Carrier screening is based on a simple biological premise. Many severe genetic disorders, including thalassemias, metabolic conditions, and neuromuscular diseases, follow an autosomal recessive inheritance pattern, meaning a child is affected only when both parents carry a pathogenic variant in the same gene. Carriers themselves are typically completely healthy, with no symptoms and often no family history, which is precisely why untargeted testing has historically missed so many at-risk couples. When both members of a couple are carriers of variants in the same gene, each pregnancy carries a 25 percent chance of being affected. Knowing this risk in advance opens a range of reproductive options, from preimplantation genetic testing during in vitro fertilization to prenatal diagnosis, informed family planning, and preparation for the medical care an affected child might need.

What distinguishes the Singapore program is its deliberate tailoring to Asian genetic diversity. Rather than adopting a panel built around variants common in European populations, the team designed a customized 112-gene panel targeting recessive diseases that are population-specific to the major ancestral groups represented in the country, including Chinese, Malay, Indian, and other Asian communities. This approach reflects a growing recognition in genomics that variant databases and screening panels calibrated on European data perform poorly elsewhere, both missing genuine carriers and generating confusing results from variants that behave differently across ancestries. Singapore, with its compact geography and well-characterized multiethnic population, provides an ideal setting to demonstrate how precision medicine can be adapted to Asian diversity rather than imported wholesale from Western frameworks.

The program operates nationwide, and its pilot phase began in September 2024. Participants receive culturally tailored online education about the screening program before providing samples, and results are returned with genetic counseling and a full discussion of reproductive options. The numbers reported so far illustrate both the appetite for such testing and the practical realities of implementation. Since the pilot began, 1,619 couples have registered interest in the program, and 60 percent of those deemed eligible went on to participate. Among the 550 couples who had received their results at the time of reporting, six couples, or 1.0 percent, were identified as being at increased risk of having a child affected by a recessive genetic condition. That figure, while small in absolute terms, represents couples who now have the knowledge to make fully informed reproductive decisions, something that would otherwise have remained invisible to them.

Beyond the laboratory and clinic, the research team invested heavily in understanding how the wider community views genetic screening, recognizing that a program’s success depends as much on social acceptance as on scientific accuracy. The researchers surveyed 1,002 community members, including both couples who had participated in the program and members of the general public. The results showed that interest in carrier screening was high, with 59 percent of respondents expressing interest across the cohort. However, the survey also revealed important fault lines: awareness of carrier screening, intent to participate, and understanding of the implications for reproductive options differed significantly by sociodemographic factors such as ancestry and religion. These findings underscore that a one-size-fits-all communication strategy would leave parts of the population behind, potentially exacerbating existing health inequities rather than reducing them.

Religious and cultural sensitivity emerged as a central theme of the implementation effort. The team engaged directly with religious leaders, whose support for the program was indicated through the engagement process, a step that reflects the realities of implementing reproductive genetics in a society where religious beliefs can shape attitudes toward prenatal testing and reproductive choice. By building these relationships before scaling up, the program aimed to ensure that its messaging and services would be culturally appropriate and that communities would not feel targeted or stigmatized by screening offers. This kind of groundwork is often overlooked in genomic medicine programs, which tend to emphasize technical validation over social license, but the Singapore experience suggests the two are inseparable.

The healthcare professional perspective revealed a different set of challenges. Among 113 healthcare professional respondents, there was broad acknowledgment that carrier screening will become routine in medical care, a consensus that mirrors international trends as sequencing costs fall and professional guidelines expand. Yet the same respondents reported limited confidence and limited resources for delivering this service. This gap between expected demand and workforce readiness is a familiar problem in genomics. Genetic counseling capacity is scarce in most countries, and frontline physicians in obstetrics, general practice, and family medicine often receive little training in interpreting carrier screening results or communicating residual risk. The Singapore findings suggest that any country contemplating population screening must budget as much for professional education and counseling infrastructure as for the genetic tests themselves.

