorised their travelling times to key healthcare facilities and explored associations with key outcomes - HPV-status, stage at diagnosis, treatment received, and one-year mortality. Multivariable regression models adjusted for key confounders. 6692 patients were included. Patients with the longest travelling time (≥ 60 min or island) were less likely to present with advanced-stage disease (OR 0.73, 95 % CI: 0.54-0.98) and were significantly less likely to die within one year (HR 0.64, 95 % CI: 0.46-0.88). No difference was observed in proportion of HPV-positive cancers across travel time categories. There were also no significant differences in proportions receiving surgery or treated within 31 days of diagnosis. The association between geography and HNC in Scotland is complex and differs from previous studies in other cancers. Patients with the longest travel time had lower risk of advanced stage at presentation and reduced one-year mortality with no apparent difference in HPV-prevalence or treatment access. In context these findings suggest that travelling time disadvantage is not uniform across cancer types and highlights the need for cancer site-specific approaches to monitoring and reducing inequalities. This large, population-based analysis provides the most comprehensive assessment of HNC and geography in Scotland to date. Findings challenge assumptions of consistent travel time disadvantage and can inform policy on equitable cancer care delivery in the pre-pandemic era.

Mental disorders are a major and evolving contributor to morbidity among women of child-bearing age (WCBA). However, long-term trends, geographic inequalities, and the future burden in this population remain incompletely characterised. We quantified the burden of mental disorders among WCBA (15-49years) from 1990 to 2021 and projected trends to 2050. We assessed the burden of 10 mental disorder categories among WCBA aged 15-49years in 204 countries and territories using GBD 2021, including 9 specified mental disorders and a residual category ("other mental disorders"). We analysed prevalence and disability-adjusted life-years (DALYs) as numbers and age-standardised rates (ASPR and ASDR). A Bayesian age-period-cohort model was used to generate projections through 2050. Overall, ASPR and ASDR declined from 1990 to 2019; compared with the pre-pandemic baseline in 2019, both indicators were higher in 2020-2021. Age-specific prevalence generally increased with age and peaked at 40-44years, although patterns differed by disorder category. At the national level, Greenland and Portugal had the highest ASPR and ASDR, whereas Vietnam had the lowest prevalence and North Korea had the lowest DALYs. Across the 21 GBD regions, higher SDI was associated with higher ASPR and ASDR, with marked regional heterogeneity. Projections suggested that the burden of mental disorders among WCBA will increase through 2050, largely driven by anxiety and depressive disorders. The burden of mental disorders among WCBA remains substantial and is projected to rise through 2050, with increases during 2020-2021 relative to the 2019 baseline. These findings underscore the need for context-specific strategies that strengthen surveillance and expand accessible prevention and care-particularly for anxiety and depressive disorders-across diverse sociodemographic settings.

Funding shortfalls persist for practices in the most deprived areas, despite capitation formula adjustments. Did deprivation scores predict practice payment trends between 2018-19 and 2023-24? Multivariable analysis of English general practices (2018-19 to 2023-24), excluding practices with <750 patients or average payments >£500/patient, using published data. We fitted a quadratic mixed effects model, using cluster-robust standard errors. The outcome was log-transformed average NHS practice payments per patient (net of deductions/reimbursements). The fixed effects were time (categorical), the Index of Multiple Deprivation (IMD) score (higher score = greater deprivation), and seven covariates (geographical, population or organisational). The random effect was practices' random intercepts. Among 5,726 included practices (85.2% of England's total), median payments increased in nominal terms [8.6%] but decreased in real-terms [-12.6% (consumer price index), -9.0% (health inflation)]. The IMD-payment trend relationship was curvilinear, peaking at IMD 49.8 (1.4% above mean deprivation, IMD 23.2), declining to 0.6% higher at IMD 70. More positive payment trends were associated with the non-London regions, rurality, greater long-term conditions (LTCs) prevalence, and higher baseline payments; less positive trends with more under 16s, larger lists and Personal Medical Services contracts. In interaction models, rurality increased whilst higher LTCs decreased IMD's impact. Deprivation had a positive but diminishing association with payment trends as deprivation increased, moderated by geography and morbidity. Payment uplifts must match inflation. Funding formulas must better compensate for deprivation/morbidity, address the attenuated positive effect of deprivation in high-LTC practices and minimise geographical inequalities.

