Lu H, Wu Z, Zhou X
… +5 more, Yang W, Lv Y, Shi J, Zheng Y, Ji R
BMC Public Health
· 2026 Jun · PMID 42337586
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BACKGROUND: Circadian Syndrome (CircS), a cluster encompassing metabolic dysregulation, short sleep duration, and depression, has been implicated in various chronic diseases. Gastroesophageal reflux disease (GERD) is a h...BACKGROUND: Circadian Syndrome (CircS), a cluster encompassing metabolic dysregulation, short sleep duration, and depression, has been implicated in various chronic diseases. Gastroesophageal reflux disease (GERD) is a highly prevalent digestive disorder; however, its prospective association with CircS remains unclear. METHODS: This prospective cohort study utilized data from the UK Biobank, including 330,925 participants free of GERD at baseline. CircS was defined as meeting at least four of seven components. The primary outcome was incident GERD, identified through the first recorded diagnosis code from linked hospital, primary care, death registry, and self-report data. Cox proportional hazards models were used to estimate hazard ratios with sequential adjustments for demographics, socioeconomic status, lifestyle factors, and medication use. RESULTS: Over a median follow-up of 13.05 years, 28,554 incident GERD cases were documented. In the fully adjusted model, CircS was associated with a significantly increased risk of GERD (HR = 1.20; 95% CI: 1.16-1.23). All seven individual components were each associated with GERD risk in separate fully adjusted models, with the strongest associations observed for depression (HR = 1.38) and short sleep (HR = 1.29). A significant dose-response relationship was evident as the number of components increased. Subgroup analyses revealed stronger associations among individuals aged under 65 years, women, non-White participants, and those not using proton pump inhibitors. CONCLUSIONS: Circadian Syndrome is independently associated with incident GERD, with depression and short sleep as core driving components. These findings support the integration of circadian, metabolic, and psychological health assessments into GERD risk stratification.
Lee GM, Hong J, Hwang YS
… +3 more, Lee H, Lee H, Kim JH
BMC Public Health
· 2026 Jun · PMID 42337533
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BACKGROUND: Retirement is a major life transition that may influence functional capacity and overall well-being in later life. This study examined whether life satisfaction buffers declines in active ageing following ret...BACKGROUND: Retirement is a major life transition that may influence functional capacity and overall well-being in later life. This study examined whether life satisfaction buffers declines in active ageing following retirement. METHODS: We used nationally representative data from the Korean Longitudinal Study of Ageing (2014-2022). Participants were adults aged 55 years and older who experienced a self-reported retirement transition during the observation period. Life satisfaction was measured on a 0-100 scale and categorized into higher and lower groups. The primary outcome was the continuous Active Ageing Index (AAI), and subdomains of health, participation, and security were also examined. Propensity score matching and comparative interrupted time series analyses were applied, and generalized estimating equation models estimated post-retirement changes. RESULTS: Individuals with higher life satisfaction had higher AAI levels across retirement-centered time points, and GEE models suggested a relatively less pronounced post-retirement decline in the continuous AAI index. In subdomain analyses, significant group-by-time interactions were observed in the health domain at retirement and in the participation domain at selected post-retirement time points, whereas no significant interactions were observed in the security domain. CONCLUSIONS: Life satisfaction may serve as a protective psychological resource during retirement transitions. Policies and interventions that enhance subjective well-being may promote sustained active engagement and resilience in later life.