The program sits within a broader national strategy. It forms part of Singapore’s National Precision Medicine initiative, a multi-phase government effort to build genomic infrastructure tailored to Asian populations, supported by the National Research Foundation and the Ministry of Health. Funding for the carrier screening program itself came through the Temasek Foundation and strategic academic funds, with the community questionnaire study supported by Singapore’s Social Science Research Council. This layered funding model, combining philanthropy, national research investment, and health system integration, may prove instructive for other countries weighing how to finance genomic screening programs that are expected to run for decades rather than years.

The technical architecture of the program also merits attention. The 112-gene panel was developed with contributions from the hospital’s DNA Diagnostic and Research Laboratory and the national diagnostics manufacturing hub, with a dedicated reporting system built at the National Heart Centre Singapore. Variant classification follows established frameworks from the American College of Medical Genetics and Genomics, and population frequency data drawn from resources such as the Genome Aggregation Database inform the interpretation of variants in the local context. Ethics approval was obtained from the SingHealth Centralised Institutional Review Board, and the program’s design incorporated input from clinical geneticists, genetic counselors, and genetics nurses who reviewed the educational content delivered to participants. The result is an end-to-end system in which education, testing, reporting, and counseling are integrated rather than bolted together.

The authors conclude that these early outcomes and community engagement findings are now guiding the expansion of population-based carrier screening in Singapore, but they are explicit that this expansion is contingent on addressing practical challenges through equitable outreach and professional training. The study’s significance extends well beyond the island nation. Most of the world’s population lives in Asia, yet genomic screening programs have been designed and validated overwhelmingly in Europe, North America, and Australia. Singapore’s experience demonstrates that population-specific panels, culturally grounded engagement, and honest assessment of healthcare workforce limitations can be combined into a workable national program. As other Asian countries develop their own precision medicine strategies, the Singapore model offers both a technical template and a cautionary lesson: the genetics may be the easy part, and the harder work lies in earning the trust of diverse communities and preparing clinicians to translate genomic knowledge into genuinely useful reproductive choices.

Subject of Research: Implementation of population-based reproductive carrier screening for diverse Asian populations in Singapore

Article Title: Implementing reproductive carrier screening to include diverse Asian populations: insights from Singapore

Article References: Bylstra, Y., Juann, M. Y., Teo, J. X., Goh, J., Choi, C., Chan, S., Song, C., Yin Goh, J. C., Siew Chai, N. B., Lieviant, J. A., Toh, H. J., Chan, S. H., Blythe, R., Menezes, M., Yang, C., Hodgson, J., Graves, N., Sng, J., Lim, W. W., … Jamuar, S. S. (2026). Implementing reproductive carrier screening to include diverse Asian populations: insights from Singapore. BMC Medicine. https://doi.org/10.1186/s12916-026-05286-w

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05286-w

Keywords: reproductive carrier screening, genetic testing, precision medicine, Singapore, Asian populations, autosomal recessive disease, genetic counseling, population screening, community engagement, healthcare professionals, gene panel, thalassemia

Organized breast cancer screening is one of the quiet success stories of modern public health. By inviting women in a target age group to attend mammography at regular intervals, organized programs detect tumors earlier than opportunistic screening, and earlier detection translates directly into better treatment outcomes and reduced breast cancer specific mortality. In Flanders, the regional Breast Cancer Screening Program has been associated with substantial reductions in deaths from the disease among women who participate. Yet the program has a persistent Achilles heel: participation remains suboptimal overall, and it follows a steep social gradient. In neighborhoods where average income hovers around the poverty line, participation rates fall below 40 percent, meaning that the women who could benefit most from early detection are precisely the ones least likely to be screened.