State-level abortion restrictions in the US enforced after the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision have worsened geographic, racial, and socioeconomic inequities in abortion access, warranting investigation of experiences for individuals who travel out of state to seek abortion care. To highlight the obstacles abortion seekers must overcome to obtain care, to identify common barriers and facilitators of interstate abortion travel, and to offer recommendations for abortion organizations, policymakers, and advocates to expand access for individuals living in states with abortion bans. This qualitative study analyzed data obtained from out-of-state participants collected as part of a larger cross-sectional, mixed-methods study. All English- and Spanish-speaking patients from out of state who were at least 16 years of age and medically cleared for research attending 2 abortion clinics in Illinois between September and November 2023 were eligible. Participants completed a self-administered survey and a semistructured interview. Directed content analysis was used to identify emergent and crosscutting themes. In total, 33 individuals (all self-identified as female or a woman) completed the survey and interview. Most participants were between 20 and 24 years of age (n = 12 [36%]) or 30 years or older (n = 12 [36%]), and from southern US states with a total abortion ban (n = 25 [76%]). From the time participants decided to terminate their pregnancy to the day of the abortion appointment, they experienced a median of 14.0 days of delay, with a mean (SD) of 29.6 (36.5) days of delay. Patient journeys of seeking abortion were categorized into 3 phases: information gathering, planning finances and travel, and traveling and completing the appointment. Participants reflected on how restrictive policies in their home states deepened abortion stigma and stifled access to accurate information. Most participants encountered their longest delays in the information-gathering phase, as they had to find legitimate clinics, often without any referrals, and navigate the complex web of laws between states. When patients had personal financial security, strong social support, or were in geographic proximity to a state in which abortion was legal, their journeys were facilitated. In this cross-sectional qualitative study of participants traveling across state lines for abortion, the policy landscape and abortion stigma of the home state, information and resource availability, and interpersonal support shaped their journeys in the post-Dobbs landscape. To improve cross-state abortion access for individuals in states with abortion restrictions or bans, policy change should be coupled with increased visibility of accurate information, charitable funding, and abortion stigma reduction. Abortion support organizations and the public should continue to enable access through social support services, such as volunteer drivers and abortion doulas.

The Diversity and Equity Committee (DEC) of the Asian Pacific Society of Nephrology (APSN) conducted a regional review to characterise disparities in kidney disease burden, healthcare access and nephrology service delivery across the Asia-Pacific (AP) region. A descriptive summary was compiled using national reports, registries, and expert inputs from DEC representatives. Data included kidney disease prevalence, dialysis and transplant modalities, healthcare system characteristics and disparity-related indicators. Comparative insights were drawn across countries using structured tables and narrative synthesis. The AP region exhibits a disproportionate burden of chronic kidney disease (CKD) and kidney failure with marked heterogeneity in disease aetiology, healthcare financing, and infrastructure. High-income countries such as Japan, Korea, Taiwan and Australia demonstrate mature universal insurance systems, comprehensive dialysis networks and national CKD prevention programs. Middle- and lower-income countries-including Indonesia, Myanmar, Mongolia and parts of South and Southeast Asia-face critical challenges such as workforce shortages, limited dialysis and transplant capacity and geographic inequities. Despite these challenges, several countries have introduced exemplary models to enhance equity and sustainability in kidney care: PD-first policies (Hong Kong, Thailand), pay-for-performance CKD programs (Taiwan), Kidney Health Plan 2033 (Korea), HALT-CKD (Singapore), and ACT-KID (Malaysia), indigenous kidney health efforts in Australia and the inclusion of additional insurance points for patient education in Japan. Persistent gaps remain in early detection, transplantation access, rural care and minority equity. Kidney disease care in the Asia-Pacific region reflects both diversity and disparity. Although universal health coverage and national kidney health initiatives have improved access in many countries, substantial inequities persist across geography, income and cultural groups. The collective experiences highlight both common challenges and innovative solutions. Strengthening regional collaboration, policy-driven efforts and sustainable workforce development are essential to achieving equitable kidney health for all.

Assessing global patterns and health risks of vegetables as a dietary mercury exposure pathway.

