Category: Statistics

JAMA Health Forum. 2024 Dec 6;5(12):e244365. doi: 10.1001/jamahealthforum.2024.4365.

ABSTRACT

IMPORTANCE: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.

OBJECTIVE: To determine the rate of drug overdose among Medicaid beneficiaries.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.

EXPOSURE: Participation in the Medicaid program.

MAIN OUTCOME: Death of a drug overdose.

RESULTS: In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.

CONCLUSIONS AND RELEVANCE: The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.

PMID:39641942 | DOI:10.1001/jamahealthforum.2024.4365

JAMA Health Forum. 2024 Dec 6;5(12):e244304. doi: 10.1001/jamahealthforum.2024.4304.

ABSTRACT

IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace.

OBJECTIVE: To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included patients 18 to 64 years old in Colorado who were not enrolled in Medicare at dialysis initiation. Data analysis was conducted from May to August 2023.

EXPOSURE: Introduction of the ACA Marketplace in 2014.

MAIN OUTCOMES AND MEASURES: Medicare, Medicaid, or private insurance enrollment in the first year after dialysis initiation, and dialysis spending by insurance type.

RESULTS: Of 2005 patients included in the sample, 1416 (70.6%) were 45 to 64 years old, and 1259 (62.8%) were male. A lower proportion of patients with incident ESKD starting dialysis were newly enrolled in Medicare in the years following the ACA (361 of 713 [50.6%]) compared to 2 years prior (420 of 595 [70.6%]). Unadjusted rates of switching from Medicaid to Medicare 1 year after dialysis initiation decreased 14.3 percentage points over time (68.9% in 2012-2013 vs 58.3% and 54.6% in 2014-2015 and 2016-2017, respectively). Unadjusted rates of switching from private insurance to Medicare 1 year after dialysis initiation decreased by 22.3 percentage points (68.1% in 2012-2013 vs 52.2% and 45.8% in 2014-2015 and 2016-2017, respectively). Over the entire 2012 to 2017 period, quarterly dialysis spending in the first year of dialysis among patients with private insurance was higher than among those with Medicare coverage ($26 351-$29 781 vs $10 039-$12 741).

CONCLUSIONS AND RELEVANCE: This cross-sectional study demonstrates that lower Medicare enrollment rates over time among those initiating dialysis may be inducing higher social spending. This finding raises concerns about the effectiveness of Medicare policies and federal leverage to improve access, outcomes, and value of dialysis care.

PMID:39641939 | DOI:10.1001/jamahealthforum.2024.4304

JAMA Netw Open. 2024 Dec 2;7(12):e2444983. doi: 10.1001/jamanetworkopen.2024.44983.

ABSTRACT

IMPORTANCE: Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair).

OBJECTIVE: To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI.

DESIGN, SETTING, AND PARTICIPANTS: Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024.

EXPOSURES: PUs acquired during surgical or first rehabilitative SCI care.

MAIN OUTCOMES AND MEASURES: The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression.

RESULTS: The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01).

CONCLUSIONS AND RELEVANCE: In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

PMID:39641930 | DOI:10.1001/jamanetworkopen.2024.44983

JAMA Netw Open. 2024 Dec 2;7(12):e2447902. doi: 10.1001/jamanetworkopen.2024.47902.

ABSTRACT

IMPORTANCE: The American Heart Association proposed Life’s Essential 8 (LE8) as an enhanced measurement tool for cardiovascular health.

OBJECTIVE: To examine the association of LE8 with risk of atherosclerotic cardiovascular disease (ASCVD) incidence and prognosis in veterans.

DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study of US veterans enrolled in the Department of Veterans Affairs (VA) Million Veteran Program (MVP) between 2011 and 2022. Data were analyzed from 2023 to 2024.

EXPOSURE: LE8 score ranged from 0 to 100, with higher score indicating better cardiovascular health.

MAIN OUTCOMES AND MEASURES: The primary outcome was total ASCVD incidence in veterans without baseline ASCVD, and the secondary outcome was incidence of a major adverse cardiovascular event (MACE) among veterans with and without ASCVD at baseline.