This pattern, in which preventive services reach the advantaged first and most, is one of the most stubborn mechanisms by which health inequities reproduce themselves. Women with lower incomes, lower educational attainment, or migration backgrounds may face practical barriers such as inflexible work schedules, childcare responsibilities, or unstable housing, but they also face informational and cultural barriers: invitation letters written in formal administrative language, health literacy demands that assume familiarity with screening concepts, and materials that never reflect the lives or languages of the readers. The research team, led by Allegra Ferrari of the University of Antwerp together with colleagues at the Center for Cancer Detection in Bruges and partner institutions, set out to test whether redesigning a single piece of communication could begin to dismantle those barriers.

The intervention itself was deliberately co-created rather than imposed. The tailored reminder letter was developed together with women of low socioeconomic status and with experts from sector organizations, including community health workers and groups supporting migrant and disadvantaged communities such as Solidaris, FMDO, Saamo, and others. This participatory design process matters scientifically as well as ethically: materials written by professionals for a hypothetical audience often miss the actual sticking points, whether those are distrust of institutions, confusion about what a mammogram involves, or simply a letter that reads like a bill rather than an invitation. By grounding the wording, tone, and structure in the lived experience of non-attenders, the team aimed to produce a reminder that felt personal, understandable, and actionable.

To evaluate the letter rigorously, the researchers ran a two-arm, parallel-group, superiority randomized controlled trial between April and June 2024. The study population consisted of women who had not responded to the standard screening invitation, the so-called non-attenders, a group in which conventional outreach typically underperforms. In total, 7,922 non-attenders were randomized in a one-to-one ratio. The control group received the standard invitation alone, while the intervention group received the standard invitation plus the tailored reminder letter. The primary outcome was attendance at screening within 40 days, a window chosen to capture the immediate behavioral response to the mailing. Because participation data were drawn from screening and health insurance registries through secure data linkage performed by the InterMutualistic Agency, the outcome measurement was objective and complete, immune to the recall and self-selection biases that plague survey-based studies.

The results were unambiguous. Overall, 997 women, or 12.6 percent of the study population, attended screening within 40 days. Participation was substantially higher in the intervention arm, at 15.8 percent, than in the control arm, at 9.4 percent, an absolute difference of 6.4 percentage points corresponding to an odds ratio of 1.81 with a 95 percent confidence interval of 1.58 to 2.07. In plain terms, a woman who received the tailored reminder had roughly 81 percent higher odds of attending screening within the window than an otherwise identical woman who received only the standard invitation. For a static intervention, a letter added to an existing centralized mailing system, that effect size is remarkable, and the statistical precision of the estimate leaves little doubt that the difference was driven by the intervention rather than by chance.

The most consequential finding, however, emerged when the researchers stratified the analysis by socioeconomic status. About 27 percent of participants were classified as low-SES. Among these women, the tailored reminder tripled participation, raising attendance from 4.0 percent in the control group to 12.0 percent in the intervention group, an absolute gain of 8 percentage points and an odds ratio of 3.24 with a 95 percent confidence interval of 2.27 to 4.61. Among women who were not classified as low-SES, the effect was more modest, lifting participation from 11.7 percent to 16.9 percent, an absolute gain of 5.2 percentage points and an odds ratio of 1.53. Because the intervention worked more strongly for the disadvantaged group, it did not merely raise overall participation; it actively narrowed the socioeconomic gap in screening, compressing a participation difference of nearly 8 percentage points at baseline to roughly 5 percentage points after the reminder.

This equity-narrowing property is what distinguishes the trial from the many studies that show reminders can nudge attendance. Interventions that raise participation uniformly, or that work better among the advantaged, tend to widen absolute disparities even as they improve population averages, a phenomenon sometimes described as intervention-generated inequality. Here the opposite occurred, and the mechanism is plausible: the letter was designed specifically to address the barriers faced by women of low socioeconomic status, so it functioned as what epidemiologists call a proportionate universalism-style intervention, universal in delivery but calibrated in content to those with the greatest need. The trial was registered at ClinicalTrials.gov as NCT07472036, and the protocol received ethics approval from the University of Antwerp together with formal endorsement from the Flemish Working Group on Breast Cancer Screening. Because the reminder was embedded in routine screening communications and involved only a minor modification to the standard invitation scheme, individual informed consent was not required, and no participant’s access to screening or usual care was affected.

