Effective triage in the emergency department (ED) is crucial for ensuring timely and appropriate care. The Emergency Severity Index (ESI) is a widely used triage system with strong predictive value for clinical outcomes. However, its performance in middle-income countries remains understudied, particularly in settings with variable resource availability, diverse patient populations, and inconsistent triage practices. This study aimed to assess in-hospital mortality across ESI levels and evaluate the ESI's diagnostic performance in predicting mortality among ED patients in a middle-income country. We conducted a retrospective cohort study at a tertiary care hospital in Thailand, including 331,182 ED patients from January 2016 to December 2021. Data on demographics, ESI level, comorbidities, and outcomes (mortality, ICU admission, and length of stay) were analyzed. The primary outcome was in-hospital mortality across ESI levels 1–5, while secondary outcomes included ICU admission, hospital length of stay, and ED resource utilization. The overall in-hospital mortality rate was 0.6%. However, mortality was significantly higher among patients triaged as ESI level 1 (17%), compared with those at levels 2 (1.7%), 3 (0.3%), 4 (<0.1%), and 5 (0%). ICU admission rates were highest among ESI level 1 patients (35%), followed by those at level 2 (9.8%), with rates declining as triage acuity decreased. ESI levels 1 and 2 demonstrated strong predictive performance for mortality, with a sensitivity of 82.1% and a negative predictive value of 99.9%. Patients classified as ESI level 1 had the highest utilization of diagnostic and therapeutic interventions, including blood tests (93%), supplemental low-flow oxygen (36%), and mechanical ventilation (30%). ESI level 1 was associated with significantly higher in-hospital mortality, ICU admissions, and resource utilization compared with other levels. These findings support the continued use of the ESI for ED triage, especially in middle-income settings.

BackgroundDuring the past decade, China has witnessed a rapid increase in healthcare utilization. However, whether this surge in healthcare use is reasonable remains an urgent question to be answered, particularly for informing scientific policy design and adjustment in future health systems reform. We aimed to analyze the differences in healthcare utilization trends among Chinese adults aged 50 and above in comparison with other countries and regions, and to investigate the association between socioeconomic status (SES) and healthcare utilization in China.MethodsParticipants aged 50 and over were drawn from the ageing surveys conducted in China, the United States, South Korea, and Europe. SES was measured using education level, total household income, and employment status. Random-effects negative binomial regression models were employed to examine the association between SES and healthcare utilization.ResultsFrom 2011 to 2020, the outpatient utilization rates in China showed no clear long-term upward or downward trend. The inpatient utilization rates in the United States (tau-b = − 0.02, P < 0.001) and South Korea (tau-b = − 0.05, P < 0.001) declined gradually, whereas inpatient utilization rates in China continuously grew (tau-b = 0.08, P < 0.001). In China, inpatient utilization rates across different SES groups generally showed an upward trend (P < 0.01). Elementary and lower education was positively associated with inpatient utilization rates compared to middle school and higher education (IRR = 1.11, 95% CI: 1.04–1.18, P = 0.003). Similar patterns were observed for low household income (IRR = 1.08, 95% CI: 1.02–1.14, P = 0.007), non-employment (IRR = 1.39, 95% CI: 1.32–1.47, P < 0.001) and retirement (IRR = 1.38, 95% CI: 1.26–1.52, P < 0.001). These associations remained significant even among individuals covered by the Urban and Rural Resident Basic Medical Insurance (URRBMI). Participants with lower SES were more likely to report having two or more chronic diseases and poor self-rated health (P < 0.001).ConclusionsInpatient utilization rates among middle-aged and older adults in China have experienced excessive growth over the past decade. Low SES was associated with high inpatient utilization, likely attributable to the poorer health status of low-SES groups. This association persisted in people covered by URRBMI. Policy reforms should prioritize the development of primary care, targeted health management, and equitable adjustments to health insurance. These measures are essential for curbing unnecessary hospitalizations and advancing healthcare equity in China.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41256-025-00464-4.