RESULTS: A total of 413 052 veterans (mean [SD] age, 65.8 [12.1] years; 378 162 [91.6%] male) were included. Based on 1.7 million person-years of follow-up of 279 868 veterans without any ASCVD at baseline, 45 067 veterans had an ASCVD event during follow-up. Total LE8 score and each component LE8 factor score was associated with incident ASCVD in an inverse, linear, dose-response manner. For veterans without prior ASCVD, those with an LE8 score between 80 and 100 had lower risk of ASCVD compared with those with an LE8 score of 0 to 49 (adjusted hazard ratio [aHR], 0.36 [95% CI, 0.35-0.38]). Similarly, risk of MACE was significantly lower among veterans with an LE8 score of 80 to 100 regardless of baseline ASCVD status (with ASCVD: aHR, 0.52 [95% CI, 0.48-0.56]; without ASCVD: aHR, 0.14 [95% CI, 0.13-0.15]) compared with those with ASCVD and an LE8 score of 0 to 49.

CONCLUSIONS AND RELEVANCE: In this cohort study of US veterans, higher LE8 scores were associated with significantly lower ASCVD incidence risk and lower likelihood of developing adverse cardiovascular events regardless of ASCVD status at baseline. These results support the utility of LE8 for health promotion and ASCVD prevention.

PMID:39641929 | DOI:10.1001/jamanetworkopen.2024.47902

JAMA Netw Open. 2024 Dec 2;7(12):e2449243. doi: 10.1001/jamanetworkopen.2024.49243.

ABSTRACT

IMPORTANCE: Understanding whether there are racial and ethnic and residential disparities in prenatal telehealth uptake is necessary for ensuring equitable access and guiding implementation of future hybrid (ie, both telehealth and in-person) prenatal care.

OBJECTIVE: To assess temporal changes in individuals using hybrid prenatal care before and during the COVID-19 public health emergency (PHE) by race and ethnicity and residence location in the US.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed electronic health record data of prenatal care visits from the National COVID Cohort Collaborative Data Enclave, comprising data from 75 health systems and freestanding institutes in all 50 US states. Data were analyzed on 349 682 nationwide pregnancies among 349 524 people who gave birth from June 1, 2018, through May 31, 2022. Multivariable generalized estimating equations were used to examine variations in receiving hybrid vs only in-person prenatal care. Data phenotyping and analysis occurred from June 13, 2023, to September 27, 2024.

EXPOSURES: Prenatal period overlap (never, partially, or fully overlapping) with the COVID-19 PHE, maternal race and ethnicity, and urban or rural residence.

MAIN OUTCOMES AND MEASURES: Hybrid vs in-person-only prenatal care.

RESULTS: Of 349 682 pregnancies (mean [SD] age, 29.4 [5.9] years), 59 837 (17.1%) were in Hispanic or Latino individuals, 14 803 (4.2%) in non-Hispanic Asian individuals, 65 571 (18.8%) in non-Hispanic Black individuals, 162 677 (46.5%) in non-Hispanic White individuals, and 46 794 (13.4%) in non-Hispanic individuals from other racial and ethnic groups. A total of 31 011 participants (8.9%) resided in rural communities. Hybrid prenatal care increased from nearly none before March 2020 to a peak of 8.1% telehealth visits in November 2020, decreasing slightly to 6.2% by March 2022. Among the fully overlapping group, urban residents had nearly 2-fold odds of hybrid prenatal care compared with rural people (adjusted odds ratio [AOR], 1.98; 95% CI, 1.84-2.12). Hispanic or Latino people (AOR, 1.48; 95% CI, 1.41-1.56), non-Hispanic Asian people (AOR, 1.47; 95% CI, 1.35-1.59), and non-Hispanic Black people (AOR, 1.18; 95% CI, 1.12-1.24) were more likely to receive hybrid prenatal care than non-Hispanic White people.

CONCLUSIONS AND RELEVANCE: In this cohort study, hybrid prenatal care increased substantially during the COVID-19 PHE, but pregnant people living in rural areas had lower levels of hybrid care than urban people, and individuals who belonged to racial and ethnic minority groups were more likely to have hybrid care than White individuals. These findings suggest that strategies that improve equitable access to telehealth for people who live in rural areas and people in some minority racial and ethnic groups may be useful.