The implications extend well beyond Flanders. Many countries with organized screening programs, from the Netherlands and the United Kingdom to Canada and Australia, rely on centralized invitation systems that mail standardized letters to eligible populations. Such systems are efficient but blind to the social heterogeneity of their recipients. The Belgian trial demonstrates that the marginal cost of adding a second, better-designed communication for non-responders is small, while the marginal benefit is concentrated exactly where public health needs it most. For program managers, the actionable lesson is procedural as much as technical: involve non-attenders and community organizations in drafting the message, test it in a randomized design rather than assuming it will work, and measure effects stratified by socioeconomic position so that equity impacts are visible rather than hidden in pooled averages.

Certain caveats deserve honest acknowledgment. The trial was registered retrospectively, which is a limitation in reporting rigor even though the randomized design and registry-based outcomes protect the main findings. The 40-day follow-up window captures immediate response but not whether the effect persists across screening rounds or whether reminded women return at the next invitation cycle. And a letter, however well crafted, cannot resolve structural barriers such as transport, childcare, or inflexible working hours that no amount of wording can overcome. Still, the core result stands as a persuasive proof of concept: communication designed with, rather than merely for, disadvantaged communities can measurably shift behavior and reduce inequity at population scale. As health systems confront the rising costs of late-stage cancer care, the humble reminder letter, co-written with the women it serves, may prove one of the best investments in the equity toolkit.

Subject of Research: Tailored reminder letters to reduce socioeconomic inequities in organized breast cancer screening participation

Article Title: Improving participation in breast cancer screening through a tailored reminder letter: a randomized controlled trial tackling socioeconomic inequities

Article References: Ferrari, A., Goossens, M., Van Bos, L., van de Veerdonk, W., Vandemaele, E., Vanhecke, J., Tran, T. N., Martens, P., Ding, L., de Bock, G. H., & Van Hal, G. (2026). Improving participation in breast cancer screening through a tailored reminder letter: a randomized controlled trial tackling socioeconomic inequities. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03027-2

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03027-2

Keywords: breast cancer screening, health equity, randomized controlled trial, reminder letter, health communication, socioeconomic status, mammography, population screening, Belgium, Flanders, cancer prevention, public health

Population-based screening programs are typically evaluated using a participation rate, which is calculated as the proportion of the eligible target population that completes a screening test during a defined round. But before a person can be counted as a non-participant, program organizers must first determine whether they are even eligible. Individuals who have already undergone a colonoscopy, who are under active surveillance for colorectal disease, or who have been diagnosed with certain serious illnesses should be medically excluded from the denominator. If these exclusions are under-ascertained, the denominator remains artificially inflated, and the reported participation rate is mechanically deflated. Conversely, departments that manage to identify more medically ineligible individuals will report higher participation rates, even if the actual number of people screened is identical. It is this mechanical link between exclusion ascertainment and participation estimates that the French research team, led by Akoï Koïvogui of the Université Sorbonne Paris Nord and colleagues, set out to quantify.

The challenge is that the tools available for identifying medically ineligible individuals vary dramatically from one part of France to another. Screening programs can draw on three principal external data sources: primary health insurance data, which capture reimbursements for procedures and treatments; hospital morbidity data, which record hospitalizations and diagnoses; and cancer registry data, which provide detailed information on diagnosed malignancies. Not every department has enjoyed the same access to these provider data, and not every department has used them with the same consistency. Between 2010 and 2023, only 21 of the 60 departments studied obtained data from a medical data provider institution, and they did so for an average of just 6.8 years within the study window. This patchwork of data access creates what the authors describe as heterogeneity in exclusion practices, and it raised a critical methodological question: how much of the variation in reported participation rates across France reflects genuine differences in screening uptake, and how much reflects differences in the ability to refine the eligible population?