Lu S, Lin Z, Yeung C
… +5 more, Zou F, Xie X, Liang X, Gao Y, Zhu S
BMC Public Health
· 2026 Jun · PMID 42337522
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BACKGROUND: Robust forecasting of hepatitis B trends is important for long-term surveillance and public health planning in China. However, evidence remains limited regarding how different forecasting frameworks perform w...BACKGROUND: Robust forecasting of hepatitis B trends is important for long-term surveillance and public health planning in China. However, evidence remains limited regarding how different forecasting frameworks perform when applied to a long-term national hepatitis B surveillance series under a unified out-of-sample evaluation design. METHODS: Monthly reported hepatitis B cases in China from January 2004 to December 2024 were obtained from national public surveillance databases. Data from January 2004 to December 2023 were used as the training set, whereas data from January to December 2024 were reserved as an independent validation set. Ten forecasting models were evaluated, including Seasonal autoregressive integrated moving average (SARIMA), Bayesian structural time series (BSTS), four standalone machine-learning models (random forest, support vector machine, XGBoost, and LightGBM), and four residual-based SARIMA-machine-learning hybrid models. Model performance was assessed using mean absolute error (MAE), range-normalized root mean square error (NRMSE), mean absolute percentage error (MAPE) and Nash-Sutcliffe Efficiency (NSE). In addition, the average annual percentage change (AAPC) was estimated to summarize the long-term annual trend in reported case counts.The best-performing models were further used to forecast monthly hepatitis B case counts in 2025. RESULTS: A total of 252 monthly observations were included. The mean monthly number of reported hepatitis B cases was 91,901. The annual reported case counts did not show a statistically significant long-term trend (AAPC = - 0.561%, P = 0.12), whereas the monthly series exhibited a stable seasonal pattern, with peaks typically occurring in March and troughs in December followed by January. Among the candidate SARIMA structures, SARIMA(2, 1, 0)(1, 0, 3) was selected as the optimal model. In the overall model comparison, BSTS achieved the best validation performance, with the lowest MAE (10014.27), NRMSE (38.49%), MAPE (7.18%) and highest NSE(-0.92) among all ten models. Among the hybrid models, SARIMA-LightGBM performed best, with corresponding validation values of 10903.35, 40.14%, 8.07% and - 1.09, respectively. In 2025, BSTS achieved an MAE of 13,437.42, NRMSE of 9.53%, MAPE of 12.04%, and NSE of - 0.41, with 95% posterior predictive intervals used to quantify forecast uncertainty. CONCLUSIONS: Forecasting performance differed across model classes in long-term national hepatitis B surveillance. BSTS showed the best overall predictive performance. These findings support empirical model selection and suggest that BSTS-based forecasting may serve as a supportive tool for early warning, resource allocation, and long-term hepatitis B surveillance planning when interpreted together with reporting-system and policy context.
Carmona BA, Reyes LI, Orman MC
… +1 more, Bellows LL
BMC Public Health
· 2026 Jun · PMID 42337517
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BACKGROUND: Early Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental w...BACKGROUND: Early Childhood Education (ECE) educators experience high levels of stress, burnout, and job turnover, contributing to workforce instability. Efforts to better understand how interpersonal and environmental work-related factors contribute to burnout and job turnover intentions are essential to improving ECE educator wellbeing. Grounded in the social ecological model, this study quantitatively examined how stress, the social climate (social support and social strain), and health behaviors contribute to burnout and job turnover intentions in ECE educators. METHODS: The StayWell ECE (Staff and Youth Wellness for Early Childhood Educators) project administered two online surveys to licensed ECE educators in New York: the Health Behaviors Survey (n = 1,423), assessing burnout, stress, turnover intentions, and health behaviors (diet, physical activity, and sleep), and the Social Environment Survey (n = 263), assessing workplace social climate (social support and social strain). Multiple linear regression analyses examined associations between burnout, the social climate, and health behaviors. Path analysis was conducted to test relationships among perceived stress, the social climate, burnout, and turnover intentions, controlling for age, income, and education; model fit was evaluated using chi-square, comparative fit index, root mean square error of approximation, and standardized root mean square residual. RESULTS: Higher burnout was significantly associated with poorer diet quality and lower physical activity and sleep. Lower workplace social support was also associated with poorer diet quality and sleep. Path analysis demonstrated adequate model fit and showed that stress was associated with lower social support, higher social strain, and higher levels of burnout. Social strain was strongly associated with two burnout subdomains (lower emotional exhaustion and depersonalization; p < 0.01 and p < 0.01), while social support was associated with one (greater personal accomplishment; p < 0.01). All burnout subdomains were associated with higher turnover intentions. CONCLUSIONS: Findings highlight burnout as a key mechanism linking stress and workplace social climate to health behaviors and turnover intentions among ECE educators. Interventions that reduce perceived stress and address both social support and social strain may improve wellbeing, support healthier behaviors, and reduce job turnover in this workforce.
