While home-based rehabilitation following hip fracture typically costs less than institutional care, questions remain about care quality equivalence. To compare care quality between home-based and institutional rehabilitation by examining 1-year mortality and 30-day readmission rates among hip fracture patients. We identified 10,790 community-dwelling hip fracture patients aged 60+ from the Norwegian Patient Registry (2018-2019). Patients receiving institutional rehabilitation were matched with those receiving home-based care using propensity score matching. Logistic regression examined treatment effects on outcomes. After propensity score matching, home-based treatment was associated with lower mortality (OR = 0.44; 95% CI, 0.38-0.51) and lower readmission rates (OR = 0.56; 95% CI, 0.49-0.63) compared to treatment at institutions. Community-dwelling hip fracture patients receiving institutional rehabilitation had higher mortality and readmission rates than those treated at home, suggesting superior care quality with home-based treatment.

Pemphigus vegetans (PVg) is a rare variant of pemphigus vulgaris with distinct clinical and histological features, with fewer than 200 cases reported. To systematically review cases of PVg and summarize clinical, histopathological, immunological features, treatment, and outcomes. Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched (1889-January 2025) using "pemphigus AND vegetans." Eligible studies included case reports, series, and observational studies. Data on demographics, subtypes, histopathology, immunopathology, treatment, and outcomes were extracted. A total of 197 cases from 148 studies were identified. Mean age was 52.2 years with near-equal gender distribution. Oral mucosa was the commonest initial site (44.7%); flexural areas such as groin and axilla were frequently involved. Reported triggers included drugs, infections, and vaccination. Of 89 classified cases, the Hallopeau variant (52.8%) appeared to have higher remission rates (97.5%) and lower mortality (2.4%) than the Neumann variant (83.8% remission, 16.1% mortality). Key histological findings included suprabasal acantholysis (84.9%) and eosinophilic microabscesses (65.05%). Direct immunofluorescence showed intercellular IgG (92.3%) and C3 (53.4%). Oral corticosteroids (89.5%) were the most used therapy. Relapse occurred in 23% of patients achieving remission. This review highlights the need for standardized diagnostic criteria, improved immunological profiling, and collaborative data collection to guide evidence-based management.

This study evaluates the impact of Law No. 12,858/2013, known as the "royalties law", on the allocation of resources for healthcare in Brazilian municipalities that receive oil revenues. This law, which has not been empirically evaluated before, changes the way oil revenues are allocated and mandates that a portion be directed to healthcare and education to promote sustainable development and intergenerational equity. Using the difference-in-differences method combined with propensity score matching, we investigate whether there was an increase in expenditures on primary healthcare and whether this resulted in improvements in both primary care and more complex healthcare services. To achieve this goal, we use a large set of disaggregated health indicators, such as expenditures on primary care, child vaccination, infant mortality, hospital admissions, and inpatient mortality. The results indicate that the royalties law is associated with a positive impact on healthcare services in the benefiting municipalities. The increase in primary care investments in the treated municipalities is associated with the improvement of this sector, strengthening preventive actions and reducing the need for more complex services. More effective monitoring of pregnant women and expanded child vaccination contributed to lower infant mortality rates. In medium and high complexity healthcare services, there was a reduction in hospital admissions and inpatient mortality. This suggests that strengthening primary care can optimize the functioning of the entire healthcare system. Furthermore, it is important for policymakers in Brazil to reassess the minimum 15% of own revenue that municipalities must allocate to healthcare. The robustness of our conclusions is confirmed by a triple difference model, which indicates that the observed effects are not driven by pre-existing trends or other confounding factors. Additionally, our findings are not sensitive to tests for parallel trends, falsification in treatment assignment, or variables unrelated to primary care. This study contributes to understanding how natural resource revenues can be used to promote sustainable development and improve public health. It also offers valuable insights for policymakers in resource-rich countries, helping to design effective strategies to manage revenues and invest in human capital sustainably.

