Category: Statistics

JAMA Netw Open. 2026 Mar 2;9(3):e261796. doi: 10.1001/jamanetworkopen.2026.1796.

ABSTRACT

IMPORTANCE: Failure to account for the full complexity and costs of high-need populations in the risk-adjusted capitated payment model for Medicare Advantage (MA) plans may create financial disincentives for plans to invest in comprehensive care for affected beneficiaries, potentially exacerbating health disparities.

OBJECTIVE: To evaluate the association of reinstatement of Alzheimer disease and related dementias (ADRD) hierarchical condition categories (HCCs) into the MA risk-adjusted payment model in 2020 with access, affordability, and quality of care for beneficiaries with ADRD.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined a nationally representative sample of MA beneficiaries from the Medicare Current Beneficiary Survey (2015-2022). Beneficiaries with ADRD and those without ADRD but with comparable neurological diseases (stroke, paralysis, or Parkinson disease) before and after 2020 were included. Data analyses were performed between January and December 2025.

EXPOSURES: Reinstatement of the ADRD HCC into the MA risk adjustment formula in 2020.

MAIN OUTCOMES AND MEASURES: Primary outcomes were accessibility of needed care, medical financial burden, satisfaction with specialist access, and satisfaction with quality of care. These outcomes were assessed using a difference-in-differences model to compare changes between the treatment and control group before and after the inclusion of ADRD HCCs in the MA risk adjustment model in 2020.

RESULTS: Among 5353 MA beneficiary observations (1239 [23.1%] aged 65-74 years; 3127 [58.4%] aged ≥75 years; 1785 male [33.3%]), 1629 (30.4%) reported a diagnosis of ADRD, and 3724 (69.6%) did not report an ADRD diagnosis. Compared with MA beneficiaries without ADRD, those with ADRD reported lower rates of difficulty accessing care (142 beneficiaries [8.7%] vs 394 beneficiaries [10.6%]) and medical financial burden (235 beneficiaries [19.3%] vs 740 beneficiaries [25.1%]), but slightly lower rates of satisfaction with specialist access (1384 beneficiaries [90.8%] vs 3267 [92.7%]) and care quality (1495 beneficiaries [92.8%] vs 3414 beneficiaries [93.0%]). Reintroducing ADRD HCCs into the MA risk-adjusted payment model was associated with a 6.62 percentage-point decrease in reporting any troubles accessing needed care (β = 0.06; 95% CI, -0.11 to -0.02; P = .005) and a 9.20 percentage-point decrease in reporting any medical financial burden (β = -0.09; 95% CI, -0.16 to -0.02; P = .009) among MA beneficiaries with ADRD. No significant association was observed for satisfaction with specialist access or with quality of care among MA beneficiaries with ADRD.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of MA beneficiaries, reintroducing ADRD HCCs into the MA risk adjustment model was associated with improved care access and reduced financial burden among MA beneficiaries with ADRD. These findings suggest that risk adjustment that better reflects the costs of chronic, complex conditions may better align MA plan incentives with the needs of high-need populations and promote care equity.

PMID:41823963 | DOI:10.1001/jamanetworkopen.2026.1796

JAMA Netw Open. 2026 Mar 2;9(3):e260679. doi: 10.1001/jamanetworkopen.2026.0679.

ABSTRACT

IMPORTANCE: The US Centers for Disease Control and Prevention (CDC) define health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” Achieving this, according to the CDC, requires sustained efforts to address longstanding and contemporary inequities, reduce social and economic obstacles to care, and eliminate preventable differences in health and health care outcomes. Few operational models currently exist to support clinical teams in navigating health equity factors in clinical settings. The Healthcare Equity Consult Service (HECS) was established to assess concerns that contextual or interpersonal factors, including potential bias, may be shaping patient care and to provide structured support to patients, families, and clinical teams.