BMC Public Health
· 2026 Jun · PMID 42337516
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BACKGROUND: Perinatal depression affects up to 30% of women in Kenya, yet many contributing factors remain poorly understood. We explored mental health problems, social needs, and associated risk factors among women ante...BACKGROUND: Perinatal depression affects up to 30% of women in Kenya, yet many contributing factors remain poorly understood. We explored mental health problems, social needs, and associated risk factors among women ante- and postnatally in Kajiado County, southern Kenya, from the perspectives of women and health-care workers (HCWs). METHODS: We conducted a qualitative study based on dual-perspective focus group interviews with mothers (ante- and postnatal) and HCWs in five health-care facilities (two urban and three rural) across Kajiado County (5-11 March 2025). Interviews were recorded, transcribed verbatim, translated into English when needed, and analysed using qualitative content analysis with an explorative and inductive approach. The text was divided into meaning units and manually coded in Atlas.ti ( https://atlasti.com ). Themes, subthemes and categories were articulated following a stepwise, iterative and reflexive process of abstraction and interpretation. RESULTS: Across five sites, 51 mothers and 39 HCWs participated. Three themes were developed relating to stress, distress and affecting mental wellbeing, (a) Women's autonomy and self-determination - mothers lacked control over resources or decision-making, while shouldering most household responsibilities, and HCWs highlighted the vulnerability of girls subjected to early marriage and female genital mutilation, often unprepared for motherhood, (b) Responsive maternal and mental health care - distance, costs, and low expectations limited access, while women feared traumatic births, miscarriage, and caesarean sections, and (c) Community knowledge and acceptance of mental health problems - mental health problems were often seen as irrationality or spiritual possession, delaying care. Stigma was particularly associated with caesarean sections, mental health problems, and HIV. CONCLUSIONS: Our findings describe how maternal mental health is closely intertwined with gender norms and prevailing perceptions of mental illness including stigma. Expanding maternal mental health services may be important but it is unlikely to be sufficient in isolation. Sustainable change may depend on the promotion of women's rights, increased mental health literacy at the community level, and the engagement of men. In addition, fear of traumatic birth and stigma associated with CS may need to be addressed not only at the individual level but also within the broader community context.
Wen YP, Brauer ER, Choi S
… +2 more, Comulada WS, Choi KR
BMC Public Health
· 2026 Jun · PMID 42337515
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BACKGROUND: Cancer survivors are twice as likely to experience psychological distress, with racial and ethnic minorities reporting higher distress and healthcare needs compared to non-Hispanic White Americans. However, t...BACKGROUND: Cancer survivors are twice as likely to experience psychological distress, with racial and ethnic minorities reporting higher distress and healthcare needs compared to non-Hispanic White Americans. However, this group is more likely to seek informal support over formal care. Discrimination has been identified as a key factor influencing individuals' mental health and help-seeking behaviors, but its impact on mental healthcare utilization remains unclear. METHODS: This cross-sectional study used surveys and electronic health records from the All of Us Research Program. Adults aged 18 or older who self-identify as Asian, Hispanic, or Black/African American, have a cancer history, and responded to surveys on discrimination and mental healthcare utilization were included. Multivariable regression models estimated the association between discrimination and mental healthcare utilization, stratified by race and ethnicity. RESULTS: One thousand nine hundred twenty-two ethnic minority cancer survivors participated. 249 (13.0%) were Asian Americans, 909 (47.3%) were Black/African Americans, and 673 (39.8%) were Hispanic Americans. Most participants were female (70.1%, n = 1,348), had health insurance (95.1%, n = 1,828), and were US-born (71.2%, n = 1,368). Demographic patterns varied across groups. 