Right atrial phasic strain in risk stratification of patients with Pulmonary Arterial Hypertension.

Sodium-glucose cotransporter 2 inhibitor use and outcomes after surgical aortic valve replacement.

Background: Medicaid-insured patients experience higher rates of late-stage cancer diagnosis and worse survival than non-Medicaid patients. The impact of Medicaid enrollment timing on cancer outcomes is less clear. This study examines the association between Medicaid enrollment and timing with tumor stage and cancer-specific survival for breast, colorectal, and lung cancers. Methods: We analyzed SEER-Medicaid linked data for 276,755 breast, 104,784 colorectal, and 101,058 lung cancer patients < 65 years of age. Patients were categorized as non-Medicaid enrollees, pre-diagnosis enrollees (≥12 months before), or post-diagnosis enrollees (≤12 months after). Multivariable logistic regression estimated odds ratios of late-stage diagnosis, and cause-specific Cox proportional hazards models were used to assess cancer-specific survival, adjusting for demographic and socioeconomic factors. Results: Compared to non-Medicaid enrollees, post-diagnosis enrollees had the highest odds of late-stage diagnosis (breast cancer: OR: 3.41; colorectal cancer: OR: 3.78; lung cancer: OR: 1.87). Pre-diagnosis enrollees also had increased odds, but the association was weaker than post-diagnosis enrollees. Cancer-specific mortality was higher for both pre- and post-diagnosis enrollees compared to non-Medicaid enrollees for each cancer examined across tumor stage at diagnosis. Among Medicaid enrollees, those enrolled post-diagnosis had higher cancer-specific mortality than those enrolled pre-diagnosis for localized-stage colorectal (HR: 1.82) and lung cancer (HR: 1.30). In contrast, those enrolled post-diagnosis had lower mortality than those enrolled pre diagnosis for distant-stage breast cancer (HR: 0.91). Conclusions: Compared with cancer patients not insured by Medicaid, post-diagnosis Medicaid enrollment was associated with a greater likelihood of late-stage cancer and worse cancer-specific survival across each cancer type examined. Future research is warranted to examine the role of Medicaid enrollment timing in cancer care to better understand its impact on cancer outcomes.

Introduction Several factors influence mortality and survival after hip fracture, including nutritional status, which is associated with both incidence and prognosis. However, there is little evidence on the impact of oral nutritional supplements (ONS) on the survival of these patients, and the available results are mixed. Our aim was to analyze the effect of adherence to ONS treatment on post-hospital mortality, with the hypothesis that this would be lower in an adherent group. Methods Prospective study of patients aged 65 years or older, admitted for fragility hip fracture. Follow-up was carried out at 3, 6 and 12 months to evaluate retrieval of ONS in pharmacies and survival. Adherence was considered if ONS were withdrawn for 3 months or longer. The sample was divided into four groups: (1) well-nourished patients without prescription of ONS, (2) moderately malnourished patients without prescription of ONS, (3) moderate or severely malnourished patients with prescription of ONS but without adherence, and (4) moderately or severely malnourished patients with prescription of ONS and adherence. Mortality between groups was compared by means of a Cox regression, adjusted for confounding variables. Results 300 patients were included (mean age 82.9 years; 79.3% female), with severe malnutrition in 19.7%. Non-adherent malnourished patients showed a significantly higher risk of death than adherent malnourished patients (HR = 3.67; 95% CI: 1.41–9.57; p = 0.008). Non-adherent malnourished patients had a significantly higher risk of death compared to well-nourished patients (HR = 2.95; 95% CI: 1.31–6.65; p = 0.009). Malnourished patients without ONS had a non-significant higher mortality risk than well-nourished patients (HR = 1.66; 95% CI: 0.72–3.84, p = 0.236). Adherent malnourished patients showed a non-significant trend toward lower mortality than well-nourished patients (HR = 0.80; 95% CI: 0.25–2.56; p = 0.712). Conclusion In our study, 3-month adherence to ONS is associated with a reduction in 3, 6 and 12-month mortality in older patients with a hip fracture when compared to non-adherent patients and shows a trend toward an improved survival rate than that of well-nourished patients.