BackgroundAs benign prostatic hyperplasia (BPH) becomes increasingly prevalent, there is a growing need for simple and accurate methods to predict its risk. This study aimed to develop and validate a prediction model to identify males at high risk of developing BPH.MethodsThe model was developed using data from 210,408 participants in the UK Biobank and externally validated with 5394 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 294 participants from the Fengshen study. Six methods were employed to construct prediction models utilizing readily available medical characteristics at baseline. The DeLong tests were used to assess the differences in the area under the curves (AUCs). Cox regression was adopted to examine the relationships between the predictors and BPH.ResultsDuring a median follow-up period of 13.2 years (interquartile range [IQR] 12.3–14.0), 7.0 years (IQR 6.8–7.0) and 4.0 years (IQR 2.2–5.0), 18,681 males in the UK Biobank, 309 males in the CHARLS, and 27 males in the Fengshen study developed BPH. The model developed using the LightGBM method exhibited the highest discriminative capability among the six methods. Following feature reduction based on importance ranking, a full model with 17 predictors was established for BPH prediction (AUC = 0.688 ± 0.004). Age was the most important feature that contributed to the model, with older males showing a higher hazard ratio (HR) of 1.091 (95% confidence interval [CI] 1.089–1.094) for BPH incidence. Furthermore, a final simplified model was developed using five predictors (age, hypertension time, blood glucose, urate, and serum creatinine) identified in both the CHARLS and Fengshen studies for potential clinical application. It has been transformed into a user-friendly web tool to facilitate clinical utility.ConclusionsThe model, incorporating five easily accessible predictors with acceptable predictive abilities for incident BPH, can help identify individuals at high risk of BPH in the general population.Supplementary InformationThe online version supplementary material available at 10.1186/s41256-025-00456-4.

Driven by climate change, viral evolution, intensified human mobility, and increasing population susceptibility, mosquito-borne diseases are extending their geographic range and public health impact worldwide. The 2025 chikungunya outbreak in Foshan, Guangdong Province, provided a critical real-world assessment of the province’s local surveillance and emergency response system. This commentary aims to elucidate the effectiveness, strengths, and limitations of Foshan’s outbreak response, and to identify lessons for strengthening early warning and vector-borne disease preparedness. Containment was achieved within three weeks through coordinated multi-sectoral emergency activation, rapid case detection, and precision vector control. However, the response also exposed systemic vulnerabilities, including delayed activation of warning mechanisms, limitations in entomological surveillance, and deficiencies in multi-source data integration. Addressing these gaps will require establishing a multi-source, data-driven early warning system; institutionalizing standardized cross-border surveillance and response protocols; expanding genomic and epidemiological research capacity; and strengthening research capacities and workforce resources from a global perspective to enhance global preparedness against emerging mosquito-borne diseases.

BackgroundThe rapid aging in the Philippines presents significant challenges, including high rates of activities of daily living (ADL) disability among older adults. While research has identified various social determinants of ADL disability, there is a gap in understanding how their joint impact on disability among older Filipinos. We adopted the polysocial score approach to assess these joint associations of multiple social factors with disability among older adults in the Philippines.MethodsIndividuals included in the analysis were from the Longitudinal Study of Ageing and Health in the Philippines. Twenty-nine social factors from five domains were included. The Light Gradient Boosting Machine (LightGBM) model was employed to identify and rank key social determinants, which were then incorporated into a logistic regression model to derive the polysocial score, both continuously and in categories and assessed its association with ADL disability. Model performances were assessed by discrimination, calibration, and reclassification (compared to a reference model). All analyses were separated for men and women.ResultsWe included 5,000 participants (37.0% men) with an average age of 68.3 years. The polysocial score included 19 social factors for men and 18 for women. Among men, the most significant predictors were the frequency of engaging in social activities and the number of friends they had contact with. Attending religious services outside the home and the frequency of attending social activities were the most important factors for women. Eleven social factors overlapped between men and women. Individuals with moderate or high polysocial scores exhibited reduced likelihood of experiencing ADL disability relative to those with low scores. We observed satisfactory model performance among men and women.ConclusionsWe identified important social factors for men and women and their joint association with ADL disability. The polysocial score could be used to design person-centered social interventions that promote health and support independence.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41256-025-00453-7.