78.8% (n = 1514) and 67.7% (n = 1301) of respondents experienced everyday and healthcare discrimination, respectively. 24.5% (n = 470) used mental healthcare within the past year. Experiencing everyday discrimination was associated with higher odds of mental healthcare utilization among Hispanic American cancer survivors (OR = 2.40, 95% CI [1.68, 3.51]) and increased it by 57% among Black/African American cancer survivors (OR = 1.57, 95% CI [1.07, 2.31]). However, it did not significantly influence such use among Asian Americans. Conversely, discrimination in healthcare settings was not associated with the odds of mental healthcare utilization. Increased age and an advanced degree were independently associated with lower odds of mental healthcare utilization, while specific cancer types, like head and neck cancers, were correlated with higher odds of such use. CONCLUSIONS: Racial and ethnic minority cancer survivors experienced high levels of discrimination, and those experiencing everyday discrimination were more likely to use mental healthcare. Healthcare discrimination did not significantly increase mental healthcare utilization, suggesting unsuccessful engagement with mental healthcare. Anti-discrimination efforts should be organizational initiatives with clear benchmarks. Survivors of head and neck, thyroid, endocrine, and colorectal cancers may benefit most from integrated mental health services in routine oncology care.
Yuan K, Huang Y, Song J
… +4 more, Chen Z, Wang X, Wang Z, Zhang L
BMC Public Health
· 2026 Jun · PMID 42337512
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OBJECTIVE: This study aims to investigate the association between different blood pressure levels and all-cause mortality, as well as their impact on life expectancy, among middle-aged and elderly Chinese adults. METHODS...OBJECTIVE: This study aims to investigate the association between different blood pressure levels and all-cause mortality, as well as their impact on life expectancy, among middle-aged and elderly Chinese adults. METHODS: The data from China Health and Retirement Longitudinal Study (CHARLS) (2011-2020) was used. Participants with complete baseline and follow-up data was included in this analysis. According to the baseline blood pressure participants were categorized into three groups: normal blood pressure, high-normal blood pressure, and hypertension. The Cox proportional hazards regression model was employed to assess the impact of different blood pressure levels on all-cause mortality risk and the model with age as the time scale was used to estimate the life expectancy gap. RESULTS: This study included a total of 9,972 participants aged 45 and above, comprising 4,924 males and 5,048 females. After multivariable adjustment, compared to the normal blood pressure, the hazard ratios (HRs) for all-cause mortality in the high-normal blood pressure and hypertension groups were 1.14 (95% CI: 0.97-1.34) and 1.69 (95% CI: 1.46-1.95), respectively. Life expectancy analysis indicated that, compared to individuals with normal blood pressure, the years of life lost due to high-normal blood pressure and hypertension were 2.26 (95% CI: 2.05-2.45) and 5.75 (95% CI: 5.54-5.96) years at age 45, 2.19 (95% CI: 2.05-2.35) and 5.46 (95% CI: 5.31-5.63) years at age 55, and 2.05 (95% CI: 1.94-2.16) and 4.79 (95% CI: 4.68-4.89) years at age 65. Sex-stratified analysis revealed that hypertension was associated with a greater reduction in life expectancy among females, whereas high-normal blood pressure had a more pronounced impact on males. Sensitivity analyses yielded results consistent with the primary analysis, further confirming the robustness of the study findings. CONCLUSION: This study confirms that in the middle-aged and elderly population in China, hypertension is significantly associated with an increased risk of all-cause mortality. Both high-normal blood pressure and hypertension lead to a reduction in life expectancy, with noticeable gender differences. These findings underscore the importance of early intervention for individuals with hypertension, even when blood pressure is in the high-normal range. Additionally, it is crucial to develop precise intervention strategies tailored to gender differences to reduce the burden of cardiovascular diseases and improve the overall health of the Chinese population.