Background: Combat-related lower extremity injuries frequently require prolonged tourniquet application to control life-threatening hemorrhage. Although effective for hemorrhage control, prolonged ischemia followed by reperfusion substantially increases the risk of rhabdomyolysis, acute kidney injury (AKI), limb loss, and mortality. The optimal timing of anti-rhabdomyolysis infusion therapy in relation to tourniquet release remains uncertain. Methods: This retrospective single-center cohort study analyzed 120 Ukrainian military casualties with combat-related lower extremity injuries requiring prolonged tourniquet application and subsequent surgical management, including fasciotomy and tourniquet release. Patients were divided into two groups based on infusion strategy: standard therapy initiated after tourniquet release and early anti-rhabdomyolysis infusion therapy initiated before tourniquet removal during the ischemic phase. Primary outcomes included dialysis-requiring AKI, limb amputation, and death. Multivariable logistic regression models were adjusted for baseline physiological severity, including shock index at admission and baseline acid–base status. Model performance was evaluated using the Akaike Information Criterion (AIC) and receiver operating characteristic (ROC) analysis. Propensity score–based inverse probability of treatment weighting (IPTW) was applied as a sensitivity analysis. Results: After adjustment, early infusion therapy was independently associated with lower rates of dialysis-requiring AKI (adjusted odds ratio [OR] 0.33; 95% confidence interval [CI] 0.13–0.84; p = 0.020), limb amputation (OR 0.32; 95% CI 0.11–0.95; p = 0.040), and mortality (OR 0.23; 95% CI 0.07–0.77; p = 0.017). Adjusted models demonstrated good discriminative ability, with areas under the ROC curve of 0.813 for AKI, 0.838 for amputation, and 0.823 for mortality. Sensitivity analyses using IPTW yielded consistent results. Conclusions: In combat-related lower extremity injuries requiring prolonged tourniquet application, early initiation of anti-rhabdomyolysis infusion therapy prior to reperfusion is associated with significantly reduced risks of severe AKI, limb loss, and death. These findings suggest that preventive renal-protective strategies initiated before tourniquet release may improve outcomes in high-risk military trauma settings and warrant further prospective investigation.

Bacillus toyonensis biovar thuringiensis Bto_UNVM-42: A novel strain with potential for the biological control of nematodes.

Background Heparin may mitigate secondary brain injury in subarachnoid hemorrhage (SAH), but its effect on survival in non-traumatic SAH (NSAH) remains uncertain. This study aimed to investigate the association between early prophylactic heparin use (within 72 h of admission) and mortality outcomes in patients with NSAH. Methods We performed a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC) and the eICU Collaborative Research Database (eICU-CRD). Patients were stratified by early heparin use. Cox models, Kaplan–Meier (KM) curves, subgroup analyses, and comprehensive propensity score–based sensitivity analyses were applied to assess the robustness of the observed associations. The primary outcome was in-hospital mortality; 28-, 90-, 180-, and 365-day mortality were secondary outcomes. Findings were validated using the eICU-CRD cohort. Results In the MIMIC-IV cohort, early heparin use was associated with lower in-hospital mortality (HR 0.62, 95% CI 0.39–0.97, p = 0.037), which was confirmed in the eICU-CRD cohort (HR 0.47, 95% CI 0.22–1.00, p = 0.049). Consistent reductions were also observed for 28-day (HR 0.57, p = 0.009), 90-day (HR 0.62, p = 0.010), 180-day (HR 0.63, p = 0.009), and 365-day mortality (HR 0.61, p = 0.004) in the MIMIC-IV cohort. Subgroup analyses and KM curves further supported these findings. Propensity score-based sensitivity analyses further validated the robustness of these findings in both cohorts. Conclusion Early prophylactic heparin was associated with lower risk-adjusted short- and long-term mortality in NSAH.