BackgroundAccess to primary healthcare (PHC) services is a critical determinant of population health outcomes and a key indicator of health system performance. However, comprehensive methods for batch assessment of PHC accessibility and the associated economic burden are relatively scarce. This gap is particularly evident in developing countries, where accessibility challenges are often more pronounced.MethodsWe developed an integrated assessment methodology for the large-scale calculation of travel costs to access PHC services. This methodology combines high-resolution friction surface mapping, the construction of a comprehensive PHC facility spatial dataset, and the application of least-cost path algorithms. The batch processing capability of the methodology ensures efficient computation while maintaining high spatial resolution, enabling a detailed evaluation of PHC accessibility and its economic burden across diverse geographical contexts.ResultsOur analysis revealed that 88.70% of Chinese mainland’s population could access PHC facilities within an hour, indicating relatively good overall accessibility to primary healthcare services. However, significant regional disparities in accessibility and associated economic burdens were observed. While urban areas, particularly in eastern and coastal regions, generally exhibit high levels of accessibility, rural and remote areas, especially in the western and northwestern regions, face substantial challenges in reaching PHC facilities. The total economic burden associated with travel to PHC facilities in Chinese mainland is estimated at approximately 38.29 billion CNY annually. The southern, northern, and northwestern regions accounted for 62.91%, 21.72%, and 14.94% of the total burden respectively, with northwestern provinces facing a disproportionately high economic burden relative to their GDP.ConclusionsOur methodology supports future large-scale, high-resolution accessibility analyses that can guide interventions aimed at addressing healthcare disparities and improving equity. The empirical application of this methodology in Chinese mainland revealed significant disparities in PHC access across the country and quantified the substantial economic costs associated with these disparities.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41256-025-00451-9.

There is growing recognition of the need for global health and associated research to decolonise. Yet discourse so far has overlooked the role that research paradigms play within this. Left unaddressed, this omission could further engender hierarchical approaches in global health research. The transformative paradigm articulates the relationships between evidence, power and oppression. With this acknowledgement, we can strive for positive social change through research. In this commentary, we argue the importance of considering the transformative paradigm in efforts to decolonise global health research. We provide an initial overview of key terms in this debate, before exploring what is meant by a research paradigm in more detail and then arguing that a transformative paradigm offers unique and powerful opportunities to address enduring colonial inequities in global health research; we then illustrate how this was applied in a recent mixed methods study which explored experiences and barriers to accessing cancer treatment in Ghana. We show how researcher sensitivity to historical injustices and community-based values were vital to our study design and also in specific methods like a participatory creative task and qualitative interviews. This commentary is important as part of the wider debate about decolonising global health and provides a unique critical insight into how research and how particularly research paradigms are of importance in this task, offering suggestions based on a transformative paradigm.

Patient involvement in health technology assessment (HTA) has been extensively explored and implemented in high-income countries, but little is known about it in low- and middle-income countries (LMICs). This study aimed to provide a comprehensive picture of the current state and trends of patient involvement in HTA research, which can inform future research in the LMICs. Publications on patient involvement in HTA from January 1, 1900, to December 31, 2023, were retrieved from the core databases of the Web of Science. We applied a bibliometric analysis to reveal the collaboration patterns, hot topics, and evolution of the research field. Co-occurrence, clustering, citation, and burst analyses were performed using VOSviewer and CiteSpace, with results visualized for interpretation. A total of 175 articles were eligible for inclusion. The first valid article was published in 2000. The number of publications has increased since 2011. The most productive countries and institutions were Canada and McMaster University. The studies focused on five hot topics: patient preferences, priority setting, qualitative research, drug development, and hospital-based HTA. The burst analysis revealed that priority setting and cost effectiveness were the research frontiers. While patient involvement in HTA research has gained increasing attention, the research conducted in the LMICs remain limited. It is recommended that LMICs participate in international research collaborations, and focus on the five hot topics and emerging frontiers to advance both their research capacity and practical implementations.