BackgroundDiabetes mellitus (DM) and depression commonly co-occur, worsening self-management, complications, and survival. Yet long-term, population-based surveillance of mortality that involves both conditions remains limited.ObjectiveTo characterize national trends in mortality co-listing diabetes and depression and to examine disparities by demographics and geography.MethodsWe analyzed U. S. Multiple Cause-of-Death records from CDC WONDER for 1999–2023. Deaths that listed diabetes (ICD-10 E10–E14) and depressive disorders (ICD-10 F32–F33, F41.2) as underlying or contributing causes were included. We calculated crude and age-adjusted mortality rates (AAMRs) per 100,000, directly standardized to the 2000 U. S. population, and fitted segmented Joinpoint regression to estimate annual percent change (APC) and average APC. Stratifications included sex, age group, race/ethnicity, Census region, state, urban–rural category (2020 NCHS scheme applied uniformly across years), and place of death, with adherence to CDC WONDER suppression rules.ResultsNational AAMRs were low and broadly stable through the mid-to-late 2000s, rose in the late 2010s, and plateaued in the early 2020s. Rates were consistently higher in men than women and increased with age, peaking in adults aged 85 years or older. By race/ethnicity, non-Hispanic American Indian/Alaska Native populations had the highest AAMRs, followed by non-Hispanic Black and Hispanic groups, with non-Hispanic White and non-Hispanic Asian/Pacific Islander populations lower. Regionally, the West had the highest rates and the Northeast the lowest; nonmetropolitan counties exceeded metropolitan counties. States showed wide heterogeneity, with roughly threefold differences between the top and bottom deciles.ConclusionMortality involving co-occurring depression and diabetes shows an upswing in the late 2010s and substantial demographic and geographic inequalities. These findings support targeted, place-based strategies and integrated diabetes–mental health care to reduce preventable deaths.

Hypertension remains a dominant contributor to cardiovascular morbidity and premature mortality, with India experiencing a persistent dual burden of high prevalence and suboptimal diagnosis, treatment, and control. The North-Eastern Region (NER) of India is epidemiologically distinctive because of its heterogeneous ethnic composition, rugged geography, varied urbanization trajectories, and differential access to health services—features that can shape strong spatial patterning of cardiometabolic risk. The fifth round of the National Family Health Survey (NFHS-5, 2019–2021) enables an unprecedented district-level view of blood pressure indicators and related determinants, offering an opportunity to identify geographic inequities and intervention priorities. This review synthesizes peer-reviewed evidence relevant to hypertension in NER, with emphasis on geographic heterogeneity, measurement considerations, and gradients in screening and management. Thus, the paper discusses the methodological approaches for characterizing spatial distributions, interprets the likely drivers of spatial heterogeneity in the NER, such as the socioeconomic gradients, health-system reach, and behavioral risks, and outlines policy implications for targeting screening and treatment programs in hard-to-reach geographic settings. The review concludes by proposing a practical analytical framework for NER-focused impact of hypertension that balances interpretability, uncertainty communication, and program relevance.

A state-level analysis of musculoskeletal disability reveals persistent geographic inequities with implications for diagnostic imaging.

In England, National Health Service (NHS) memory services provide most dementia diagnostic and immediate post-diagnostic care. We aimed to co-design and conduct a survey regarding diagnostic and post-diagnostic care, and perceived readiness for new treatments. We invited all memory services in England to complete the survey. We compared services by provider type, investigating whether service characteristics (provider type, rurality, region, referral rates, staffing mix, accreditation) were associated with diagnosis rates and psychological therapy provision. 139/188 (73.9%) memory services participated, 130 (93.5%) provided by mental health/community and 9 (6.5%) by acute trusts. We estimated that English memory services receive 192,418 referrals/year, 98.7% to mental health/community trust services. In these services, the median annual referral rate per Full Time Equivalent (FTE) staff was 100.8 (Interquartile range: 56.7-132.8). Of FTE memory service staff, 14.0% (9.0-19.0%) were doctors. Acute trust-based services reported fewer referrals (45.8, 21.1-99.5) and had more doctors (33.0%, 23.0-43.0% FTE). More acute trust services felt ready to prescribe dementia Disease Modifying Treatments (N = 8 [88.9%]) than mental health/community services (N = 50, [41.7%]), while fewer acute trusts offered post-diagnostic psychological therapy routinely (N = 5 [55.6%]) vs. (N = 100 [77.5%]) in community services. NHS region (β = 0.70 [95% Confidence interval (CI): 0.08, 1.32]) and rurality (β = 2.14, [95% CI: 1.32, 2.96]) predicted lower diagnostic rates; regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to the local aged 65 + population size. We identified marked geographical inequalities. People in regions with less resourced memory services and rural areas had less access to timely diagnosis and care.