Traumatic brain injury (TBI) patients are at risk of sudden deterioration, requiring timely diagnostics and treatment to prevent secondary cerebral injuries. This study investigated lead times in prehospital and early intrahospital TBI management, assessing their association with geographical conditions, hospital caseloads, and patient outcomes. This nationwide, observational cohort study included 5036 TBI patients (during 2018-2022) from the Swedish Trauma Registry (SweTrau). Lead times from trauma to alarm, from alarm to hospital arrival, and times to first computed tomography (CT) from alarm and hospital arrival, respectively, were calculated. These were analyzed against the geographical distribution of healthcare, hospital caseloads, and 30-day mortality. The majority of the cohort arrived in hospital within one hour and suffered a mild-to-moderate TBI. In univariate analyses, healthcare regions with larger geographical catchment areas exhibited longer time of prehospital management from alarm to arrival in hospital than smaller regions. Meanwhile, in multivariate linear regressions, larger region catchment area was independently associated with longer times from trauma to alarm and from alarm to hospital, but shorter time from alarm to first CT. In similar multivariate analyses, higher caseload was associated with longer time from alarm to first CT. Patients who were initially managed in a local hospital exhibited longer lead times overall, except from time to first CT from arrival in hospital. Furthermore, in the whole cohort, longer time from alarm to first CT and from arrival in hospital to first CT were associated with lower rate of mortality in univariate logistic regressions. However, this did not hold true in multivariate analysis after adjusting for demography and injury severity. Lead times in TBI management varied by both geographical and hospital-bound factors. Faster lead times in TBI were associated with higher mortality in univariate analysis, but this association disappeared in multivariate analysis, suggesting that clinical severity rather than time alone is the stronger predictor of outcome. Nonetheless, it remains believed that efficient and qualitative management is a fundamental necessity for better outcomes in TBI management.

The emergence of COVID-19 has placed unprecedented pressure on healthcare systems worldwide. Although the clinical features of COVID-19 are well-documented in adults, limited data are available regarding its impact on infants, particularly across different age groups. To compare the clinical presentation, laboratory findings, and outcomes of infants aged ⩽6 months with those aged >6 months diagnosed with COVID-19. Retrospective cross-sectional study. This study was conducted at a tertiary pediatric hospital in Saudi Arabia. Data were extracted from electronic medical records of 388 infants with confirmed COVID-19 between March 2020 and December 2022. Demographic information, clinical signs and symptoms, laboratory parameters, and clinical outcomes were analyzed and compared between the two age groups using appropriate statistical methods. Among 388 infants diagnosed with COVID-19, 54.6% were aged ⩽6 months. Less than half of the cohort was symptomatic, with fever (41.0%), cough (37.1%), and rhinorrhea (20.1%) being the most common symptoms. Gastrointestinal symptoms differed significantly by age: infants >6 months had higher rates of diarrhea than those ⩽6 months (58.6% vs 41.4%, P = .028). Most infants had normal white blood cell (WBC) counts (76.5%), though WBC abnormalities varied by age group: leukopenia was more frequent in infants ⩽6 months, while leukocytosis was more common in older infants (P = .009). Elevated C-reactive protein was observed in 63.0% of tested infants, and hyperglycemia was detected in 83.6%. COVID-19-related mortality was low (1.03%), primarily affecting infants ⩽3 months with pre-existing comorbidities. SARS-CoV-2 infection in infants was generally mild, with low rates of complications and mortality. However, infants aged ⩽6 months demonstrated greater clinical vulnerability compared to older infants. These findings underscore age-specific differences in clinical presentation and support the need for tailored risk assessment and management approaches in pediatric care.