de Klerk JN, Haziqah-Rashid A, Widlake E
… +18 more, Wilson R, Pilgrim J, Vaux AGC, Tanianis-Hughes J, Delnicka A, Jealous AS, Abbott AJ, Haines C, Johnston CJ, Miller F, Sherlock K, Bursali F, Gandy S, Biddlecombe SM, Medlock JM, Blagrove MSC, Baylis M, Sedda L
BMC Public Health
· 2026 Jun · PMID 42337508
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Culex mosquitoes are widespread in temperate regions and play a key role in transmitting veterinary and human vector-borne diseases. In the United Kingdom, Culex pipiens s.l. is highly prevalent and a competent vector of...Culex mosquitoes are widespread in temperate regions and play a key role in transmitting veterinary and human vector-borne diseases. In the United Kingdom, Culex pipiens s.l. is highly prevalent and a competent vector of West Nile and Usutu viruses. Coupled with the northward expansion of West Nile virus in Europe, this raises concerns about emergence in the UK. For public and animal health preparedness, and effective vector control planning, it is essential to better understand the distribution of Culex mosquitoes in this area.This study developed species distribution maps for Culex pipiens pipiens, Culex pipiens molestus, and Culex torrentium abundance using data from the first nationwide stratified active mosquito surveillance programme in England and Wales in 2023, supplemented with adaptive surveillance in 2024. Culex p. pipiens models predicted higher abundances than the other two taxa. Regions of high abundance occurred across most of England, apart from the northwest, with the highest in eastern regions and estuarine areas. In contrast, higher elevation areas, including most of Wales, the North Pennines, and Yorkshire Dales, showed markedly lower abundances. Environmental drivers differed between forms. Culex p. pipiens abundance was strongly associated with precipitation-related covariates, whereas Culex p. molestus was mostly influenced by temperature covariates. These findings highlight the importance of modelling the two forms separately in risk analyses and distribution studies.The resulting models provide timely ecological insights to support surveillance prioritisation and provide a foundation for future work aimed at guiding public health planning and targeted vector management.
Shi L, Sutori S, Lögdberg U
… +2 more, Carli V, Eliasson ET
BMC Public Health
· 2026 Jun · PMID 42337495
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BACKGROUND: Men have 2-4 times higher suicide mortality than women and are less likely to seek help, with disparities linked to restrictive masculine norms and stigma. This review aimed to synthesize the effectiveness of...BACKGROUND: Men have 2-4 times higher suicide mortality than women and are less likely to seek help, with disparities linked to restrictive masculine norms and stigma. This review aimed to synthesize the effectiveness of suicide prevention interventions targeting men and identify gender-tailoring strategies. METHODS: Studies evaluating suicide prevention interventions targeting men were included if conducted in male-only samples and reporting outcomes related to suicidality (e.g., suicide deaths, suicide attempts, suicidal ideation), depression, or help-seeking (e.g., behaviors, intentions, attitudes). Six databases (MEDLINE, Embase, PsycINFO, Cochrane Library, Web of Science, and CINAHL) were searched for peer-reviewed English-language studies published up to 31 December 2025. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively. The protocol was registered in PROSPERO (CRD420250655554). RESULTS: Seventeen articles evaluating 14 interventions were included. Only one study assessed suicide deaths, and none occurred. Among RCTs, no significant effects were observed for suicide attempts, suicidal ideation, or depression. Help-seeking behaviors and intentions showed mixed evidence of improvement, with no improvement in help-seeking attitudes. Gender-tailoring strategies were synthesized into seven categories: intervention design and development, risk targeting, content and messaging, outreach and recruitment, delivery modalities, male representation and role modeling, and communication and action orientation. CONCLUSIONS: Evidence for the effectiveness of suicide prevention interventions targeting men remains limited, with no clear effects on suicidality or depression and mixed evidence for improvements in help-seeking. Risk of bias was generally moderate to high. A wide range of gender-tailoring strategies was identified. Further development of gender-responsive approaches and more rigorous evaluation are needed to reduce male suicide mortality.
