Category: Statistics

Health Serv Res. 2026 Oct;61(5):e70150. doi: 10.1111/1475-6773.70150.

ABSTRACT

OBJECTIVE: To describe how the characteristics of Medicare Advantage (MA) beneficiaries with end-stage kidney disease (ESKD) changed after the 21st Century Cures Act expanded MA eligibility, and to document accompanying changes in utilization.

STUDY SETTING AND DESIGN: The 2021 Cures Act opened MA to previously diagnosed ESKD patients. Prior to 2021, ESKD patients were ineligible for MA unless diagnosed while enrolled. This cross-sectional descriptive study used 2017-2023 claims to compare enrollee characteristics before and after 2021, using interrupted time-series analysis of monthly hospitalizations, emergency department visits, and outpatient visits.

DATA SOURCES AND ANALYTIC SAMPLE: Optum’s de-identified Clinformatics Data Mart Database (2017-2023) provided data on 216,205 MA beneficiaries with ESKD (359,172 beneficiary-years).

PRINCIPAL FINDINGS: Post-policy, enrollees were younger, had lower comorbidity burden and lower education attainment, and were more likely to report household incomes below $40,000. Hospitalization rates were lower immediately post-policy by 0.013 per beneficiary-month (6% relative decline; 95% CI, -0.022 to -0.003; p < 0.05). ED visits showed no immediate difference but increased over time. Outpatient visits remained largely stable.

CONCLUSIONS: Expanded MA eligibility was associated with a substantial shift in the ESKD MA case mix toward younger, relatively healthier, and more socioeconomically vulnerable beneficiaries. Utilization changes reflect these compositional differences.

PMID:42663502 | DOI:10.1111/1475-6773.70150

Eur J Ophthalmol. 2026 Aug 28:11206721261481272. doi: 10.1177/11206721261481272. Online ahead of print.

ABSTRACT

PurposeTo evaluate the clinical utility of novel systemic inflammatory indices in pediatric allergic conjunctivitis and to examine their relationship with disease severity.MethodsThis prospective, cross-sectional study included 28 patients with vernal keratoconjunctivitis (VKC), 32 with seasonal allergic conjunctivitis (SAC), and 32 healthy controls. Systemic inflammatory indices were calculated using complete blood count (CBC) and albumin data. Clinical symptom and sign scores were recorded in the VKC group. Intergroup comparisons for both CBC values as well as inflammatory biomarkers were investigated.ResultsHemoglobin and platelet counts were significantly higher in VKC patients compared to controls (p = 0.024 and p = 0.012, respectively), while eosinophil counts were elevated in both VKC and SAC groups relative to controls (p = 0.002 and p < 0.001). SII, SIRI, and PIV values were significantly higher in VKC patients than in both SAC and control groups (p < 0.05), whereas NLR, PLR, and HALP did not differ significantly among the groups. No statistically significant correlations were found between inflammatory indices and clinical symptom or sign scores in the VKC group.ConclusionComposite inflammatory indices, particularly SII, SIRI, and PIV, may support the distinction between VKC and SAC at a group level by reflecting differences in systemic immune activation. Although these indices were not associated with clinical severity scores, their elevation in VKC underscores underlying immunological differences between chronic and milder allergic conjunctivitis subtypes and suggests a potential role for systemic inflammatory indices as adjunctive tools to support clinical assessment.

PMID:42663483 | DOI:10.1177/11206721261481272

Strabismus. 2026 Aug 28:1-8. doi: 10.1080/09273972.2026.2719731. Online ahead of print.

ABSTRACT

INTRODUCTION: To evaluate whether subtle facial anthropometric variations may influence the perceived noticeability of exotropia.

METHODS: This was a cross-sectional study of adult participants over the age of 18 years old recruited via social media platforms. Digitally generated facial images were used to create a baseline male face with a constant moderate-angle left exotropia and eight modified images with ±5% changes in palpebral fissure length, intercanthal distance, facial width, and facial height. Participants completed randomized pairwise comparisons, selecting which image demonstrated more noticeable ocular misalignment. Relative noticeability was quantified using Elo rating scores. A Bradley-Terry model was used to estimate odds ratios comparing each modified image with baseline. Subgroup analyses were performed by sex and age. The main outcome measure was perceived noticeability of exotropia based on participant-selected pairwise comparisons.

RESULTS: A total of 201 participants completed the survey (mean age 32.5 ± 11.4 years; 59.2% female). Both decreased palpebral fissure length (Elo score: 1 517.27 ± 16.6) and decreased intercanthal distance (Elo score: 1 512.72 ± 14.1) were ranked as having higher perceived noticeability of exotropia, whereas increased palpebral fissure length (Elo score: 1 485.58 ± 16.4) was ranked as having a lower perceived noticeability. In the Bradley-Terry model, decreased palpebral fissure length (OR 5.87, p < .001), decreased intercanthal distance (OR 3.96, p < .001), and increased intercanthal distance (OR 1.43, p < .05) were associated with higher odds of perceived noticeability relative to baseline, while increased palpebral fissure length (OR 0.41, p < .001) was associated with lower odds. Modifications in facial width and facial height were not statistically significant compared to baseline. Perceived noticeability did not differ by participant sex or age group.