OBSERVATIONS: This report describes HECS consults conducted from August 2022 to March 2024 across 3 hospitals within an academic medical center in the US. Consults were referred by clinicians, patients, or families to assess equity-related or contextual interpersonal factors during hospitalization. HECS assessments followed a structured, real-time process that included medical record review, patient interviews, conversations with family members, and care team briefings and facilitated interventions to mitigate any potential systemic barriers, communication breakdowns, or perceived bias. Illustrative cases reflected themes in which patients, families, or clinical teams perceived that contextual factors might be shaping care processes, caregiver participation, or trust during clinical encounters. HECS interventions included direct engagement with patients, families, and health care teams to support equitable care. HECS provided real-time recommendations and coaching to clinical care team members regarding perceived biases and contextual factors relevant to patient care. In some instances, these recommendations informed subsequent review or refinement of institutional policies and care processes.

CONCLUSIONS AND RELEVANCE: The HECS model offered a promising strategy for embedding equity-centered interventions into acute care delivery. HECS recommendations leveraged multidisciplinary expertise in response to patient experiences and an acknowledgment of societal barriers with a focus on equitable solutions. These recommendations were incorporated into treatment plans and informed institutional efforts to review and refine clinical practice and policies.

PMID:41823962 | DOI:10.1001/jamanetworkopen.2026.0679

JAMA Health Forum. 2026 Mar 6;7(3):e260078. doi: 10.1001/jamahealthforum.2026.0078.

ABSTRACT

IMPORTANCE: Many US cities track firearm violence with annual homicide counts, which may not capture prevention gains, nonfatal injury trends, and stretches of peace. Metrics that quantify days without shootings provide an opportunity to communicate resilience and guide action. To provide a fuller picture, we introduce 4 novel metrics-shooting-free days (SFDs), shooting death-free days (SDFDs), consecutive shooting-free days (CSFDs), and multiple shooting-free days (MSFDs)-that, to our knowledge, have not previously been calculated across major US cities.

OBJECTIVES: To introduce, compute, and compare the 4 novel metrics across the 10 largest US cities from 2015 through 2024 and to test temporal trends.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional, time-series analyses of daily gun violence incidents measured in 10 US cities with populations exceeding 1 million using Gun Violence Archive data to construct city-day observations from all fatal and nonfatal shooting incidents recorded between January 1, 2015, through December 31, 2024. Linear regressions were used to estimate annual trends. Data were analyzed from June 2025 through January 2026.

EXPOSURES: Calendar year and city, operationalized as city-year panels derived from daily counts of persons shot (killed or injured).

MAIN OUTCOMES AND MEASURES: SFDs are defined as days per year with no shooting incidents; SDFDs, days with no shooting deaths; CSFDs, maximum number of consecutive days per year with no shooting incidents; and MSFDs, days with fewer than 2 people shot. Outcomes were computed per city per year and calculating the mean across years.

RESULTS: Of the 10 cities, Chicago had the lowest means (1.6 SFDs, 86.9 SDFDs, 0.6 CSFD, and 9.6 MSFDs per year) whereas San Diego had the highest (291.5 SFDs, 337.6 SDFDs, 24.2 CSFDs, and 347.3 MSFDs). A pronounced pullback occurred from 2019 through 2021. Phoenix and Dallas-Fort Worth had significant declines in all 4 metrics. Overall trends were significantly downward: -4.79 SFDs per year (P < .05), -4.50 SDFDs per year (P < .05), -0.30 CSFDs per year (P < .05), and -8.37 MSFDs per year (P < .01). Jacksonville, was the only city to show a significantly improved metric, in MSFDs (0.84 days per year; P < .05).

CONCLUSIONS AND RELEVANCE: These novel metrics highlight periods of success and safety rather than focusing on negative outcomes. Metrics varied widely, worsened overall during the study decade, and highlighted cities with policies and practices that could be replicated. Incorporating shooting-free metrics into public dashboards can motivate communities, sharpen accountability, and guide interventions in US cities.