BMC Public Health
· 2026 Jun · PMID 42337488
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BACKGROUND: Polysubstance use contributes substantially to substance-related morbidity and mortality in Canada, yet contemporary population-level estimates of alcohol-involved polysubstance use are limited. We estimated...BACKGROUND: Polysubstance use contributes substantially to substance-related morbidity and mortality in Canada, yet contemporary population-level estimates of alcohol-involved polysubstance use are limited. We estimated national prevalence patterns and examined associations with self-reported harms using 2023 Canadian Substance Use Survey (CSUS) data. METHODS: We conducted a cross-sectional analysis of the 2023 CSUS public-use microdata file, including Canadians aged ≥ 15 years residing in the provinces. Past-year substance-use patterns were categorized as single-substance use, drug-only polysubstance use (≥ 2 drug classes without alcohol), and drug-plus-alcohol polysubstance use (alcohol plus ≥ 1 drug class). Weighted prevalence estimates were calculated using survey weights and 1,000 bootstrap replicate weights. Survey-weighted logistic regression examined associations with any self-reported harm. A primary model adjusted for sociodemographic confounders; a sensitivity model additionally adjusted for self-rated physical and mental health. RESULTS: Past-year polysubstance use was reported by 27.2% (95% CI 26.0-28.5) of respondents and was predominantly alcohol-involved (27.0%, 95% CI 25.7-28.3). Drug-only polysubstance use was uncommon (0.3%, 95% CI 0.2-0.4). Common patterns included alcohol plus cannabis (14.4%) and alcohol plus stimulants (11.6%). Compared with single-substance use, drug-plus-alcohol polysubstance use was associated with reporting any harm (adjusted odds ratio [aOR] 4.80; 95% CI 1.02-22.69). Results were robust in sensitivity analyses adjusting for self-rated health (aOR 4.41) and using a stricter concurrent-use definition (aOR 5.72). CONCLUSIONS: Past-year polysubstance use is common in Canada and is largely driven by alcohol co-use. Integration of alcohol into polysubstance prevention, screening, and surveillance frameworks may strengthen public health responses to substance-related harms.
Akiyama MJ, Kaba-Diakite F, Dimaulaluan M
… +12 more, Riback LR, Antigua JR, Holmes CS, Ackerman MF, Castillo A, Linder M, Day RF, Travers A, Cunningham CO, Deng Y, Zhang C, Fox AD
Lancet Public Health
· 2026 Jul · PMID 42335913
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BACKGROUND: Criminal legal system-involved individuals face barriers to care after release from carceral settings. Elevated SARS-CoV-2 risk while incarcerated, together with living in congregate settings post-incarcerati...BACKGROUND: Criminal legal system-involved individuals face barriers to care after release from carceral settings. Elevated SARS-CoV-2 risk while incarcerated, together with living in congregate settings post-incarceration, increase the risk of respiratory viral infection transmission. This study evaluated a community health worker-led point-of-care SARS-CoV-2 testing and education intervention in a re-entry-focused community-based organisation compared with standard referrals. METHODS: This non-blinded, parallel group, randomised controlled trial, conducted in partnership with a community-based organisation in New York City (NYC), NY, USA, enrolled clients who were released from incarceration in the previous 90 days, fluent in English or Spanish, and residing within NYC for the study duration. Participants were randomly assigned (1:1) via computer-generated randomisation to onsite point-of-care testing and education or standard of care referral to offsite testing sites over 12 months. All participants were advised to test every 3 months. The study was not masked due to the nature of the intervention. The primary outcome was the proportion of patients with at least one SARS-CoV-2 test performed with results received during the 12-month period. Primary analyses were done by intention-to-treat using logistic or Poisson regression modelling. This trial was registered with ClinicalTrials.gov, NCT04878328, and is completed. FINDINGS: Between April 14, 2022, and May 22, 2024, 572 formerly incarcerated individuals were assessed for study eligibility. After the exclusion of 247 individuals, and a further 75 who did not attend enrolment, 250 participants were randomly assigned to the two study groups (125 to onsite point-of-care testing and education and 125 to standard of care). 