PMID:39641928 | DOI:10.1001/jamanetworkopen.2024.49243

JAMA Netw Open. 2024 Dec 2;7(12):e2449430. doi: 10.1001/jamanetworkopen.2024.49430.

ABSTRACT

IMPORTANCE: Comprehensive data on the prevalence of various life stressors and their role in posttraumatic stress disorder (PTSD) among women are lacking.

OBJECTIVE: To determine the prevalence of a broad range of life stressors and their association with PTSD in a large nationally representative cohort of women.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used data from the population-based Stress-And-Gene-Analysis, which invited women in Iceland to complete an online survey from March 1, 2018, to July 1, 2019. Participants were a nationally representative sample of women 18 to 69 years of age. This analysis was conducted from January 21, 2022, to September 13, 2024.

EXPOSURES: History of 23 life stressors assessed with the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) and additional survey questions.

MAIN OUTCOMES AND MEASURES: The main outcome was probable PTSD during the past month assessed for the worst life stressor experienced as evaluated with the PTSD Checklist for DSM-5. Modified Poisson log-linear models were used to assess prevalence ratios (PRs) of PTSD by type of life stressor, adjusting for multiple covariates, including number of life stressors and time since the worst life stressor.

RESULTS: Overall, 28 199 women participated in the study (mean [SD] age, 43.8 [13.7] years). The prevalence of life stressors varied substantially, ranging from 3.3% for war or armed conflict-related events to 66.4% for unwanted sexual experiences. The overall prevalence of probable PTSD was 15.9% and varied substantially across life stressor types. The highest prevalence of probable PTSD was for sexual assault (1427 of 3872 [36.9%]) and lowest for natural disasters (15 of 456 [3.3%]). Interpersonal trauma, specifically sexual assault (adjusted PR [APR], 6.66 [95% CI, 4.01-11.04]), other unwanted sexual experience (APR, 4.33 [95% CI, 2.53-7.42]), and physical assault (APR, 4.44 [95% CI, 2.63-7.49]) were associated with the highest prevalence increase of probable PTSD compared with natural disasters as the reference category.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of 28 199 women in Iceland, which ranks highest globally in gender equality, found that sexual and physical assaults were among the most common life stressors reported and were associated with the highest prevalence of probable PTSD. The propensity of such trauma to result in PTSD calls for widespread societal efforts to prevent sexual and physical violence and reduce gender-based disparities in mental health.

PMID:39641927 | DOI:10.1001/jamanetworkopen.2024.49430

Int Clin Psychopharmacol. 2024 Dec 6. doi: 10.1097/YIC.0000000000000576. Online ahead of print.

ABSTRACT

Deficits in social cognition may impair emotional processing and facial emotional recognition (FER) in patients with bipolar disorder (BD) and schizophrenia. FER is generally explored using photographs or images of static faces that do not fully capture the complexity of real-life facial stimuli. To overcome this limitation, we developed a set of dynamic virtual faces depicting six basic emotions (i.e. happiness, sadness, anger, fear, disgust, and surprise) and a neutral expression suitable for presentation in immersive and nonimmersive virtual realities. This study presents preliminary findings on the differences in FER accuracy from a frontal view between immersive and nonimmersive virtual realities among patients experiencing a relapse of schizophrenia (n = 10), a manic phase of BD (n = 10), and a group of healthy controls (HCs) (n = 10). As a secondary objective, we compare the FER accuracy across these three groups. Patients with schizophrenia and BD showed similar accuracy in recognizing emotions in immersive and nonimmersive virtual reality settings. However, patients with schizophrenia exhibited lower FER accuracy than HCs in both settings. Individuals with BD showed intermediate accuracy between those with schizophrenia and HCs, although these differences were not statistically significant. Notably, recognition of negative emotions was significantly impaired in both groups of patients.

PMID:39641922 | DOI:10.1097/YIC.0000000000000576

Bull Math Biol. 2024 Dec 6;87(1):12. doi: 10.1007/s11538-024-01379-w.