PMID:41823961 | DOI:10.1001/jamahealthforum.2026.0078

JAMA Health Forum. 2026 Mar 6;7(3):e260108. doi: 10.1001/jamahealthforum.2026.0108.

ABSTRACT

IMPORTANCE: The Global Burden of Disease (GBD) reports widely used estimates of mortality and disability-adjusted life-years (DALYs) and related risk factors. However, the overall reliability of these estimates between GBD iterations has not been assessed.

OBJECTIVE: To evaluate the instability and inconsistency of GBD risk factor estimates for mortality and DALYs across GBD iterations.

DATA SOURCES: GBD risk factor collaboration estimates extracted from the published tables of GBD iterations and the Institute for Health Metrics and Evaluation repository.

STUDY SELECTION: GBD risk factor collaboration publications published for 2010 through 2023.

DATA EXTRACTION AND SYNTHESIS: Death and DALY estimates were manually extracted by 1 reviewer with independent validation of a random sample of 100 by another with no discrepancies. Risk factor naming was harmonized across iterations to ensure comparability; those with inconsistent definitions were excluded.

MAIN OUTCOMES AND MEASURES: Fluctuations were calculated for numbers of deaths and DALYs for each risk factor across GBD iterations during the study period (2010-2023) and between the original and subsequently revised estimates for each year (1990-2021). Differences were expressed as a ratio of the minimum to maximum range to the mean (R:M) and coefficient of variation. Detail analyses assessed diet and low physical activity. Point estimates were compared to the previous iterations’ estimates 95% uncertainty intervals (95% UI) for GBD 2019, 2021, and 2023.

RESULTS: Across GBD iterations from 2010 to 2023, the median (range) R:M was 0.8 (0-3.8) for deaths, and 0.7 (0.1-3.3) for DALYs. Level 2 dietary and child and maternal malnutrition death estimates showed high instability (R:M >1 for 9 of 16 and 4 of 8 risks, respectively). When comparing original estimates with GBD 2019, 2021, and 2023 estimates for the same years, the median R:M was 0.4 (0-2.9) for both deaths and DALYs. The coefficient of variation was greater than 0.2 for 336 of 675 death estimates (50%). Specifically, 70% to 96% of point estimates for red meat, sugar-sweetened beverages, fruits, vegetables, and seafood omega-3 fatty acids in GBD 2021 fell outside the GBD 2019 95% UI. In GBD 2023, only diet high in trans fats had more than half of point estimates outside the GBD 2021 95% UI.

CONCLUSIONS AND RELEVANCE: This meta-epidemiological assessment indicates that GBD estimates are substantially unstable, particularly for behavioral risks, making them unlikely to simply reflect genuine changes over time, and warranting caution in interpretation.

PMID:41823958 | DOI:10.1001/jamahealthforum.2026.0108

JACC Clin Electrophysiol. 2026 Feb 26:S2405-500X(26)00125-8. doi: 10.1016/j.jacep.2026.01.050. Online ahead of print.

ABSTRACT

BACKGROUND: Although ventricular arrhythmias (VAs) are common after left ventricular assist device (LVAD) implantation, the features of early electrical storm (ES) remain poorly characterized.

OBJECTIVE: This study aimed to evaluate the incidence and clinical impact of early ES in LVAD recipients.

METHODS: This international, multicenter, retrospective study included 1,309 recipients of LVADs implanted between 2006 and 2019. Early ES was defined as ≥3 sustained VA episodes within 24 hours during the first 30 days’ postimplantation. The primary outcome was 3-month all-cause mortality. Secondary endpoints included 3-month cardiac mortality and early (≤30 days) right ventricular (RV) failure.