DISCUSSION: Subtle variation in periocular facial anthropometric features may influence the perceived noticeability of exotropia independent of deviation magnitude. Periocular features, particularly palpebral fissure length and intercanthal distance, appear to play a greater role in perception than broader facial dimensions. These findings suggest that facial context may contribute to the cosmetic appearance of strabismus and may help explain variability in perception among patients with similar measured deviations.

PMID:42663454 | DOI:10.1080/09273972.2026.2719731

JMIR Res Protoc. 2026 Aug 27;15:e92566. doi: 10.2196/92566.

ABSTRACT

BACKGROUND: Cancer-related pain remains highly prevalent and frequently undertreated despite advances in oncological therapies and analgesic strategies. Multidisciplinary approaches are recommended to optimize complex cancer pain management and integrate supportive care; however, robust real-world evidence evaluating their measurable clinical and patient-reported impact remains limited. Structured multidisciplinary cancer pain committees may be associated with changes in pain outcomes, quality of life, and patient experience, but prospective evaluations in routine clinical practice are scarce.

OBJECTIVE: The primary objective of this study is to describe changes in pain intensity following multidisciplinary evaluation in patients with cancer-related pain. Secondary objectives include describing changes in quality of life, pain interference, opioid consumption, treatment-related adverse effects, and patient-reported experience measures (PREMs) following multidisciplinary cancer pain committee assessment.

METHODS: This is a prospective, single-center, longitudinal, observational pre-post study conducted in a tertiary university hospital. A total of 68 adult patients with cancer-related pain referred to a multidisciplinary cancer pain management committee will be consecutively included in the study. Clinical variables and patient-reported outcomes will be collected at baseline (T0, before committee evaluation) and at 60 days following multidisciplinary committee assessment (T1). The primary outcome measure will be the change in pain intensity measured using the visual analog scale. Secondary outcomes include pain interference assessed with the Brief Pain Inventory-Short Form; health-related quality of life measured with the EQ-5D; and opioid consumption, treatment-related adverse effects, and PREMs, including patient satisfaction, assessed using the Likert scale. Pre-post comparisons will be performed using paired statistical tests (2-tailed paired t test or Wilcoxon signed rank test, depending on data distribution). Statistical significance will be set at P<.05.

RESULTS: Participant recruitment began in July 2026. At the time of submission of this revised manuscript, 3 participants had been enrolled. Recruitment and follow-up are ongoing. Data collection is expected to continue through late 2027, and the primary study results are expected to be available in early 2028, following completion of data collection and statistical analysis.

CONCLUSIONS: This study will describe changes in clinical and patient-reported outcomes following multidisciplinary cancer pain committee assessment in routine clinical practice. Although causal inference is not possible because of the observational pre-post design, the findings may inform future optimization and evaluation of multidisciplinary cancer pain management pathways.

TRIAL REGISTRATION: OSF Registries ty5m9; https://osf.io/ty5m9.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92566.

PMID:42659650 | DOI:10.2196/92566

PLoS One. 2026 Aug 27;21(8):e0337982. doi: 10.1371/journal.pone.0337982. eCollection 2026.

ABSTRACT

The coefficient of variation (CV) is a frequently used standardized measure of variability that allows meaningful comparison among datasets measured using different scales or units. Although widely applied in practice, formal statistical inference for the CV under non-normal distributions has received limited attention. This study focuses on estimating the CV for the weighted exponential distribution under an adaptive Type-II hybrid progressive censoring scheme, which enhances the efficiency of life-testing experiments by balancing test duration and the number of observed failures. Both Bayesian and non-Bayesian frameworks are considered. Point estimation in the non-Bayesian framework is carried out using the maximum likelihood method, whereas interval estimates are constructed through the parametric bootstrap approach. For the Bayesian approach, posterior inference is performed through Markov chain Monte Carlo sampling with under appropriate gamma prior assumptions. To illustrate the implementation of the proposed procedures, a simulated dataset is analyzed, and a comprehensive Monte Carlo simulation study is subsequently conducted to evaluate the accuracy and efficiency of the estimators. According to the analysis, Bayesian estimators based on informative prior distributions yield more precise estimates of the CV.

