Category: Statistics

JAMA Netw Open. 2026 Jun 1;9(6):e2616141. doi: 10.1001/jamanetworkopen.2026.16141.

ABSTRACT

IMPORTANCE: Ontario’s public drug program (Ontario Drug Benefit [ODB]) announced coverage for flash glucose monitoring (FGM) systems effective September 16, 2019, for eligible patients with insulin-requiring diabetes. However, even within the context of a publicly funded program, access to benefits is complex and can be inequitable.

OBJECTIVE: To evaluate the association between immigration status and time to accessing the FGM system through the ODB program.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used retrospective data on Ontario residents 66 years or older who were ODB eligible and insulin requiring as of September 15, 2019, and followed up with individuals until March 31, 2023. Statistical analysis was performed from August 2025 to April 2026.

EXPOSURE: Immigrants were propensity score matched with long-term residents on age (within 2 years) and sex.

MAIN OUTCOME AND MEASURE: Marginal Cox proportional hazards regression models were used to examine the association between immigration status and the main outcome, time to receipt of first FGM sensor. Secondary analyses stratified the exposure according to timing of immigration (recent immigrants arriving to Canada within 10 years vs long-term immigrants).

RESULTS: A total of 109 079 individuals (median age, 73 years [IQR, 70-79 years]; 59 649 male [54.7%]) met the inclusion criteria, most of whom were long-term residents (95 677 [87.7%]). Within this cohort, 13 257 of 13 402 immigrants (98.9%) were matched with an equal number of long-term residents. In the primary analysis, immigrants had a significantly lower hazard of initiating FGM compared with long-term residents (36.7 per 100 person-years vs 38.8 per 100 person-years; hazard ratio [HR], 0.95 [95% CI, 0.93-0.98]). In secondary analyses stratified by timing of immigration, recent immigration status was associated with a significantly longer time to FGM initiation compared with long-term residents (HR, 0.87 [95% CI, 0.80-0.94]); long-term immigrants also had a significantly lower hazard of initiating FGM compared with long-term residents (HR, 0.94 [95% CI, 0.91-0.98]).

CONCLUSIONS AND RELEVANCE: In this population-based cohort study of older adults with insulin-requiring diabetes, immigrants faced a longer time to access to FGM systems compared with long-term residents, with the greatest disparity observed among people who immigrated to Canada in the past decade. Efforts are needed to address barriers that may hinder timely access to novel medications or devices, which may include health care system navigation, patient-clinician communication, and cultural or knowledge barriers.

PMID:42228372 | DOI:10.1001/jamanetworkopen.2026.16141

JAMA Netw Open. 2026 Jun 1;9(6):e2616362. doi: 10.1001/jamanetworkopen.2026.16362.

ABSTRACT

IMPORTANCE: Lower neighborhood socioeconomic status (nSES) is associated with worse stroke recovery. It remains unclear what factors could be targeted therapeutically to mitigate nSES-associated poststroke recovery differences.

OBJECTIVE: To identify the extent with which receipt of hyperacute treatment, neighborhood density of home health services, density of rehabilitation clinics, density of recreation centers, transportation access, and walkability mediate the association between nSES and stroke recovery.

DESIGN, SETTING, AND PARTICIPANTS: The population-based stroke cohort Brain Attack Surveillance in Corpus Christi (BASIC) enrolled individuals between 2009 and 2022 in Nueces County, Texas. Candidate mediators were derived from BASIC, Redfin, or the National Neighborhood Data Archive. Causal mediation analyses were performed. Participants were followed from time of stroke to 90 days after stroke. Participants’ census tracts at time of stroke were used to define neighborhoods. Individuals aged 45 years or older with completed baseline and community-dwelling 90-day assessments were included. Data analysis was performed from January 2024 to April 2026.

EXPOSURE: nSES, a validated index of neighborhood deprivation.

MAIN OUTCOMES AND MEASURES: The primary outcomes were 90-day functional status (activities of daily living [ADL] and instrumental ADL [IADL] questionnaire score), depressive symptom burden (Patient Health Questionnaire [PHQ]-8 Score), and quality of life (Stroke-Specific Quality-of-life questionnaire [SS-QoL] score). Associations between nSES and the outcomes were assessed using generalized estimating equations.

RESULTS: Among the 2203 individuals with 90-day outcomes from 77 census tracts, 1044 (47.4%) were female, the median (IQR) acute National Institute of Health Stroke Scale score was 3 (1 to 6), and the median (IQR) age was 66 (57 to 75) years. Higher nSES was associated with better outcomes across all measures (PHQ-8 score, β = -1.21 [95% CI, -1.86 to -0.56]; ADL-IADL score, β = -0.20 [95% CI, -0.27 to -0.13]; SS-QoL score, β = 0.20 [95% CI, 0.11 to 0.29]). Shifting all mediator distributions from low-nSES to high-nSES neighborhoods modestly attenuated the association of nSES with PHQ-8 score by 14.1% (95% CI, -36.3% to 64.5%) and accounted for 15.1% (95% CI, -11.0% to 41.2%) of the association of nSES with ADL-IADL score and 5.6% (95% CI, -25.4% to 36.6%) of the association of nSES with SS-QoL score. However, no evaluated factors were statistically significant mediators.

CONCLUSIONS AND RELEVANCE: In this cohort study of a biethnic urban population with predominantly mild strokes, higher nSES was associated with better outcomes. These differences were not significantly mediated by hyperacute treatment, postacute care resource density, transportation access, or walkability. Future studies should evaluate to what extent time to hyperacute treatment, postdischarge disposition, poststroke therapy intensity, and other factors may underlie differences in stroke recovery by nSES.

PMID:42228368 | DOI:10.1001/jamanetworkopen.2026.16362

JAMA Netw Open. 2026 Jun 1;9(6):e2616370. doi: 10.1001/jamanetworkopen.2026.16370.

ABSTRACT

IMPORTANCE: Due to legal restrictions, many patients pay out of pocket for later abortion care in the US. Knowledge of facility availability, self-pay prices, and state Medicaid acceptance may enable timely access to care.

OBJECTIVE: To estimate quoted self-pay prices and assess state Medicaid acceptance for later abortion care from 23 to 33 weeks of pregnancy duration.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a mystery caller design from November 2024 through April 2025. Contacted US health care facilities (clinics and hospitals) advertised offering abortion care at or after 23 weeks in August 2024.

EXPOSURE: Mystery calls at 2-week pregnancy duration periods advertised for providing care (23, 25, 27, 29, 31, and 33 weeks) to request self-pay prices. Facilities in states permitting Medicaid coverage received additional calls regarding acceptance.

MAIN OUTCOMES AND MEASURES: Facility availability by pregnancy duration, quoted self-pay prices, and reported state Medicaid acceptance.

RESULTS: A total of 130 facilities in 20 states and the District of Columbia advertised providing abortion care at or after 23 weeks of pregnancy (52 clinics, 78 hospitals). The overall response rate for obtaining at least 1 usable quoted self-pay price or range was 60.2% (112 of 186 facilities). Median self-pay prices increased from $3000 at 23 weeks to $17 250 at 33 weeks, with a statistically significant increase of $2541 from 23 to 25 weeks. The number of facilities providing care declined from 130 at 23 weeks to 31 at 25 weeks and 3 at 33 weeks. Among facilities in states with Medicaid coverage, 73 of 105 (69.5%) consistently reported accepting Medicaid; acceptance declined at later pregnancy durations and varied by state.

CONCLUSIONS AND RELEVANCE: In this cross-sectional mystery call study of 130 facilities advertising later abortion care in August 2024, self-pay prices increased with pregnancy duration, while service availability and Medicaid acceptance declined. Improving self-pay price transparency and expanding the availability of later abortion care, especially in states with Medicaid coverage, may facilitate more timely access to care.

PMID:42228367 | DOI:10.1001/jamanetworkopen.2026.16370

JAMA Netw Open. 2026 Jun 1;9(6):e2616375. doi: 10.1001/jamanetworkopen.2026.16375.

ABSTRACT

IMPORTANCE: Statin use has been associated with improved survival in patients with breast cancer, but there are no data on the association between statin use and survival in different intrinsic breast cancer subtypes.

OBJECTIVE: To assess the associations between statin use and survival in patients with early breast cancer of different intrinsic subtypes.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based cohort study of female patients with invasive breast cancer diagnosed in Finland between 1995 and 2013. The cohort was limited to early breast cancer cases with sufficient data for surrogate intrinsic subtyping. All data originated from Finnish national registries. Statistical analyses were performed from September to November 2023.

EXPOSURE: Statin use, statin dose, and blood cholesterol levels before and after diagnosis.

MAIN OUTCOMES AND MEASURES: All-cause and breast cancer-specific mortality during follow-up.

RESULTS: A total of 7389 female patients with early breast cancer were included (median [range] age at diagnosis, 60 [21-102] years). Prediagnostic statin use was not associated with breast cancer-specific or all-cause mortality. Postdiagnostic statin use was associated with lower age-adjusted breast cancer-specific (hazard ratio [HR], 0.68; 95% CI, 0.57-0.82) and all-cause (HR, 0.83; 95% CI, 0.75-0.92) mortality. In a multivariable-adjusted model, statin use was associated with higher breast cancer-specific survival in all hormone receptor-positive subtypes (luminal A-like, luminal B-like [HER2-negative], and luminal B-like [HER2-positive]). All-cause mortality was lower among statin users in patients with hormone positive and triple-negative subtypes. One-year lag-time analysis or adjustment for blood-cholesterol levels after breast cancer diagnosis did not affect the results substantially. While the benefit of statin use was noticed in all statin users regardless of dose intensity, a trend of dose-dependent risk reduction was observed regarding breast cancer-specific mortality.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with early breast cancer, prediagnostic statin use was not associated with higher survival; however, postdiagnostic statin use was associated with lower all-cause and breast cancer-specific mortality among patients with hormone receptor-positive intrinsic subtypes. These findings suggest that statin therapy may improve survival of patients with early hormone receptor-positive subtypes.

PMID:42228366 | DOI:10.1001/jamanetworkopen.2026.16375

Jpn J Radiol. 2026 Jun 2. doi: 10.1007/s11604-026-02020-7. Online ahead of print.

ABSTRACT

PURPOSE: Boron neutron capture therapy (BNCT) dose planning conventionally uses a tumor-to-blood (T/B) ratio derived from the tumor maximum standardized uptake value (SUVmax) of fluorine-18-labeled 4-borono-L-phenylalanine (¹⁸F-BPA) positron emission tomography (PET) (individual model). It remains unclear whether tumor SUVmax or individual model doses predict outcomes in accelerator-based BNCT for head and neck cancer (HNC). We investigated the correlation of ¹⁸F-BPA PET SUVmax and individual model doses with treatment response.

MATERIALS AND METHODS: We retrospectively analyzed 30 patients with HNC treated with accelerator-based BNCT (2020-2021). The Kaplan-Meier method was used for survival analysis. Dose parameters (Dmax, Dmin, and D80%) were calculated using the uniform model (T/B = 2.5) and the individual model (T/B = Tumor SUVmax/Blood-pool SUV). Correlations between tumor SUVmax or dose parameters and best treatment response [complete response (CR) vs. non-CR] were evaluated using the Mann-Whitney U test.

RESULTS: The objective response rate was 90%, and the CR rate was 50%. CR status strongly predicted superior 2 years overall survival, locoregional control, and progression-free survival (all p < 0.05). However, no significant differences were observed between the CR and non-CR groups for tumor SUVmax, uniform model doses, or individual model doses (all p > 0.05).

CONCLUSION: ¹⁸F-BPA PET SUVmax and the conventional individual model did not demonstrate a statistically significant association with CR in patients with HNC after accelerator-based BNCT. These findings question the utility of tumor SUVmax-based dosimetry, suggesting that current models require refinement.

PMID:42228342 | DOI:10.1007/s11604-026-02020-7

Clin Pharmacokinet. 2026 Jun 1. doi: 10.1007/s40262-026-01654-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Cagrilintide is a long-acting amylin agonist under development as monotherapy for weight management and as a fixed-dose combination with the glucagon-like peptide-1 receptor agonist semaglutide (CagriSema) for weight management and treatment of type 2 diabetes. Two studies were conducted to assess the effects of renal or hepatic impairment on pharmacokinetics, safety and tolerability following single doses of cagrilintide.

METHODS: In both studies, adult participants were categorised into four groups on the basis of renal or hepatic function (normal function and mild, moderate or severe impairment) and received a single dose of cagrilintide 0.6 or 0.9 mg, respectively. The primary endpoint was area under the cagrilintide plasma concentration curve from time zero extrapolated to infinity (AUC_0-∞) from baseline (day 1) to day 36 (renal impairment study) or day 39 (hepatic impairment study). Other pharmacokinetic parameters included maximum observed cagrilintide plasma concentration (C_max), time to C_max (t_max) and safety.

RESULTS: The renal impairment study included 33 participants (normal function, n = 14; mild impairment, n = 7; moderate impairment, n = 7; severe impairment, n = 5) and the hepatic impairment study included 32 participants (normal function, n = 14; mild impairment, n = 7; moderate impairment, n = 7; severe impairment, n = 4). In both studies, total cagrilintide exposure (AUC_0-∞), C_max and other pharmacokinetic parameters were similar across groups with no consistent patterns observed with renal or hepatic impairment. Compared with normal renal function, the estimated ratio of the mean AUC_0-∞ was 1.23 (90% confidence interval [CI], 0.91-1.66) in mild impairment, 1.18 (0.87-1.59) in moderate impairment and 1.21 (0.87-1.68) in severe impairment. Compared with normal hepatic function, the estimated ratio of the mean AUC_0-∞ was 0.99 (0.89-1.11) in mild impairment, 1.01 (0.91-1.12) in moderate impairment and 1.11 (0.96-1.30) in severe impairment. Overall, 21 and 16 treatment-emergent adverse events (TEAEs) were reported in 11 and 9 participants in the renal and hepatic studies, respectively. In both studies, no serious TEAEs, TEAEs leading to study withdrawal or deaths were reported. No increase in number of adverse events with increasing renal or hepatic impairment was observed, and no new safety or tolerability findings with cagrilintide were identified with renal or hepatic impairment.

CONCLUSIONS: In these studies, within the limitations of small sample sizes, no clinically relevant differences in cagrilintide pharmacokinetics were observed in participants with renal or hepatic impairment compared with those with normal function, suggesting that dose adjustment is not warranted for these populations. Cagrilintide was well-tolerated and there were no unexpected safety issues.

TRIAL REGISTRATION: Studies are registered at ClinicalTrials.gov (NCT04209049 registered 23 December 2019 and NCT05564104 registered 3 October 2022).

PMID:42228334 | DOI:10.1007/s40262-026-01654-0

Ophthalmic Physiol Opt. 2026 Jun 2. doi: 10.1007/s44402-026-00110-7. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effects of scleral contact lens wear on central corneal thickness, corneal or stromal swelling and intraocular pressure, and to identify factors that may influence these outcomes.

METHODS: A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the AMSTAR-2 quality assessment tool (registration number PROSPERO CRD420251141392). The PubMed, Web of Science and Scopus databases were searched without language or date restrictions. Eligible studies included prospective, observational, controlled or crossover designs assessing physiological changes during or after scleral contact lens wear. Mean differences with 95% confidence intervals (CIs) were pooled using random- or fixed-effects models. Heterogeneity was quantified using the I-squared statistic, and meta-regressions examined the influence of lens and patient-level factors.

RESULTS: Twenty-two studies, including 830 eyes, were analysed. Scleral contact lens wear produced a small but statistically significant increase in central corneal thickness while the lens was in place (mean difference: 7.93 µm; 95% CI: 4.92-10.95; p < 0.001; I² = 0%) and no significant change after lens removal (mean difference: 1.49 µm; p = 0.34). Corneal or stromal swelling showed a small increase of 0.88% (p < 0.001; I² = 83%), consistent with the small magnitude and variability of these changes across studies. Intraocular pressure after lens removal showed no significant variation (mean difference: 0.38 mmHg; p = 0.27; I² = 78%).

CONCLUSIONS: Scleral contact lens wear induces minimal and largely reversible changes in corneal thickness and intraocular pressure. Daytime wear of modern high-oxygen-permeable lenses appears to be physiologically safe, although selective monitoring remains advisable in high-risk patients.

PMID:42228331 | DOI:10.1007/s44402-026-00110-7

Clin Child Fam Psychol Rev. 2026 Jun 2. doi: 10.1007/s10567-026-00573-7. Online ahead of print.

ABSTRACT

The arrival of a baby and the early years of a child’s life represent a critical period for parents, often marked by increased parental stress that can impact both their well-being and the child’s development. Although parental stress has been widely studied, no systematic review has yet focused specifically on early childhood. To address this gap, we conducted a systematic review synthesizing evidence on factors examined as antecedents of parental stress during the first three years postpartum. Following PRISMA guidelines, we included 108 quantitative studies published in the past 12 years that investigated variables statistically modeled as predictors of parental stress. Key determinants of parental stress were identified at three levels: (1) at the personal level, internalizing symptoms, adverse childhood experiences, and perinatal negative experiences were related to higher stress; (2) at the relational level, marital satisfaction and coparenting quality were associated with lower stress; and (3) at the contextual level, social support from friends and family served as a protective factor of parental stress, while children’s developmental problems served as risk factors. Despite the increasing number of longitudinal studies and the growing inclusion of fathers in research, few studies have focused on participants from social minority groups or from non-Western contexts. These findings may contribute to the development of effective strategies to support families during the early years of parenthood.

PMID:42228327 | DOI:10.1007/s10567-026-00573-7

J Cancer Educ. 2026 Jun 2. doi: 10.1007/s13187-026-02918-w. Online ahead of print.

ABSTRACT

Breast Cancer necessitates effective patient education. Large language models (LLMs) facilitate patient health consultation, yet their generated medical content may contain misleading and unsafe information. Systematic evaluations of mainstream LLMs for breast cancer health guidance are currently lacking. This study evaluated six LLMs’ (ChatGPT-5.4-thinking, Claude-4.6-sonnet, Gemini-3.1-Pro, DeepSeek-V3.2, Doubao-2.2-thinking, and ERNIE 4.5 Turbo) performance in breast cancer consultation via a structured checklist. A set of 61 standardized questions regarding breast cancer was developed based on Google Trends, clinical guidelines, practical experiences, and expert reviews. Responses from each LLM were independently evaluated by three breast cancer experts focusing on quality, accuracy, comprehensiveness, and safety. Besides, four patients independently evaluated the satisfaction and understandability of their selected three questions of interest. This study utilized Bernard’s Global Quality Score (GQS) tool to assess quality. Readability was assessed using the Chinese Resource Platform (CRP). Other indicators were evaluated using self-designed questionnaires. Statistical analyses were performed using RStudio. In expert evaluations, ERNIE 4.5 Turbo had the highest descriptive quality score and was among the top-performing models in safety (Bonferroni-adjusted P < 0.05), while several models performed comparably in comprehensiveness. There was no significant difference in accuracy among the models. ChatGPT-5.4-thinking scored significantly lower in safety, and Doubao-2.2-thinking had significantly lower reading difficulty, required age, and Chinese character count (adjusted P < 0.05). In patient evaluations, ERNIE 4.5 Turbo showed the highest descriptive satisfaction and understandability ratings. Six large language models performed strongly in breast cancer question-answering, with ERNIE 4.5 Turbo ranking highest. However, issues like poor readability and unsafe recommendations remain in answers. Future research should prioritize enhancing patient readability to facilitate AI’s application in precision cancer health education.

PMID:42228312 | DOI:10.1007/s13187-026-02918-w

Ann Biomed Eng. 2026 Jun 2. doi: 10.1007/s10439-026-04187-6. Online ahead of print.

ABSTRACT

BACKGROUND: Aortic regurgitation (AR) alters normal blood flow patterns in the left ventricle (LV), affecting diastolic filling dynamics, and is commonly quantified by the regurgitant fraction (RF). However, conventional diagnostic methods have notable limitations, prompting growing interest in four-dimensional flow magnetic resonance imaging (4D-flow MRI) as a tool for quantitatively assessing AR severity. In parallel, viscous energy dissipation (VED), which captures the energy loss caused by viscous forces within blood flow, provides additional important insight into the hemodynamic burden imposed on the LV by valvular dysfunction.

OBJECTIVE: This study aims to investigate the potential correlation between RF and VED in patients with AR, hypothesizing that higher RF values are associated with increased VED, thereby reflecting greater hemodynamic compromise.

METHODS: This pilot study included 10 patients with diagnosed AR and 9 healthy controls, all of whom underwent standardized cardiac MRI, including 4D-flow MRI. Volumetric blood flow and VED were assessed using validated post-processing techniques. Statistical analyses were conducted to evaluate group differences and explore the correlation between RF and VED.

RESULTS: In healthy controls, LV flow exhibited a typical pattern during diastole and systole, forming a vortex during filling. Severe AR patients displayed disrupted LV flow, with regurgitant jets altering the flow dynamics. Quantitatively, integrated kinetic energy (iKE), vorticity (iVRT), and VED (iVED) were significantly elevated in AR patients compared to controls: iKE (0.003 ± 0.002 J vs. 0.001 ± 0.0004 J, p = 0.019), iVRT (0.304 ± 0.0738 s^-1 vs 0.251 ± 0.0466 s^-1, p = 0.077), and iVED (0.434 ± 0.307 mW vs. 0.166 ± 0.055 mW, p = 0.020). An increase was observed in patients with severe AR compared to controls, iKE rose to (0.005 J vs. 0.001 J), iVRT (0.335 s^-1 vs. 0.233 s^-1), and iVED (0.792 mW vs. 0.174 mW). All three parameters positively correlated with RF: iVRT (R² = 0.175, p = 0.1263; Spearman R = 0.486), iVED (R² = 0.628, p = 0.0038; Spearman R = 0.597), and iKE (R² = 0.601, p = 0.0051; Spearman R = 0.616), indicating that increasing regurgitation severity is associated with greater intraventricular energy and flow disruption.

CONCLUSION: This study quantifies the impact of AR on LV flow dynamics and demonstrates elevated VED in patients with AR. The observed correlation underscores the potential of VED as a complementary metric to RF in evaluating the hemodynamic impact of valvular regurgitation. Further studies with larger cohorts are needed to validate these findings and explore their clinical implications.

PMID:42228301 | DOI:10.1007/s10439-026-04187-6