To answer this question, the researchers conducted a retrospective ecological study using aggregated screening-round data from Santé publique France, the national public health agency, combined with information from a 2021 national survey documenting the exclusion practices of departmental screening management structures. Their analytical strategy had two components. First, they used mixed-effects models to assess the association between the duration of access to each of the three external data sources and the crude medical exclusion rate. Second, because participation is mechanically influenced by exclusion ascertainment, they analyzed a complementary outcome: the screened fraction of the total target population, which is immune to changes in the denominator. This dual approach allowed them to separate statistical artifacts from real changes in screening behavior.

The findings were striking. Longer use of primary health insurance data was associated with higher medical exclusion rates, with a regression coefficient of 0.35 and a 95 percent confidence interval of 0.24 to 0.47. Longer use of hospital morbidity data showed a similar direction of effect, with a coefficient of 0.14 and a confidence interval of 0.04 to 0.24. Cancer registry data, by contrast, showed no independent association with exclusion rates, suggesting that registries alone contribute little to the identification of medically ineligible individuals in the French context. In practical terms, departments with sustained access to insurance and hospital data were systematically better at refining their screening denominators than departments without such access.

The consequences for screening indicators followed directly. Departments with provider-data access reported higher participation rates than departments without it, but part of this difference turned out to reflect more complete refinement of the eligible population rather than greater screening uptake. When the team examined the screened fraction of the target population as a complementary outcome, the difference between departments was considerably more limited. In other words, some of the apparent gap in screening performance between French departments may have been an illusion produced by unequal data infrastructure rather than a real difference in how many people actually completed their screening tests.

To push the analysis further, the researchers turned to model-based counterfactual projections, using Monte Carlo methods to estimate how screening indicators might have evolved under two hypothetical scenarios of more sustained data access. The first scenario assumed uninterrupted use of provider data until 2023 in the departments that had used them at any point between 2010 and 2023. The second, more ambitious scenario assumed continuous provider-data use from 2010 onward in all departments. Under the second scenario, the projections suggested that more sustained access to provider data would have increased the reported medical exclusion rate by 6 percentage points and the reported participation rate by 2 percentage points. These are not trivial shifts. A two-point rise in reported participation, achieved purely through better denominator refinement, could meaningfully alter how departments are ranked, how resources are allocated, and how the program as a whole is judged against European targets.

The study’s implications extend well beyond France’s borders. Organized screening programs throughout Europe, and indeed around the world, depend on accurate denominators to measure performance, and many face comparable fragmentation in the availability of medico-administrative data. The French experience illustrates a subtle but important form of measurement bias: when the infrastructure needed to exclude medically ineligible individuals is unequally distributed, the resulting indicators are not comparable across jurisdictions, and programs serving populations with equal screening behavior may appear to perform very differently. This matters for policy planning, because participation rates are often used to identify underperforming regions, justify interventions, and evaluate the effect of program changes. If part of the observed variation is an artifact, interventions may be targeted at the wrong places, and genuine improvements may go unrecognized.

The authors argue that equitable access to provider data and the adoption of standardized exclusion algorithms based on the Système national des données de santé, France’s national health data system, would substantially improve program evaluation. The SNDS, which links insurance claims, hospital discharge records and other medico-administrative sources at the national level, offers a route to uniform exclusion ascertainment that would remove the geographic lottery currently embedded in the program’s statistics. The study was conducted as part of the continuous evaluation process of the colorectal cancer screening program and received approval under the framework of the French National Commission for Informatique and Civil Liberties, with all data anonymized before analysis and processing steps compliant with the European General Data Protection Regulation. The research did not receive specific funding from any public, commercial or non-profit agency, and the authors declare no competing interests.

What emerges from this work is a clear message for the growing movement toward data-driven public health: the quality of the data infrastructure is not a technical afterthought but a determinant of what programs can honestly see. As countries invest in screening for colorectal and other cancers, ensuring that every region has the same ability to identify who should and should not be counted may be as important as any improvement in invitation strategies or test logistics. Until then, the apparent shortfall in France’s screening participation—and possibly in other countries’—may partly be a story about data pipelines rather than about patients.