PMID:42659621 | DOI:10.1371/journal.pone.0337982

JCO Clin Cancer Inform. 2026 Jul-Sep;10(3):e2500376. doi: 10.1200/CCI-25-00376. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: The National Cancer Institute Comorbidity Index (NCI-CI) captures patient-level comorbidity burden using diagnosis codes found in administrative claims or electronic health record (EHR) data. However, it is less well understood how claims- and EHR-based comorbidity measures compare. We determined the concordance between the claims-based and EHR-based NCI-CI using a linked data source.

MATERIALS AND METHODS: This study used a linkage of tumor registry, EHR, and Medicare claims data. Eligible patients were 65 years and older and were diagnosed and/or received their first course of treatment in 2019-2020. We formed comparison pairs determined by the data source, period relative to the diagnosis date, length of interval for calculating the index, and type of comorbidity index. The primary pair was the 12-month prediagnosis NCI-CI calculated using claims (NCI-CI_claims) and EHR (NCI-CI_EHR) data. We compared pairs using descriptive statistics, correlation coefficients, and histograms. We also identified patient-level factors associated with claims/EHR comorbidity discordance using models of categorical outcomes.

RESULTS: The final sample included 1,616 individuals. The median values for NCI-CI_claims and NCI-CI_EHR were 0.6 (range: 0-4.11) and 0.29 (range: 0-3.06), respectively. We identified moderate correlation (0.49-0.52) between the claims-based and EHR-based comorbidity measures across all comparison pairs. Among individuals with claims-based comorbidities, 32 percent did not report any of those comorbidities based on the EHR data. Older age (eg, age 80+ years) was positively associated with the odds of having a discordant pair.

CONCLUSION: In this study, we found moderate correlations between claims-based and EHR-based approaches to NCI comorbidity measures. Mean comorbidity index values were consistently higher using claims data potentially because of more complete capture of health care utilization and diagnoses outside of the hospital system using claims data.

PMID:42659595 | DOI:10.1200/CCI-25-00376

Obstet Gynecol. 2026 Aug 27. doi: 10.1097/AOG.0000000000006415. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine the association between the Affordable Care Act (ACA) Medicaid expansion and severe maternal morbidity (SMM) during delivery hospitalization.

METHODS: This was a retrospective, repeated cross-sectional study using data from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. All delivery hospitalizations from 2010 to 2018 were analyzed; of the 26 U.S. states included, 16 expanded Medicaid in January 2014 and 10 did not. The primary outcome was the SMM rate, as defined by Centers for Disease Control and Prevention criteria, exclusive of blood transfusion. We used a quasi-experimental design to compare changes in the SMM rate from preexpansion (2010-2013) to postexpansion (2015-2018) in states that expanded Medicaid compared with those that did not. Generalized synthetic control models were used to estimate the adjusted average treatment effect on the treated.

RESULTS: The study sample included 11.98 million delivery hospitalizations; among those hospitalized, 82,903 (69.2/10,000) experienced SMM. The ACA Medicaid expansion was associated with a 5.2% (95% CI, 2.1-8.2) increase in the proportion of delivery hospitalizations paid for by Medicaid, but not with any statistically significant change in the SMM rate (0.02%; 95% CI, -0.01 to 0.04). Results were consistent in the subgroup analyses by maternal race and ethnicity and in sensitivity analyses.

CONCLUSION: Expanded access to public health insurance was not associated with a reduction in SMM during delivery hospitalizations. Additional clinical and policy interventions may be required to improve maternal health outcomes.

PMID:42659592 | DOI:10.1097/AOG.0000000000006415

Obstet Gynecol. 2026 Aug 27. doi: 10.1097/AOG.0000000000006407. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess associations among maternal geographic residence, access to obstetric care, and nonspontaneous delivery, including labor induction and prelabor cesarean delivery, in individuals with low-risk term pregnancies.

METHODS: We analyzed cross-sectional 2022 National Center for Health Statistics natality data, restricted to individuals with healthy, low-risk, term (37-40 weeks of gestation) singleton births. Maternal residence was classified along the rural-urban continuum and county-level maternity care access designations. Deliveries were categorized as spontaneous (reference) or nonspontaneous (ie, clinician initiated) and further classified as induction or prelabor cesarean. Cox proportional hazards models (with data augmentation as appropriate) were used to estimate hazard ratios (HRs) adjusted for maternal age, race and ethnicity, prepregnancy body mass index (BMI), and cigarette smoking status.