RESULTS: Early ES occurred in 56 patients (4.3%), with a median onset at 5 days’ postimplantation. Patients with early ES experienced higher 3-month all-cause mortality (adjusted HR [aHR]: 3.09; 95% CI: 1.91-5.01; P < 0.01) and increased early RV failure (aHR: 2.05; 95% CI: 1.10-3.92; P = 0.03). Notably, early VA without ES showed no prognostic impact. Multivariable analysis identified 4 independent predictors of early ES: pre-LVAD RV S’ wave ≤9.5 cm/s (aHR: 2.25; 95% CI: 1.23-4.14), heart failure duration of ≥5 years (aHR: 2.41; 95% CI: 1.10-5.28), history of VAs (aHR: 4.43; 95% CI: 2.21-8.87), and prior mechanical circulatory support (aHR: 6.40; 95% CI: 2.12-19.33). The EarlyES-LVAD score, based on these variables, showed good discrimination (C-statistic 0.75) and stratified patients into low-risk (score 0-1), intermediate-risk (score 2-3), and high-risk (score 4-6) groups, with corresponding early ES rates of 1.1%, 3.9%, and 12.4%.

CONCLUSIONS: Early ES, but not isolated early VAs, is associated with substantially worse outcomes in LVAD recipients. The EarlyES-LVAD score enables practical risk stratification, facilitating targeted therapeutic interventions in high-risk patients.

PMID:41823945 | DOI:10.1016/j.jacep.2026.01.050

JACC Clin Electrophysiol. 2026 Feb 24:S2405-500X(26)00126-X. doi: 10.1016/j.jacep.2026.01.051. Online ahead of print.

ABSTRACT

BACKGROUND: Accurate selection of patients who will benefit from a primary-prevention implantable cardioverter-defibrillator (ICD) remains a challenge. Cardiac magnetic resonance imaging (CMR) of myocardial tissue heterogeneity and EntropyX_QT, a nonlinear electrocardiographic (ECG) measure of cardiac repolarization dynamics, predict ventricular tachyarrhythmias (VTs) and sudden cardiac arrest.

OBJECTIVES: Because CMR and EntropyX_QT are fundamentally distinct structural and electrical measures, we hypothesized that they add major independent prognostic value to conventional clinical predictors of sudden cardiac arrest.

METHODS: In 230 consecutive patients with a left ventricular ejection fraction ≤35% in sinus rhythm, baseline exposures before primary prevention ICD implantation included demographics, history, medications, laboratory results, conventional ECG indices of heart rate and QT variability, CMR myocardial tissue characterization, and EntropyX_QT. The primary endpoint was ICD shock for VT, and secondary endpoints included all-cause events, including mortality.

RESULTS: Over 6.1 ± 3.3 years of follow-up, 62 patients (27%) received appropriate ICD shocks. In multivariable analyses, EntropyX_QT and CMR gray zone mass yielded adjusted hazard ratios (per SD change) of 1.8 (95% CI: 1.4-2.3) and 1.5 (95% CI: 1.2-1.8), respectively, and improved Harrell’s C-statistic from 0.59 to 0.73 in a model composed of conventional clinical predictors, left ventricular end-systolic volume (LVESV) and prescribed diuretics. EntropyX_QT was the strongest predictor in years 1-3, whereas CMR and LVESV were stronger in years >3. Moreover, EntropyX_QT independently predicted the secondary endpoints.

CONCLUSIONS: EntropyX_QT and CMR gray zone mass complement each other and conventional risk factors, improving risk stratification for appropriate ICD shock and mortality, and together may enhance the selection of primary prevention ICD recipients. (Prospective Observational Study of the ICD in Sudden Cardiac Death Prevention (PROSe-ICD; NCT00733590).

PMID:41823943 | DOI:10.1016/j.jacep.2026.01.051

J Nutr Educ Behav. 2026 Mar 12:S1499-4046(26)00035-7. doi: 10.1016/j.jneb.2026.01.020. Online ahead of print.

ABSTRACT

OBJECTIVE: Valid, reliable, and comprehensive instruments enable early care and education (ECE) sites to self-assess nutrition and physical activity practices and policies, but availability is limited. Therefore, we developed and assessed the test-retest reliability and convergent validity of the Site-Level Assessment Questionnaire (SLAQ).

DESIGN: Reliability testing compared questionnaires completed by ECE personnel at 2 time points (reliability pairs). Convergent validity testing compared questionnaires completed by ECE personnel with questionnaires completed by researchers (validity pairs). Semistructured interviews with personnel who completed the SLAQ informed revisions.

SETTING: California Supplemental Nutrition Assistance Program Education-eligible ECE sites.

PARTICIPANTS: Convenience sample of 32 ECE sites (18 school districts; 14 Head Starts).

VARIABLES MEASURED: Seventy-six items assessing wellness policies, federal food program participation, meals, snacks, beverages, food environment, feeding practices, nutrition education, gardens, physical activity, screen time, family involvement, and breastfeeding support.

ANALYSIS: Weighted κ test statistics and percent agreement were calculated for each item to assess agreement between reliability pairs and validity pairs.

RESULTS: Eighty-eight percent of items showed moderate or higher reliability; 52% had moderate or higher validity. On the basis of these results and interview findings, the SLAQ was revised to address issues identified.

CONCLUSIONS AND IMPLICATIONS: Findings suggest acceptable validity and reliability of the SLAQ for assessing policies and practices at SNAP-Ed-eligible ECE sites in California. Further testing with larger, randomly selected, and geographically and socioeconomically diverse populations could broaden its application. As is, the comprehensive assessment data the SLAQ provides can be used to identify opportunities for improving ECE practices and policies that support children’s health.

PMID:41823935 | DOI:10.1016/j.jneb.2026.01.020

J Adolesc Health. 2026 Mar 13:S1054-139X(26)00004-2. doi: 10.1016/j.jadohealth.2026.01.002. Online ahead of print.

ABSTRACT

PURPOSE: Suicide continues to be a leading cause of death among young adults aged 18-25. Young adults are increasingly turning to crisis text services (CTSs) for support with suicidal ideation (SI). This study identified characteristics associated with young adults’ CTS use and outlined suggested improvements from users (“texters”).

METHODS: Young adults with a history of SI (n = 118) were recruited online and completed a cross-sectional survey. The quantitative data were analyzed using descriptive statistics and chi-square tests, and the qualitative data were analyzed using content analysis.

RESULTS: CTS use was associated with female sex, minoritized sexual orientation, having a mental health provider, and prior hospitalization for SI or a suicide attempt. Texters were more likely than nontexters to use other support sources. The most common barriers to CTS use were thinking it would not help (46%), embarrassment (41%), and wanting to solve the problem independently (35%). Texters recommended enhancing CTS by fostering warmer, more validating, and personalized interactions; improving availability and response times; and counselor training to tailor support to individual needs.

DISCUSSION: While young adults often use CTSs alongside other supports for SI, this study identifies opportunities to strengthen their usefulness and impact. Enhancing accessibility, personalization, and cultural responsiveness may help CTS better meet the needs of diverse young adults.

PMID:41823922 | DOI:10.1016/j.jadohealth.2026.01.002

J Hand Surg Am. 2026 Mar 13:S0363-5023(26)00131-0. doi: 10.1016/j.jhsa.2026.01.025. Online ahead of print.

ABSTRACT

PURPOSE: To assess scapholunate bridge augmentation with all-suture, knotless anchors in cadaveric wrists through evaluation of radiographic parameters, by comparing the bridged wrist to the wrist with an intact scapholunate interosseous ligament (SLIL) and sectioned SLIL.