Diabetes and cancer exhibit a high likelihood of co-occurrence. Diabetes serves as a risk factor for various forms of cancer and is associated with a poorer prognosis. SGLT2 (sodium-glucose cotransporter 2) inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality in the general population; however, data among the population with cancer are scarce. We aimed to assess the safety and efficacy of SGLT2itherapy among patients with diabetes and cancer. A large retrospective, single-center study including 849 patients diagnosed with diabetes and active cancer. Patients were divided into 2 groups: 169 patients treated with SGLT2i before cancer diagnosis and 680 patients SGLT2i naive. The primary end point was all-cause mortality. The secondary end point was the composite of cardiovascular outcomes, including heart failure, acute coronary syndrome, and arrhythmias. After a median follow-up of 48 months (interquartile range, 27-72), all-cause mortality was significantly lower in the SGLT2i group (67% versus 53%, P=0.001). Multivariable Cox regression identified SGLT2i as an independent predictor of reduced all-cause mortality (hazard ratio, 0.676 [95% CI, 0.532-0.860], P=0.001). Cardiovascular outcomes were higher in the SGLT2i group (28% versus 16%, P=0.001), driven by increased heart failure events (14% versus 7%, P=0.008). After propensity score matching, SGLT2i remained a significant predictor of reduced mortality (P=0.016), with no significant differences in cardiovascular outcome (P=0.067). SGLT2i was associated with lower all-cause mortality in patients diagnosed with diabetes and cancer. Randomized clinical trials are needed to confirm these findings and explore the underlying mechanism.

IntroductionHealth habits like type 2 diabetes self-care may be influenced by masculinity. Nevertheless, there is limited evidence from research that quantitatively assesses the relationship between masculinity and self-care among Mexican adult men with type 2 diabetes.ObjectiveThe purpose of this study was to investigate the association between masculinity and self-care behaviors in Mexican adult men with type 2 diabetes.MethodsA cross-sectional, correlational study was conducted with adult men previously diagnosed with type 2 diabetes at five primary healthcare centers. Data was gathered between February and June of 2019. The Conformity to Masculine Norms Inventory and Summary of Diabetes Self-Care Activities questionnaire were employed. SPSS v.26 was used to conduct correlations and multiple linear regression analysis.ResultsA total of 221 adult males participated (mean age = 52.4 years, SD = 9.8; time of diabetes evolution = 8.9 years, SD = 5.8). Alcohol consumption was reported by 42.5%, 25.3% reported smoking, and 17.6% stated having previously been diagnosed with hypertension. Masculinity was negatively correlated with self-care behaviors, including diet (r = −.200, p = .003), self-monitoring of blood glucose (r = −.133, p = .038), foot care (r = −.268, p = .001), and oral hygiene (r = −.283, p = .001). Homophobia, self-reliance, risk-taking, violence, and control over women were aspects of masculinity that were negatively associated with self-care. In regression analyses, total masculinity predicted lower diabetes self-care, with homophobia and violence emerging as significant negative predictors.ConclusionsMasculinity was negatively associated with self-care in Mexican adult men with type 2 diabetes, particularly in the dimensions of diet, self-monitoring of blood glucose, foot care, and oral hygiene. In order to increase self-care adherence, improve glycemic control, avoid complications, and lower premature mortality, future interventions should address these features of masculinity.

Adults with Repaired Systemic Biventricular Congenital Heart Disease with a Systemic Left Ventricle and Heart Failure with Reduce Ejection Fraction.