RESULTS: Among 1,157,422 low-risk term births, residents of rural and limited-access counties had a higher incidence of nonspontaneous delivery, particularly at 39-40 weeks of gestation, compared with residents of urban and full-access counties (adjusted HR 1.22 in suburban to 1.42 in the most rural counties, P trend<.01; adjusted HR 1.25 in moderate- to 1.43 in no-access counties, P trend<.01). This finding was driven by induction (observed in 34.4% of full-term deliveries; adjusted HR 1.31 in suburban to 1.56 in the most rural counties; P trend<.01; adjusted HR 1.33 in moderate- to 1.52 in no-access counties, P trend<.01). The opposite pattern was observed for prelabor cesarean delivery (4.8% of deliveries; adjusted HR 0.69 in suburban to 0.61 in the most rural counties, P trend<.01; adjusted HR 0.70 in moderate- to 0.79 in no-access counties, P trend<.01). Associations for the rural-urban continuum were driven largely by maternity care access: adjusted HR 1.05 for nonspontaneous delivery in rural/full-access counties and 1.39 in urban-suburban/no-access counties compared with urban-suburban/full-access counties. All associations were attenuated at 37-38 weeks of gestation compared with 39-40 weeks.

CONCLUSION: Maternal residence and access to obstetric care were associated with the timing and method of delivery among individuals with low-risk pregnancies, possibly reflecting differences in health care system capacity and local practice norms. Declining local access to maternity care may contribute to increased reliance on labor induction in rural and limited-access settings.

PMID:42659590 | DOI:10.1097/AOG.0000000000006407

JCO Glob Oncol. 2026 Aug;12(8):e2600130. doi: 10.1200/GO-26-00130. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: Cancer imposes substantial economic burden through indirect costs associated with labor outcomes and productivity loss. This systematic review and meta-analysis quantifies labor and productivity outcomes among patients with cancer and survivors to inform economic evaluations and policy development.

METHODS: We systematically searched PubMed, EconLit, and Web of Science databases in June 2025 using cancer, productivity loss, and labor outcomes terminology. Peer-reviewed studies reporting eight outcomes were included. Following screening of 6,239 abstracts and full-text review of 358 articles, 144 studies from 27 countries met inclusion criteria for meta-analysis.

RESULTS: The available evidence skews strongly toward formal employment situations in high-income, Western countries. We estimate a 25% productivity loss due to absenteeism (95% CI, 18 to 32) and a 23% productivity loss due to presenteeism (95% CI, 21 to 26); working hours are reduced by 19% (95% CI, 14 to 24); the return-to-work rate is 47% (95% CI, 39 to 54) with a median time of 239 days for full return; the overall job loss rate is 9% (95% CI, 8 to 11; 35% for advanced cancer; 95% CI, 22 to 48); the unemployment rate is 29% (95% CI, 22 to 36); the long-term disability/pension use is 11% (95% CI, 0 to 22); and the early retirement rate is 14% (95% CI, 8 to 20). For each reported outcome, cancer’s productivity costs are observed to be more severe among women than men.

CONCLUSION: This represents the largest comprehensive meta-analysis of cancer-related labor outcomes to date. Estimated labor and productivity consequences are in line with previous research, but outcomes varied significantly by gender, cancer stage, geographic region, and time since diagnosis. Subgroup analysis provides nuanced insight into how these factors influence labor and productivity outcomes. These evidence-based estimates provide critical inputs for economic evaluations and support development of policies to maintain professional productivity among patients with cancer and survivors.

PMID:42659587 | DOI:10.1200/GO-26-00130

JCO Glob Oncol. 2026 Aug;12(8):e2600060. doi: 10.1200/GO-26-00060. Epub 2026 Aug 27.

ABSTRACT

PURPOSE: Timely discussion of goals of care (GoC) between oncologists and patients with advanced cancer can improve end-of-life (EoL) decision making, ensuring that care aligns with individual preferences. However, barriers at multiple levels could limit timely EoL communication. This cross-sectional study examined oncologists’ perceptions of barriers to GoC discussions regarding EoL processes among patients in Puerto Rico.

METHODS: A 26-item questionnaire was distributed to oncologists in Puerto Rico, assessing three barrier domains (patient and family; physician; and systemic or external factors) and oncologists’ willingness to engage in GoC discussions. Data were collected between April 2024 and January 2025. Descriptive statistics were used to summarize oncologists’ characteristics. Differences in oncologists’ characteristics and willingness to engage in the decision-making process were assessed with the Mann-Whitney test (non-normally distributed data). Associations between barriers and oncologists’ characteristics, such as age and training, were explored.

RESULTS: A total of 60 oncologists across Puerto Rico (approximately 50% participation rate) completed the questionnaire. Over 65% identified patient- and family-related factors as the primary barriers to EoL discussions. Although 58.3% of oncologists had not received formal training in EoL, they did not perceive this as a significant barrier. Yet, those without formal training faced greater barriers.

CONCLUSION: Family and patient factors emerged as the predominant barriers. Despite oncologists’ willingness to engage in EoL discussions, the absence of formal training may hinder these conversations. Further research should focus on communication training and initiatives to provide oncologists, patients, and families with valuable resources for EoL decision making.

PMID:42659585 | DOI:10.1200/GO-26-00060