Subject of Research: Counterfactual analysis of how heterogeneous access to medical exclusion data sources affects participation estimates in France's population-based colorectal cancer screening program.

Article Title: Impact of medical exclusion data sources on population-based colorectal cancer screening round participation in France: a counterfactual analysis

Article References: Koïvogui, A., Balamou, C., Benamouzig, R., Mullaert, J., & Duclos, C. (2026). Impact of medical exclusion data sources on population-based colorectal cancer screening round participation in France: a counterfactual analysis. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15499-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15499-7

Keywords: colorectal cancer screening, France, participation rate, medical exclusion, counterfactual analysis, SNDS, health services research, population screening, Monte Carlo method, screening program evaluation, public health, cancer screening

The study’s technical approach is what sets it apart from the questionnaire-based surveys that have dominated Indonesian national health surveillance. Rather than relying primarily on interviews, the researchers put every willing participant through a battery of objective measurements. Anthropometric assessments captured body mass index and waist circumference, blood pressure was measured with calibrated devices, and each subject received a single-lead electrocardiogram to probe for silent rhythm abnormalities. Crucially, blood was drawn for biochemical analysis, including glycated hemoglobin, or HbA1c, which reflects average blood glucose over roughly three months, and a full lipid panel measuring cholesterol fractions including low-density lipoprotein. This laboratory anchoring matters because prior nationwide efforts, such as the Indonesian Health Survey of 2023, largely depended on self-reported history and tested only a limited subset of respondents with oral glucose tolerance tests and biochemical lipid profiling, leaving substantial blind spots in prevalence estimates.

The metabolic findings were perhaps the most dramatic. Sixty-nine percent of participants met criteria for obesity, a further 15 percent were overweight, and 83 percent had elevated waist circumference, a marker of central adiposity that is increasingly recognized as an independent predictor of cardiometabolic risk. Central obesity, in which fat accumulates around the abdominal organs, is metabolically active tissue that promotes insulin resistance, raises blood pressure and dysregulates lipid metabolism. That more than eight in ten screened adults carried excess abdominal fat, in a population where 80 percent of participants were women, points to a profound nutritional and lifestyle transition in this semi-urban setting. Indonesia, like much of Southeast Asia, has seen rapid shifts in diet and physical activity patterns over recent decades, and these data offer one of the clearest snapshots yet of what that transition means for the cardiovascular health of a working-age and older population outside the major megacities.

The screening also caught a quieter danger. Using the single-lead electrocardiogram, the team identified atrial fibrillation in 1.3 percent of subjects. Atrial fibrillation is an irregular heart rhythm that dramatically increases the risk of ischemic stroke, often presenting with no symptoms at all until a clot-related catastrophe occurs. Detecting it in a community cohort of adults without known cardiovascular disease underscores the value of including simple, inexpensive rhythm screening in population health programs. A single-lead ECG takes minutes and requires modest equipment, yet it can flag individuals who would benefit from anticoagulation therapy and closer follow-up, potentially preventing disabling strokes before they happen.

To understand who was most at risk, the researchers turned to multivariable logistic regression, a statistical technique that estimates the independent association between each candidate factor and an outcome while holding the others constant. The analysis showed that the presence of cardiovascular risk factors was significantly associated with older age, obesity and elevated waist circumference. These associations align with the established pathophysiology of atherosclerosis and metabolic disease, in which adiposity drives hypertension, insulin resistance and dyslipidemia over decades of exposure. But the regression results also carry a public health message: the risk factor burden in this population concentrates in identifiable, measurable subgroups, meaning targeted screening and intervention programs could plausibly reach the people who need them most without screening everyone identically.