216 (86%) participants were cisgender men, 30 (12%) were cisgender women, two (1%) were transgender women, and two (1%) were non-binary; 120 (48%) were Black and 82 (33%) were Hispanic; mean age was 42·0 years (SD 11·8). 109 (87%) of the 125 participants in the onsite point-of-care testing and education group and 67 (54%) of 125 participants in the standard of care group had at least one complete SARS-CoV-2 test (odds ratio 5·9 [95% CI 3·1-11·1]; p<0·0001). The absolute difference was 34 percentage points (95% CI 23-44; p<0·0001). The incidence rate ratio of complete SARS-CoV-2 tests was 2·4 times (95% CI 1·9-3·0, p<0·0001) as high among participants in the intervention group versus those in the standard of care group. No serious adverse events occurred. INTERPRETATION: Community-health worker-led testing and education at a re-entry-focused community-based organisation could potentially increase uptake of SARS-CoV-2 testing among formerly incarcerated individuals. Although further, larger trials are required, trusted community health workers can provide onsite point-of-care testing and health education, which has relevance for respiratory viral infections such as SARS-CoV-2 and might potentially be applicable to other infectious diseases such as HIV and hepatitis C virus. FUNDING: US National Institutes of Health.
Dupouy J, Druel V, Verges Y
… +2 more, Pariente A, Lapeyre-Mestre M
Lancet Public Health
· 2026 Jul · PMID 42335912
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BACKGROUND: There remains little evidence on whether opioid agonist treatment (OAT) is associated with a reduction in all-cause mortality in the context of widespread buprenorphine use. We aimed to study the risk of mort...BACKGROUND: There remains little evidence on whether opioid agonist treatment (OAT) is associated with a reduction in all-cause mortality in the context of widespread buprenorphine use. We aimed to study the risk of mortality in French primary care patients using OAT according to time on or off OAT treatment. METHODS: In this population-based, retrospective cohort study, we used data from the French National Health Data System (Système National de Données de Santé; SNDS). We included patients aged 15 years and older who began OAT between Jan 1, 2010, and Dec 31, 2022, and had at least two consecutively dispensed opioid agonists. Covariate data were also retrieved from the SNDS and included age, sex, deprivation index, medical comorbidities, psychiatric disorders, and concurrent medication. The primary endpoint was all-cause mortality by 1 year; all-cause mortality by 2, 5, and 7 years and specific mortality were the secondary endpoints. Multivariate Cox models accounting for time-dependent exposure (on OAT vs off OAT) were used to assess the association between OAT and mortality. FINDINGS: We included 175 191 individuals using OAT, of whom 131 444 (75·0%) were male and 43 747 (25·0%) were female. The median follow-up period was 3320 days (IQR 2055-4328). At inclusion, most patients had received buprenorphine (114 247 [65·2%]) or buprenorphine-naloxone (5895 [3·4%]). OAT use was associated with a lower risk of all-cause death at 1 year (adjusted hazard ratio [HR] 0·41 [95% CI 0·37-0·44]; absolute risk difference per 1000 person-years: 21·45 [19·32-23·58]), and this association persisted at 2 years (adjusted HR 0·36 [95% CI 0·34-0·39]), 5 years (0·36 [0·34-0·38]), and 7 years (0·40 [0·37-0·42]). OAT was also associated with lower cause-specific mortality, including injury or poisoning, drug-related deaths, accidental overdoses, infectious causes, and suicide, with similar patterns over time. The association was especially marked for buprenorphine, which had a 6-fold lower risk of all-cause death at 1 year (adjusted HR 0·16 [0·14-0·18]). INTERPRETATION: In this large, nationwide cohort of incident participants using OAT, we identified a large decrease in the risk of all-cause death associated with treatment. The association was especially marked for buprenorphine, even if this might result from indication bias. FUNDING: EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance.