Category: Statistics

JAMA Netw Open. 2024 Jul 1;7(7):e2420963. doi: 10.1001/jamanetworkopen.2024.20963.

ABSTRACT

IMPORTANCE: The risk of hepatocellular carcinoma (HCC) declines over time after hepatitis C virus (HCV) cure by direct-acting antiviral (DAA) therapies. Liver society guidelines recommend continuing HCC screening for these patients, but data on screening outcomes are lacking.

OBJECTIVE: To evaluate the association of HCC screening after HCV cure with overall survival.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated patients with HCV cirrhosis who achieved DAA-induced HCV cure in the Veterans Affairs health care system between January 2014 and December 2022. Data analysis occurred from October 2023 to January 2024.

EXPOSURES: The percentage of time spent up to date with recommended HCC screening was calculated by year of follow-up and during the 4 years preceding HCC diagnosis (the detectable asymptomatic phase).

MAIN OUTCOMES AND MEASURES: The primary outcome was overall survival after HCC diagnosis and was compared by percentage of time spent up to date with screening using Kaplan-Meier analyses and Cox proportional hazards regression. Early-stage HCC at diagnosis and curative treatment were secondary outcomes assessed using logistic regression.

RESULTS: A total of 16 902 individuals were included (median [IQR] age, 64.0 [60.5-67.4] years; 16 426 male [97.2%]), of whom 1622 developed HCC. The cumulative incidence of HCC declined from 2.4% (409 of 16 902 individuals) to 1.0% (27 of 2833 individuals) from year 1 to year 7 of follow-up. Being up to date with screening for at least 50% of time during the 4 years preceding HCC diagnosis was associated with improved overall survival (log-rank test of equality over strata P = .002). In multivariate analysis, each 10% increase in follow-up spent up to date with screening was associated with a 3.2% decrease in the hazard of death (hazard ratio, 0.97; 95% CI, 0.95-0.99). There was a statistically significant interaction between time since HCV cure and screening, with no association observed among those who received a diagnosis of HCC more than 5 years after HCV cure. Each 10% of time spent up to date with screening was associated with a 10.1% increased likelihood of diagnosis with early-stage HCC (95% CI, 6.3%-14.0%) and a 6.8% increased likelihood of curative treatment (95% CI, 2.8%-11.0%).

CONCLUSIONS AND RELEVANCE: In this cohort study of persons with HCV-related cirrhosis who achieved HCV cure and subsequently developed HCC, remaining up to date with screening was associated with improved overall survival, supporting the screening of eligible individuals.

PMID:38985470 | DOI:10.1001/jamanetworkopen.2024.20963

JAMA Netw Open. 2024 Jul 1;7(7):e2420970. doi: 10.1001/jamanetworkopen.2024.20970.

ABSTRACT

IMPORTANCE: Patients using assisted reproductive technology (ART) may need additional counseling about the increased risks of placental abruption and preterm delivery. Further investigation into the potential additive risk of ART and placental abruption is needed.

OBJECTIVE: To ascertain the risk of placental abruption in patients who conceived with ART and to evaluate if placental abruption and ART conception are associated with an increased risk of preterm delivery (<37 weeks’ gestation) over and above the risks conferred by each factor alone.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Inpatient Sample, which includes data from all-payer hospital inpatient discharges from 48 states across the US. Participants included women aged 15 to 54 years who delivered from 2000 through 2019. Data were analyzed from January 17 to April 18, 2024.

EXPOSURES: Pregnancies conceived with ART.

MAIN OUTCOMES AND MEASURES: Risks of placental abruption and preterm delivery in ART conception compared with spontaneous conceptions. Associations were expressed as odds ratios (ORs) and 95% CIs derived from weighted logistic regression models before and after adjusting for confounders. The relative excess risk due to interaction (RERI) of the risk of preterm delivery based on ART conception and placental abruption was also assessed.

RESULTS: Of 78 901 058 deliveries, the mean (SD) maternal age was 27.9 (6.0) years, and 9 212 117 patients (11.7%) were Black individuals, 14 878 539 (18.9%) were Hispanic individuals, 34 899 594 (44.2%) were White individuals, and 19 910 807 (25.2%) were individuals of other races and ethnicities. Of the total hospital deliveries, 98.2% were singleton pregnancies, 68.8% were vaginal deliveries, and 52.1% were covered by private insurance. The risks of placental abruption among spontaneous and ART conceptions were 11 and 17 per 1000 hospital discharges, respectively. After adjusting for confounders, the adjusted OR (AOR) of placental abruption was 1.42 (95% CI, 1.34-1.51) in ART pregnancies compared with spontaneous conceptions, with increased odds in White women (AOR, 1.42; 95% CI, 1.31-1.53) compared with Black women (AOR, 1.16; 95% CI, 0.93-1.44). The odds of preterm delivery were significantly higher in pregnancies conceived by ART compared with spontaneous conceptions (AOR, 1.46; 95% CI, 1.42-1.51). The risk of preterm delivery increased when patients had both ART conception and placental abruption (RERI, 2.0; 95% CI, 0.5-3.5).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, patients who conceived using ART and developed placental abruption had a greater risk of preterm delivery compared with spontaneous conception without placental abruption. These findings have implications for counseling patients who seek infertility treatment and obstetrical management of ART pregnancies.

PMID:38985469 | DOI:10.1001/jamanetworkopen.2024.20970

JAMA Netw Open. 2024 Jul 1;7(7):e2421290. doi: 10.1001/jamanetworkopen.2024.21290.

ABSTRACT

IMPORTANCE: Machine learning has potential to transform cancer care by helping clinicians prioritize patients for serious illness conversations. However, models need to be evaluated for unequal performance across racial groups (ie, racial bias) so that existing racial disparities are not exacerbated.

OBJECTIVE: To evaluate whether racial bias exists in a predictive machine learning model that identifies 180-day cancer mortality risk among patients with solid malignant tumors.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, a machine learning model to predict cancer mortality for patients aged 21 years or older diagnosed with cancer between January 2016 and December 2021 was developed with a random forest algorithm using retrospective data from the Mount Sinai Health System cancer registry, Social Security Death Index, and electronic health records up to the date when databases were accessed for cohort extraction (February 2022).

EXPOSURE: Race category.

MAIN OUTCOMES AND MEASURES: The primary outcomes were model discriminatory performance (area under the receiver operating characteristic curve [AUROC], F1 score) among each race category (Asian, Black, Native American, White, and other or unknown) and fairness metrics (equal opportunity, equalized odds, and disparate impact) among each pairwise comparison of race categories. True-positive rate ratios represented equal opportunity; both true-positive and false-positive rate ratios, equalized odds; and the percentage of predictive positive rate ratios, disparate impact. All metrics were estimated as a proportion or ratio, with variability captured through 95% CIs. The prespecified criterion for the model’s clinical use was a threshold of at least 80% for fairness metrics across different racial groups to ensure the model’s prediction would not be biased against any specific race.

RESULTS: The test validation dataset included 43 274 patients with balanced demographics. Mean (SD) age was 64.09 (14.26) years, with 49.6% older than 65 years. A total of 53.3% were female; 9.5%, Asian; 18.9%, Black; 0.1%, Native American; 52.2%, White; and 19.2%, other or unknown race; 0.1% had missing race data. A total of 88.9% of patients were alive, and 11.1% were dead. The AUROCs, F1 scores, and fairness metrics maintained reasonable concordance among the racial subgroups: the AUROCs ranged from 0.75 (95% CI, 0.72-0.78) for Asian patients and 0.75 (95% CI, 0.73-0.77) for Black patients to 0.77 (95% CI, 0.75-0.79) for patients with other or unknown race; F1 scores, from 0.32 (95% CI, 0.32-0.33) for White patients to 0.40 (95% CI, 0.39-0.42) for Black patients; equal opportunity ratios, from 0.96 (95% CI, 0.95-0.98) for Black patients compared with White patients to 1.02 (95% CI, 1.00-1.04) for Black patients compared with patients with other or unknown race; equalized odds ratios, from 0.87 (95% CI, 0.85-0.92) for Black patients compared with White patients to 1.16 (1.10-1.21) for Black patients compared with patients with other or unknown race; and disparate impact ratios, from 0.86 (95% CI, 0.82-0.89) for Black patients compared with White patients to 1.17 (95% CI, 1.12-1.22) for Black patients compared with patients with other or unknown race.

CONCLUSIONS AND RELEVANCE: In this cohort study, the lack of significant variation in performance or fairness metrics indicated an absence of racial bias, suggesting that the model fairly identified cancer mortality risk across racial groups. It remains essential to consistently review the model’s application in clinical settings to ensure equitable patient care.

PMID:38985468 | DOI:10.1001/jamanetworkopen.2024.21290

J Acquir Immune Defic Syndr. 2024 Aug 15;96(5):439-446. doi: 10.1097/QAI.0000000000003450.

ABSTRACT

BACKGROUND: Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSILs). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years old, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH).

SETTING: We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, CA.

METHODS: One hundred twenty-nine MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with a biopsy of visible lesions.

RESULTS: Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (odds ratio: 45.1, 95% confidence interval: 15.8-129); other oncogenic HPV types (odds ratio: 5.95, 95% confidence interval: 2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status.

CONCLUSION: The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remains very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening.

PMID:38985441 | DOI:10.1097/QAI.0000000000003450

J Acquir Immune Defic Syndr. 2024 Aug 15;96(5):429-438. doi: 10.1097/QAI.0000000000003447.

ABSTRACT

BACKGROUND: Studies on the incidence of COVID-19 among persons with HIV (PWHs) present varied results. Few studies have investigated the impact of COVID-19 infection on health and socioeconomic factors or COVID-19 stigma. We sought to measure the incidence and severity of COVID-19 infection among a cohort of PWHs, characterize associated risk factors and impact, and document perceptions of COVID-19-related stigma.

METHODS: Data for this cross-sectional study come from the COVID-19 survey of participants in the DC Cohort longitudinal study from October 30, 2020, through December 31, 2022. Survey results were linked to electronic health records, including HIV laboratory test results and COVID test results. We conducted analyses comparing demographic, socioeconomic, HIV measures, and stigma among those with and without self-reported COVID-19.

RESULTS: Of 1972 survey respondents, 17% self-reported COVID-19 infection, with the greatest incidence in the Omicron wave of the pandemic. We found statistically significant differences by age, employment status, essential worker status, education, and household income. Longer duration of HIV diagnosis was associated with greater incidence of COVID-19. PWHs who were overweight or obese had a greater incidence of COVID-19 compared with those who were not. Over 40% of PWHs with COVID-19 reported experiencing at least 1 form of COVID-19-related stigma.

CONCLUSION: We observed a high incidence of COVID-19 infection among PWHs in DC. Furthermore, a substantial proportion of PWHs with COVID-19 reported experiencing COVID-19-related stigma. These findings add to the existing literature on COVID-19 coinfection among PWHs and highlight the need for awareness and support for those experiencing COVID-19 stigma.

PMID:38985440 | DOI:10.1097/QAI.0000000000003447

Quintessence Int. 2024 Jul 10;0(0):0. doi: 10.3290/j.qi.b5566187. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate clasp-retained removable partial dentures (C-RPDs) with a metal framework for survival, maintenance requirements, and biological implications.

METHOD AND MATERIALS: C-RPDs were retrospectively analyzed based on patient records. Treatment failure was defined as fracture of a framework component (metal base or connector) or loss of an abutment tooth. Other outcome variables included factors that might conceivably impact C-RPD survival (maxilla vs. mandible, Kennedy classes, opposing dentitions, treatment by students vs. certified dentists), mobility and caries of abutment teeth (in relation to clasp designs), and maintenance requirements (relining, clasp or resin fractures). Differences were evaluated by appropriate statistical tests at the P ≤ .05 level.

RESULTS: A total of 612 patients (339 men, 273 women) 60.0 ± 11.5 years old at delivery were included, covering 842 C-RPDs and a mean observation period of 42.1 ± 33.2 months. Kaplan-Meier C-RPD survival was 76.2% after 5 years and 49.5% after 10 years. Biological complications (i.e. loss of abutment teeth) accounted for the vast majority (95.6%) of C-RPDs failures, and Kaplan-Meier C-RPD survival was significantly better in the mandible (P = .015). Some clasp designs contributed significantly to caries and removal of abutment teeth (both P < .05). No other significant differences were noted.

CONCLUSION: Tooth loss both emerges as the main cause of C-RPDs failure and might be amenable to careful selection of clasp designs. Overall, better C-RPD survival should be expected in the mandible. A non-contributory role of Kennedy classes and opposing dentitions is tentatively suggested based on numerically heterogeneous subgroups.

PMID:38985439 | DOI:10.3290/j.qi.b5566187

Ophthalmol Ther. 2024 Jul 10. doi: 10.1007/s40123-024-00992-1. Online ahead of print.

ABSTRACT

INTRODUCTION: This study was conducted to analyze and compare the intraocular pressure (IOP) treatment effect of the slow-eluting (SE) travoprost intracameral implant to the IOP treatment effect of topical prostaglandin analog (PGA) monotherapy in a subgroup of subjects who were on pre-study PGA monotherapy prior to enrollment in the two pivotal phase 3 trials of the travoprost intracameral implant.

METHODS: A combined study population of 133 subjects from two phase 3 trials, who were on topical PGA monotherapy at screening, subsequently underwent a washout period from their topical PGA, and then were randomized and administered an SE travoprost intracameral implant. The subjects were analyzed for the IOP treatment effects of the pre-study topical PGA monotherapy and the in-study SE travoprost intracameral implant. Paired t-tests were used to compare the difference in screening minus post-washout baseline IOP versus month 3 minus post-washout baseline IOP. The IOP-lowering efficacy in eyes administered an SE travoprost intracameral implant was compared to the IOP lowering in the same eyes while on a topical PGA monotherapy prior to study entry.

RESULTS: Pre-study topical PGA monotherapy and the SE travoprost intracameral implant demonstrated IOP treatment effects of -5.76 mmHg and -7.07 mmHg, respectively. The IOP-lowering treatment effect was significantly greater by 1.31 mmHg for the SE travoprost intracameral implant relative to pre-study PGA monotherapy (95% confidence interval: -2.01, -0.60; P = 0.0003).

CONCLUSIONS: The SE travoprost intracameral implant demonstrated superior IOP-lowering treatment effect versus pre-study topical PGA monotherapy with a superiority margin that was both statistically significant and clinically meaningful. The greater IOP reduction from baseline while on the SE implant versus pre-study topical PGA monotherapy may be a reflection of the optimized adherence and continuous elution of PGA therapy into the anterior chamber achieved with the SE travoprost intracameral implant.

TRIAL REGISTRATION: ClinicalTrials.gov identifiers, NCT03519386 and NCT03868124.

PMID:38985408 | DOI:10.1007/s40123-024-00992-1

Exp Appl Acarol. 2024 Jul 10. doi: 10.1007/s10493-024-00944-1. Online ahead of print.

ABSTRACT

Most published data on mite infestation rates in semi-arid regions have been collected over only 3 or 4 months during a specific period of the year. Therefore, the aim of this study was to observe parasite-host dynamics of hygienic and non-hygienic Africanized bee colonies considering environmental factors that may influence Varroa destructor mite infestation rates in a semi-arid region. To this end, the brood puncture method was applied to 37 colonies, forming two groups, namely G1, encompassing 16 hygienic colonies, and G2, comprising 21 non-hygienic colonies. After forming the groups, 300 worker bees from each colony were examined monthly for mite infestations and the data were correlated with climatological records. The monthly infestation average was considered low, below 10%, except in November, when it reached 12.19% ± 6.45. No statistically significant difference was observed for inter-group infestation rates (P > 0.05). When mite infestation rates were associated with climatic variables, they were linked to colony losses (32%) due to swarming. No significant correlations between hygienic behaviour and parasite infestation rates were noted. Nonetheless, these results support the idea that there is no need to apply acaricides for V. destructor control in Brazil.

PMID:38985397 | DOI:10.1007/s10493-024-00944-1

Psychiatr Q. 2024 Jul 10. doi: 10.1007/s11126-024-10082-x. Online ahead of print.

ABSTRACT

The current paper aimed to investigate the network structure and centrality indexes of hypersensitive narcissism using the hypersensitive Narcissism Scale (HSN). Additionally, we aimed to explore its relationships with dark triad personality aspects. A globally diverse sample of “53,981” participants (47.9% non-United States responders) completed the HSN and Dark Triad Dirty Dozen scale (DTD). We estimated the network structure across genders to determine the core characteristics of hypersensitive narcissism. Additionally, bridge and central nodes (characteristics) were identified. All analyses were performed using R-Studio programming software. The network comparison test indicated significant differences in the network structures between males and females (Network-Invariance: 0.0489, P < 0.01; Global Strength Invariance: 0.101, P < 0.01). In the network of HSN for male participants, characteristics with the highest strength centrality were “Highly affected by criticism” (HSN.2, strength = 1.08) and “Self-absorbed in personal pursuits” (HSN.8, strength = 1.28). For female participants, “Self-absorbed in personal pursuits” (HSN.8, strength = 1.32) and “privately annoyed by others’ needs” (HSN.10, strength = 1.21) were the highest central characteristics. The assessment of bridge strength indicated that nodes HSN.2 (Highly sensitive to criticism), scoring 0.42, and DTD.1 (Tendency to manipulate for gain, a component of Machiavellianism), scoring 0.428, showed the highest bridge strength values. The current study identified core characteristics of hypersensitive narcissism and its correlation with dark triad personality, revealing gender-specific patterns and bridging symptoms between the two constructs. These findings showed that focusing on these core characteristics may be advantageous in treating individuals exhibiting elevated levels of narcissism.

PMID:38985386 | DOI:10.1007/s11126-024-10082-x

Heart Fail Rev. 2024 Jul 10. doi: 10.1007/s10741-024-10417-7. Online ahead of print.

ABSTRACT

Acute heart failure (AHF) often leads to unfavorable outcomes due to fluid overload. While diuretics are the cornerstone treatment, acetazolamide may enhance diuretic efficiency by reducing sodium reabsorption. We performed a systematic review and meta-analysis on the effects of acetazolamide as an add-on therapy in patients with AHF compared to diuretic therapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCT). A random-effects model was employed to compute mean differences and risk ratios. Statistical analysis was performed using R software. The GRADE approach was used to rate the certainty of the evidence. We included 4 RCTs with 634 patients aged 68 to 81 years. Over a mean follow-up of 3 days to 34 months, acetazolamide significantly increased diuresis (MD 899.2 mL; 95% CI 249.5 to 1549; p < 0.01) and natriuresis (MD 72.44 mmol/L; 95% CI 39.4 to 105.4; p < 0.01) after 48 h of its administration. No association was found between acetazolamide use and WRF (RR 2.4; 95% CI 0.4 to 14.2; p = 0.3) or all-cause mortality (RR 1.2; 95% CI 0.8 to 1.9; p = 0.3). Clinical decongestion was significantly higher in the intervention group (RR 1.35; 95% CI 1.09 to 1.68; p = 0.01). Acetazolamide is an effective add-on therapy in patients with AHF, increasing diuresis, natriuresis, and clinical decongestion, but it was not associated with differences in mortality.

PMID:38985385 | DOI:10.1007/s10741-024-10417-7