Beyond physiology, the study probed the psychology of prevention. A subset of participants completed a 14-point questionnaire assessing knowledge, attitudes and practices, commonly abbreviated KAP in global health research. The median knowledge score was just 5 out of 10, and the median combined KAP score was 9 out of 14, revealing substantial gaps in what these adults understood about cardiovascular risk factors and how to control them. Further regression analysis suggested that KAP scores rose with education level but were unrelated to occupation, hinting that formal schooling, rather than workplace environment, shapes cardiovascular health literacy in this setting. Strikingly, the researchers found no significant relationship between KAP scores and the actual presence of cardiovascular risk factors. Knowing what is unhealthy, in other words, did not translate into measurably healthier risk profiles among those screened.

That disconnect between knowledge and behavior is a familiar puzzle in chronic disease prevention, but its scale here is notable. Health communication campaigns that simply inform people about the dangers of salt, sugar, tobacco and inactivity may be necessary but insufficient when the environments in which people eat, work and age make healthy choices difficult. In semi-urban North Sumatera, where community health infrastructure includes PUSKESMAS, the government community health centers, and POSBINDU, the integrated development posts designed for noncommunicable disease monitoring, the study’s findings suggest these channels exist but are not yet detecting or managing risk at the scale required. With more than half of screened adults hypertensive and most of those cases newly identified, the gap between the population’s need and the system’s reach is wide.

The study’s design deserves scrutiny as well as praise. Recruitment was opportunistic rather than a random population sample, meaning participants were people who came forward at screening sites, and four-fifths of them were women. Prevalence estimates drawn from such a cohort may not perfectly mirror the general adult population of North Sumatera, and the researchers are careful to frame the work as community-based screening rather than definitive epidemiology. Even so, the objective biochemical and instrumental measurements give the numbers a solidity that interview-based surveys cannot match, and the sheer proportion of newly diagnosed hypertension, diabetes and dyslipidemia among ostensibly healthy adults is unlikely to be an artifact. If anything, self-selection into a screening program would be expected to attract more health-conscious individuals, suggesting the true population burden could be still higher.

The ECARDIA-NS partnership between Universitas Sumatera Utara and the SingHealth Duke-National University of Singapore Global Health Institute, funded through pilot grants from both institutions, offers a model for how regional collaboration can generate locally actionable data. The authors conclude that the high burden of cardiometabolic disease, combined with the knowledge gaps the KAP survey exposed, indicates that considerably more work remains to be done in the region to address cardiovascular risk. Their findings arrive at a moment when low- and middle-income countries across Asia are confronting the collision of aging populations with rising obesity and diabetes, and when global health agencies are pressing for primary prevention strategies that identify risk before the first heart attack or stroke. In Medan and its surrounding districts, the message from this study is unambiguous: the risk factors are there, they are common, they are largely silent, and they are waiting to be found by anyone willing to measure a blood pressure, draw a blood sample and look.

Subject of Research: Prevalence and detection of cardiovascular risk factors among semi-urban adults in North Sumatera, Indonesia

Article Title: Prevalence of cardiovascular risk factors in a semi-urban population in Indonesia [Early detection of cardiovascular risk factors as primary prevention amongst North Sumatera adults (ECARDIA-NS) study]

Article References: Siregar, Y. F., Tern, P. J. W., Lei, J., Ilyas, K. K., Raynaldo, A. H., Sarastri, Y., Haykal, T. B., Andra, C. A., Habib, F., Hasan, R., Siregar, D. I. S., Koh, S. J. Q., Koh, A. S.-M., Tan, J. W. C., & Lubis, A. C. (2026). Prevalence of cardiovascular risk factors in a semi-urban population in Indonesia [Early detection of cardiovascular risk factors as primary prevention amongst North Sumatera adults (ECARDIA-NS) study]. BMC Public Health. https://doi.org/10.1186/s12889-026-29179-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29179-y

Keywords: cardiovascular risk factors, hypertension, diabetes, dyslipidemia, obesity, Indonesia, North Sumatera, population screening, primary prevention, atrial fibrillation, public health, Prevalence