Objective: To assess the short-term effect of oral zinc supplementation on mortality in preterm neonates with bacterial sepsis. Study Design: Randomized Controlled Trial. Setting: The Neonatal Unit of Sharif Medical City Hospital, Lahore. Period: December 20, 2021 to June 20, 2022. Methods: A total of 250 preterm neonates with gestational age between 28–36 weeks and diagnosed with sepsis were enrolled using non-probability consecutive sampling technique. They were randomly distributed into two groups. Group A received zinc supplementation orally (3 mg/kg twice daily), while Group B received distilled water as a placebo. Both groups received standard antibiotic treatment. Neonates were monitored in the NICU until discharge or death, and 7-day mortality was recorded. Chi-square test was applied to associate mortality rates. The p value of ≤ 0.05 was considered statistically significant. Results: The mean age of neonates in Group A was 41.19 ± 19.10 hours, while in Group B, it was slightly lower at 39.24 ± 19.63 hours. Group A had a significantly lower 7-day mortality rate of 9(7.2%) compared to Group B at 26(20.8%) (p = 0.002). No deaths occurred in the 6–18 hour age subgroup of Group A, while Group B had 8(6.4%) deaths (p = 0.005). Mortality was significantly lower in Group A among neonates with higher birth weights: 3(2.4%) vs. 12(9.6%), (p = 0.007) and gestational ages of 31–33 weeks: 5(4.0%) vs. 19(15.2%), (p < 0.001). Conclusion: Oral zinc supplementation significantly decreased short-term mortality in preterm neonates with sepsis. Zinc may serve as an effective adjunct therapy in managing neonatal sepsis.

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson's disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and explore sex-specific differences in utilization and outcomes. Methods: We conducted a retrospective nationwide population-based study using the Spanish National Hospital Discharge Database (RAE-CMBD) from 2002 to 2019. All hospital admissions with DBS implantation or explantation/revision and a diagnosis of PD, ET, or dystonia were identified. Sociodemographic variables, the Charlson Comorbidity Index (CCI), length of hospital stay (LOHS), postoperative complications, and IHM were analyzed across three calendar periods and stratified by diagnosis and sex. Results: A total of 4883 admissions for DBS electrode implantations and 497 admissions for DBS explantation/revision were recorded. PD accounted for 82.6% of implantations, followed by ET (11.2%) and dystonia (6.3%). DBS activity increased significantly over time, while median LOHS declined from 12 to 6 days for implantations and from 13 to 5 days for explantations. Overall IHM after implantation was 0.27%, decreasing to 0.05% in 2014-2019; IHM after explantation was 0.6%. Most hospitalizations had low comorbidity (CCI = 0 in 87.8%), although comorbidity increased over time. Men represented approximately 60% of procedures in PD and ET. Women with PD underwent DBS at older ages, despite similar LOHS and IHM. Postoperative complications were recorded in 14.6% of implantations, mainly hardware-related issues (5-6%) and infections (1-2%), whereas infections (33%) and mechanical problems (27%) predominated among explantations. Conclusions: DBS use in Spain has expanded substantially, with shorter hospital stays and very low in-hospital mortality. Sex-related differences in utilization are increasing, and hardware complications and infections remain the most frequent conditions associated with explantation. As complications were identified only during the same hospitalization as the DBS procedure, late post-discharge events are not captured and could be underestimated; patient-level risks cannot be derived.

Soil conditioning can generate persistent plant-soil feedbacks (PSF) that influence plant performance under subsequent growth conditions, yet the role of soil inoculum volume in mediating these effects remains poorly understood. Here, we tested how inoculum volume influences the relative strength of a known positive PSF effect. We performed a plant-soil feedback experiment with Pinus radiata D. Don in two phases: one, a "conditioning phase", and two, a "feedback phase", where inoculum from the first phase was used in different dilutions to test the growth differences resulting from conditioning. To understand how inoculum volume affects subsequent growth in the feedback phase, seedlings (n = 12 per treatment) were grown in soil from phase one using different volumetric dilutions; 100% conditioned soil, 50% conditioned soil + 50% inert media, or 25% conditioned soil + 75% inert media. Positive plant-soil feedbacks were observed in undiluted soils: seedlings produced 40-65% greater biomass and experienced 50-70% lower mortality compared to the lowest inoculum treatment. However, this response varied with dilution; the strength of plant-soil feedbacks decreased with increasing dilution of inoculum. These findings highlight soil inoculum volume as an important, but often overlooked, factor in plant-soil feedback experiments and applied soil management. Our study provides experimental evidence that effective soil conditioning depends on both conditioning and a required minimum inoculum volume to confer measurable benefits to future plantings.

