September saw six new articles enter into the top ten most read and a previous entry regain the number one spot.
Inequalities in lifespan and mortality risk
Our most read article of the month examines inequalities in lifespan in the United States across multiple social determinants of health. Using data from the American Community Survey and National Vital Statistics System of the National Center for Health Statistics, Marie-Pier Bergeron-Boucher and colleagues studied partial life expectancies across four social determinants of health: sex, marital status, education and race. The authors identified a complex interaction whereby no one specific determinant explains the full observed variation in lifespan, but the mortality risk increases with the number of such characteristics.
Methodological guidelines for benefit–risk assessments
Our most read new entry into the top 10 is a scoping review of methodological guidelines and documents for conducting and reporting benefit–risk assessments (BRAs) in health technology assessments. BRAs are an important analytical procedure during different stages of a health technology’s life cycle, such as regulatory approval, postmarketing and the technology’s use in clinical practice. However, there has not been a formal review of what methodological guidance documents are available for performing and reporting BRAs. This review found 129 methodological approaches for BRA with the most commonly referred to descriptive frameworks being the ‘Problem, Objectives, Alternatives, Consequences, Trade-offs, Uncertainty, Risk and Linked decisions’ (PrOACT-URL) and the ‘Benefit–Risk Action Team’ (BRAT). Multicriteria decision analysis (MCDA) was the most commonly cited quantitative framework.
The preventive effects of vitamin A supplements
A second new entry, and the fourth most read paper of the month, is a systematic review and meta-analysis of the preventive effects of vitamin A supplements versus placebo or no intervention for clinically important outcomes, in people of any age. The review found that vitamin A had no effect on mortality in the individually randomised trials with a moderate level of certainty. Subgroup analyses suggested that vitamin A may reduce mortality in trials including children 6–59 months old, but there was a lack of data from trials at low risk of bias in this age group.
The changing shape of English general practice
Our sixth most read paper of September, and another new entry, describes the changing shape of General Practice in England. The authors used data from NHS England, the Office for Health Improvement and Disparities and Care Quality Commission to examine trends in the organisational structure, workforce and recorded appointments by role in general practices from 2013 to 2023. The authors found a shift towards larger practices with more multidisciplinary teams and a reduction in the full-time equivalent general practice workforce. The authors found a 15% reduction in FTE-qualified GPs per 1000 patients since 2015. A workforce of one FTE GP per 2215 patients in 2022 places England in the quartile of OECD countries with the lowest number of GPs per population.
*Most read figures are based on pdf downloads and full text views. Abstract views are excluded.