ABSTRACT

The $\left[PS{I}^{+}\right]$ prion phenotype in yeast manifests as a white, pink, or red color pigment. Experimental manipulations destabilize prion phenotypes, and allow colonies to exhibit $\left[ps{i}^{–}\right]$ (red) sectored phenotypes within otherwise completely white colonies. Further investigation of the size and frequency of sectors that emerge as a result of experimental manipulation is capable of providing critical information on mechanisms of prion curing, but we lack a way to reliably extract this information. Images of experimental colonies exhibiting sectored phenotypes offer an abundance of data to help uncover molecular mechanisms of sectoring, yet the structure of sectored colonies is ignored in traditional biological pipelines. In this study, we present [PSI]-CIC, the first computational pipeline designed to identify and characterize features of sectored yeast colonies. To overcome the barrier of a lack of manually annotated data of colonies, we develop a neural network architecture that we train on synthetic images of colonies and apply to real images of $\left[PS{I}^{+}\right]$ , $\left[ps{i}^{–}\right]$ , and sectored colonies. In hand-annotated experimental images, our pipeline correctly predicts the state of approximately 95% of colonies detected and frequency of sectors in approximately 89.5% of colonies detected. The scope of our pipeline could be extended to categorizing colonies grown under different experimental conditions, allowing for more meaningful and detailed comparisons between experiments. Our approach streamlines the analysis of sectored yeast colonies providing a rich set of quantitative metrics and provides insight into mechanisms driving the curing of prion phenotypes.

PMID:39641894 | DOI:10.1007/s11538-024-01379-w

AMB Express. 2024 Dec 6;14(1):132. doi: 10.1186/s13568-024-01798-x.

ABSTRACT

Increasing evidence exists that the gut microbiome influences toxicity as well as outcomes in a variety of cancers. To investigate the role of the gut microbiome in pediatric neuro-oncology, microbiome analysis has been included in multiple prospective pediatric neuro-oncology clinical trials (NCT05009992, NCT04732065, NCT04775485). In these trials, the OMNIgene-GUT^tm preservation tubes are used for the collection of the feces. OMNIgene-GUT^tm has demonstrated reliability in preserving the composition of the gut microbiome in adults; however, its validation for use in the pediatric population remains limited. Therefore, we compared the quality of the DNA by 16S rRNA gene sequencing after various methods of stabilizing fecal samples in pediatric populations, from the direct freeze method at – 80 °C to preserving samples with OMNIgene-GUT^tm at room temperature for various durations. Our results showed that there were no statistically significant differences between the alpha-diversity, and beta-diversity. However, pairwise differential abundance analyses demonstrated that OMNIgene-GUT™ is superior in maintaining microbial community structure compared to storing samples without any preservation method. With the OMNIgene-GUT^tm‘s stabilization of the fecal samples being superior and its ease-of-use benefits, it proves to be a valid and ideal method of stabilizing fecal samples for current and future pediatric clinical trials.

PMID:39641864 | DOI:10.1186/s13568-024-01798-x

J Math Biol. 2024 Dec 6;90(1):3. doi: 10.1007/s00285-024-02165-x.

ABSTRACT

Ben-Ari and Schinazi (J Stat Phys 162:415-425, 2016) introduced a stochastic model to study ‘virus-like evolving population with high mutation rate’. This model is a birth and death model with an individual at birth being either a mutant with a random fitness parameter in [0, 1] or having one of the existing fitness parameters with uniform probability; whereas a death event removes the entire population of the least fitness. We change this to incorporate the notion of ‘survival of the fittest’, by requiring that a non-mutant individual, at birth, has a fitness according to a preferential attachment mechanism, i.e., it has a fitness f with a probability proportional to the size of the population of fitness f. Also death just removes one individual with the least fitness. This preferential attachment rule leads to a power law behaviour in the asymptotics, unlike the exponential behaviour obtained by Ben-Ari and Schinazi (J Stat Phys 162:415-425, 2016).

PMID:39641863 | DOI:10.1007/s00285-024-02165-x