METHODS: Nine cadaveric specimens were tested in 6 positions: wrist flexion, extension, ulnar deviation (UD), radial deviation (RD), clenched fist, and neutral. Radiographic parameters including scapholunate interval (SLI), scapholunate angle (SLA), and dorsal scaphoid translation (DST) were measured for each position. The SLIL was then sectioned, and parameters were measured in all 6 positions. The SLIL was repaired using one knotless anchor in the scaphoid and one in the lunate, with the repair suture from each anchor shuttled into the opposing anchor and tensioned to bridge the interval. Parameters were again measured in the 6 positions. Scapholunate interval was evaluated using repeated measures analysis of variance at α = 0.05; descriptive statistics were performed for SLA and DST.

RESULTS: Scapholunate interval was different between testing states in flexion (P < .001), UD (P < .001), RD (P = .01), clenched fist (P < .001), and neutral (P = .02). Post hoc testing revealed SLI was wider in the sectioned state than the intact state and bridged states in flexion, UD, and clenched fist. Scapholunate interval in these 3 states was similar between intact and bridged states. In neutral, SLI was narrower in the bridged state compared with intact and sectioned states. In RD, SLI was narrower in the bridged state compared with the sectioned state. Abnormal SLA (>60°) was only seen in flexion, across all 3 states. Mean DST increased after sectioning, then decreased after bridging, in extension, UD, RD, clenched fist, and neutral, although statistical conclusions cannot be drawn.

CONCLUSIONS: Scapholunate bridge augmentation restored radiographic parameters of carpal alignment.

CLINICAL RELEVANCE: With further cadaveric testing followed by clinical study, this technique may prove to be a useful treatment for SLIL injury.

PMID:41823917 | DOI:10.1016/j.jhsa.2026.01.025

Biology (Basel). 2026 Mar 7;15(5):439. doi: 10.3390/biology15050439.

ABSTRACT

Climate change, together with intensifying human activities, is reshaping global plant invasion dynamics and increasingly threatening ecosystem stability and biodiversity. Cockleburs are highly invasive weeds with strong ecological plasticity and dispersal capacity, causing widespread impacts on agricultural systems and native ecosystems. Here, we used the maximum entropy (MaxEnt) model to assess the current (2001-2020) and future (2021-2040, 2041-2060, and 2061-2080) potential distributions, key driving factors, and centroid shifts of four invasive cocklebur species-Cyclachaena xanthiifolia (=Iva xanthiifolia), Xanthium chinense, Xanthium italicum, and Xanthium spinosum-at the global scale under current climate conditions and three Shared Socioeconomic Pathway scenarios (SSP126, SSP245, and SSP585). Species occurrence records were integrated with climatic, topographic, and anthropogenic variables to project habitat suitability. Model performance was robust, with mean training and testing area under the receiver operating characteristic curve (AUC) values > 0.8 for all species and mean true skill statistic (TSS) values > 0.8 for three species (0.660 for Xanthium spinosum). Suitable habitats were jointly shaped by climatic and anthropogenic factors, although the dominant drivers differed among species. Cyclachaena xanthiifolia and Xanthium spinosum were primarily constrained by temperature and precipitation, whereas Xanthium italicum and Xanthium chinense were more strongly associated with human activity. At present, suitable habitat areas for Cyclachaena xanthiifolia, Xanthium chinense, Xanthium italicum, and Xanthium spinosum were 1196.92 × 10⁴, 358.76 × 10⁴, 888.34 × 10⁴, and 1985.14 × 10⁴ km², respectively. Future projections indicated overall contractions in suitable habitat, with pronounced interspecific variation. Xanthium chinense showed the largest mean decline (-161.23 × 10⁴ km² relative to the present), whereas Cyclachaena xanthiifolia experienced the smallest reduction (-53.15 × 10⁴ km² on average). Centroid analyses further suggested overall shifts toward higher latitudes and elevations under warming scenarios. Despite uncertainties related to climate scenario variability and assumptions inherent in species distribution modelling, these findings provide quantitative evidence to support global invasion risk assessment and climate-adaptive management of invasive cockleburs.

PMID:41823866 | DOI:10.3390/biology15050439