A burgeoning literature links state policies to health care access/use, yet little research has explored whether state policies relate to the distribution of health care itself. Drawing on census microdata and state policy data from 1960 to 2019, I investigate whether state policy liberalism shapes workforce availability and diversity. First, I find that states in New England and the Middle Atlantic have persistently benefited from larger workforces compared to those in the East South Central and Pacific, with Black and foreign-born workers disproportionately represented in "workforce disadvantaged" states. Second, I show that an increase in policy liberalism is associated with reductions in states' total health care, physician, and nursing workforces; Black and foreign-born physician and nursing workforces; and foreign-born medical assistant/health aide workforces. Taking a political economy approach toward understanding the (mal)distribution of U.S. health care sheds light on a "two-tiered" system that both reflects and reifies existing geographic inequities in population health.

Allocation of Postacute Care Services Differs Among Rural and Urban Patients after Colon Cancer Resection.

Robotic-assisted thoracoscopic surgery (RATS) has transformed thoracic surgery, yet fragmented research patterns obscure critical development trajectories and global disparities. This study analyzed 3025 RATS publications from 2000 to 2025 using Web of Science Core Collection, Scopus, and PubMed databases. Data visualization and analysis were performed with VOSviewer 1.6.19, CiteSpace 6.2.R3, and the biblioshiny R package. The analysis included 79 countries, 2925 institutions, and 13408 researchers across 634 journals. Publication trends demonstrate three distinct phases: initial stage (2000-2010), steady growth period (2011-2018), and rapid growth phase (2019-2024). The United States leads with 1061 publications and 22079 citations. Shanghai Jiao Tong University is the most influential institution (n=72), while Utrecht University Medical Center demonstrates highest citation efficiency (34.8 citations/publication). The Journal of Thoracic Disease has the most publications (n=168); Annals of Thoracic Surgery has the most co-citations (6773). Richard Van Hillegersberg is the most prolific author with 39 publications and an H-index of 17, while R.J. Cerfolio has the highest number of co-citations (citations=506). Current research hotspots include pulmonary resection, esophageal procedures, mediastinal surgery, and implementation optimization. Future research emphasizes AI integration, robotic bronchoscopy, and image-guided navigation. Critical gaps include systematic geographic inequities (2-fold citation disparities), absent cost-effectiveness evidence for diverse health care systems, and undefined training standards. RATS research exhibits systematic disparities that perpetuate global health inequities. Addressing these gaps requires coordinated international action: affordable platform development, standardized competency frameworks, and context-specific economic validation across diverse health care settings.

Background: Mental health literacy remains low in South Africa, particularly in nonurban settings. This study aims to determine the sociodemographic and geographic influences of mental health literacy among community health clinic attendees. Methods: This study used secondary data which adopted a cross-sectional study design and was conducted between November 2019 and January 2020. A total of 385 participants were recruited through convenience sampling, with approximately 77 individuals per clinic across five sites. A two-part questionnaire was used, where part A included demographic information and part B consisted of the three fictive clinical case studies which measured the participants' mental health literacy. The participants' responses regarding disorder recognition and perceived causes were analyzed via Pearson's chi-square tests. Using three fictive cases with clinical pictures indicative of mental depressive disorder, schizophrenia and general anxiety disorder, the following were assessed: (1) what type of illness do you think the person is suffering from, and (2) what do you think causes the persons' suffering? To identify predictors of recognition and perceived causes, hierarchical logistic regression was performed. Statistical significance was set at p < 0.05. All analyses were conducted via STATA version 18.1 (StataCorp, College Station, TX, USA). Results: The mean age of the study participants was 37.39 ± 11.14 years (range: 13-80). Factors such as geographic location, gender and level of education were significant predictors of recognition. Participants attending urban clinics were more likely to correctly identify correct mental disorders than those attending township clinics were [OR = 0.32; 95% CI: (0.11, 0.93); Wald χ2(1): 4.3681; p value = 0.036]. For correct causes, significant predictors included gender, education level, and geographic location. Urban clinic attendees were significantly more accurate at identifying the correct cause of mental disorders than township attendees [OR = 0.42; 95% CI: (0.21, 0.83); Wald χ2(1): 6.1504; p value = 0.013]. Conclusions: Mental health literacy in Tshwane community healthcare clinics reflects deep-rooted sociodemographic and geographic inequalities. Strengthening township clinic capacity, integrating culturally relevant health education, and prioritizing gender-sensitive outreach are essential to improve the recognition and understanding of mental disorders in underserved communities.