Background: Alcohol use patterns influence health outcomes. This study examined sex-specific drinking trajectories and their associations with all-cause mortality and coronary heart disease (CHD) in the US-based Framingham Heart Study. Method: Among 6570 participants (mean age: 55 ± 13; 55% women) followed for 15 years, a growth mixture model identified four sex-specific alcohol consumption trajectories. Cox models examined associations of alcohol trajectories with CHD and mortality over 10 years of follow-up, adjusting for covariates. Results: This study identified four distinct, sex-specific alcohol consumption trajectories: the Moderate-Decreasing group (1179 women, 0-14 g/day; 1534 men, 0-28 g/day) showed a declining moderate intake, The Low-to-None group included light or non-drinkers (992 women, 826 men), the Inverse-U group (606 women, 199 men) showed variable intake over time, while the High-Decreasing group (858 women, 376 men) had high initial consumption (women > 14 and men > 28 g/day) that declined over time. Compared with the Moderate-Decreasing group, women in other groups had higher CHD risks (HRs 1.58-1.61) and greater mortality risk in the Low-to-None (HR 1.25) and Inverse-U (HR 1.28) groups. Men in Low-to-None had higher mortality (HR 1.17) and CHD (HR 1.60), while High-Decreasing showed the highest mortality (HR 1.27). Low-to-moderate drinking was associated with lower mortality and CHD risks; however, these findings do not confirm the protective effects of alcohol use. Discussion: Our findings suggest that sustained low to moderate drinking was associated with lower risks of mortality and CHD in both women and men, compared to high-level or fluctuating patterns. Although these associations may not confirm causality, our findings emphasize the importance of investigating long-term drinking patterns in public health. Nevertheless, we caution against promoting moderate alcohol use as a strategy to reduce mortality risk or prevent CHD.

Background Data on mortality among people who inject drugs with hepatitis C virus (HCV) infection remain limited, particularly in settings with a high OAT coverage. We aimed to assess all-cause and liver-related mortality and to evaluate associations between key exposures and mortality among people who inject drugs with HCV infection. Methods We included individuals evaluated for HCV treatment in a low-threshold clinic for people who inject drugs in Oslo, Norway, between 2013–2020 and linked data to the Norwegian Cause of Death Registry. Mortality was analysed using person-time, Poisson regression models to assess crude and adjusted IRRs, and Kaplan-Meier survival curves for subgroup comparison. Results Among 506 individuals (27.8% female, median age 49.1 years, 77.0% recent injecting drug use, 15.9% liver cirrhosis, 77.8% HCV treatment uptake), 39 (7.7%) deaths were recorded. All-cause mortality was 2.11/100 PY (95% CI 1.50–2.88). Liver-related mortality was 1.07/100 PY (95% CI 0.22–3.12) among those with liver cirrhosis and 0.16/100 PY (95% CI 0.03–0.47) overall. Drug-induced deaths accounted for the largest proportion of deaths (28.2%). HCV treatment was associated with lower all-cause mortality (adjusted IRR 0.22 [95% CI 0.06–0.76]; p = 002), while liver cirrhosis was associated with increased mortality (adjusted IRR = 2.78 [95% CI 1.00–7.65]; p = 0.049). Conclusion Liver-related mortality among people who inject drugs with HCV cirrhosis was low. Mainly driven by drug-related deaths, all-cause mortality was higher among individuals with untreated HCV infection and among those with liver cirrhosis, underscoring the need for strategies that integrate HCV treatment with overdose prevention and access to broader healthcare.