BackgroundCongenital malformations remain a major cause of under-five mortality in the United States, yet contemporary long-term trends and demographic disparities have not been comprehensively evaluated. This study examined national patterns in congenital malformation-related mortality among U.S. children under 5 years from 1999 to 2023.MethodsMortality data were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) Database, focusing on congenital malformations-related deaths among children aged under 5 years between 1999 and 2023 in the U.S. Cases were identified using ICD-10 codes from Q00 to Q89.9.ResultsThis comprehensive analysis included a total of 143,931 deaths, demonstrating significant trends and disparities. The overall age-adjusted mortality rate (AAMR) declined from 34.70 (95% CI: 33.86-35.54) in 1999 to 25.95 (95% CI: 25.21-26.68) in 2023, showing an average annual percentage change (AAPC) of -1.21 (95% CI: -1.50 to -1.02). Mortality was higher in males than in females. Across all races, the least decline was noted among NH American Indian or Alaska Natives. Non-metropolitan areas exhibited higher overall AAMR (34.80 [95% CI: 34.33-35.27]) compared to metropolitan areas (29.02 [95% CI: 28.85-29.19]).ConclusionThe overall AAMR decreased from 1999 to 2023, with significantly higher deaths among males, rural regions and Alaskan Natives. These findings demonstrate an overall decline in mortality but persistent demographic and geographic inequities, highlighting the need for targeted public health and policy interventions to improve outcomes for vulnerable pediatric populations.

Tetanus, a disease caused by the neurotoxin-producing bacteria Clostridium tetani (C. tetani), remains a serious threat, particularly among individuals who are unvaccinated or under-vaccinated. Although public health guidelines in the United States continue to recommend a well-established, multi-dose vaccination schedule to prevent tetanus, recent revisions to the Centers for Disease Control and Prevention webpage language on vaccine safety prompted renewed public discussion. Despite this, extensive evidence continues to demonstrate the effectiveness and safety of tetanus immunization, and certain demographic groups remain disproportionately at risk. Globally and within the United States, natural disaster zones remain especially high-risk environments for tetanus infection. This review examines the pathophysiology of tetanus, current vaccination recommendations, and the social and geographic inequities that influence vaccine uptake. It also evaluates strategies of protection and prevention. Particular emphasis is placed on tetanus risk in disaster settings, where disrupted infrastructure, greater likelihood of contaminated wounds, and preexisting disparities in vaccination coverage compound vulnerability. A clearer understanding of these factors is essential for strengthening public health preparedness and ensuring equitable protection against tetanus, especially for populations disproportionately affected by disasters.

Breast cancer remains a leading cause of morbidity and mortality among women in Latin America. Mammography is the most effective population-based tool for early detection; however, its impact is limited by persistent social, geographic, and structural inequities. Evidence from the region indicates that ethnicity, rural residence, and health system organization play a central role in shaping unequal access to screening services. We conducted a narrative review informed by a systematic search strategy, following PRISMA 2020 recommendations. Searches were performed in 17 international and regional databases in English and Spanish, covering publications from 2015 to 2025. Eligible studies included non-interventional quantitative designs reporting mammography access, utilization, or coverage among women residing in Latin American countries. Three reviewers independently screened records, extracted data, and classified determinants of inequality into sociodemographic, geographic, and health-system domains. Of 532 records identified, 12 studies met the inclusion criteria, primarily from Mexico, Brazil, Peru, and Chile. Most analyses were based on nationally representative surveys. Mammography coverage ranged from approximately 20% to 60%, with consistently lower uptake among Indigenous women, rural populations, and women without health insurance. Reduced screening was associated with low educational attainment, socioeconomic disadvantages, rural residence, ethnic self-identification, and fragmented health system affiliation. Structural barriers, including concentration of diagnostic infrastructure in urban areas, reliance on opportunistic screening models, and limited capacity for systematic follow-up, were recurrent across countries. Inequities in mammography access and utilization in Latin America reflect deeply rooted social and structural determinants rather than a lack of screening technology alone. Reducing preventable breast cancer mortality requires strengthening organized, population-based screening programs, decentralizing diagnostic services, improving continuity of care, and implementing culturally appropriate strategies tailored to Indigenous, rural, and uninsured populations.

Federal Policy Changes Endanger Medicaid's Critical Role in Perinatal Care and Health Equity.

Bridging the Gap: Addressing Geographic and Socioeconomic Inequities in Access to Cardiac Catheterization in India

Visualizing Geographic Variation and Systemic Inequities of Disease Burden and CAR T-cell Therapy Access in Multiple Myeloma in the US