Category: Statistics

JAMA Netw Open. 2025 Dec 1;8(12):e2548936. doi: 10.1001/jamanetworkopen.2025.48936.

ABSTRACT

IMPORTANCE: Studies of nursing home (NH) residents show lower than expected antiretroviral therapy (ART) use, but it is unclear whether ART use changes across the transition from the community to long-term NH stay.

OBJECTIVE: To examine changes in ART use across the transition from the community to long-term NH stay.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined long stays in US NHs for people with HIV in a sample of 5% of Medicare claims from 2014 to 2019. Stays were at least 30 days long, had at least 3 months between multiple stays, and were for those continuously enrolled in Medicare for the stay and 6 months before. Analysis was completed in May 2025.

EXPOSURES: Admission year demographics included age, race and ethnicity (non-Hispanic Black, non-Hispanic White, and other [American Indian or Alaska Native, Asian or Pacific Islander, other, and unknown]), binary sex, Medicaid eligibility, whether the stay was preceded by a skilled nursing stay, and whether disability was Medicare original eligibility. NH characteristics included for-profit status, census region, and facility quality rating.

MAIN OUTCOMES AND MEASURES: Linear regression estimated changes in the proportion of days covered by 3-drug ART, and hierarchical multinomial logistic regression estimated the risk of never having, losing, or gaining ART vs always having it, across the transition from the community to long-term NH stay.

RESULTS: There were 713 long NH stays for 657 people with HIV (mean [SD] age, 61.0 [11.4] years) across 598 facilities; 271 stays (38%) were for people aged 65 years and older. Only 23 individuals lost ART (3%), 97 individuals (14%) gained ART, 185 individuals (26%) never had ART, and 408 individuals (57%) always had ART across the transition. Excluding those who lost ART, all other groups were mostly men (never, 132 men [71%]; always, 289 men [71%]; gained, 72 men [74%]) and Black (never, 85 individuals [46%]; always, 237 individuals [58%]; gained, 58 individuals [60%]). There was an increase in the proportion of days covered (mean intercept α = 13.92; 95% CI, 9.57-18.29). Compared with always having ART, Black race (relative risk [RR], 0.52; 95% CI, 0.35-0.77), polypharmacy (RR, 0.41; 95% CI, 0.23-0.74), and disability as original Medicare eligibility (RR, 0.47; 95% CI, 0.29-0.77) were associated with lower risk of never having ART. For-profit facilities were associated with higher risk (RR, 1.63; 95% CI, 1.03-2.59) of never having ART. Polypharmacy was associated with lower risk of gaining ART (RR, 0.15; 95% CI, 0.05-0.49).

CONCLUSIONS AND RELEVANCE: These findings suggest that long-term NH stays may be associated with improved ART use among people with HIV because most stays without ART never had ART before admission.

PMID:41385225 | DOI:10.1001/jamanetworkopen.2025.48936

JAMA Netw Open. 2025 Dec 1;8(12):e2549457. doi: 10.1001/jamanetworkopen.2025.49457.

ABSTRACT

IMPORTANCE: Hospitalization in older adults leads to a decline in daily living activities, and countries experiencing demographic aging face an increase in hospitalization rates and health care costs. Health care systems that can reduce the probability of ambulatory care-sensitive condition (ACSC) hospitalization among older populations are needed.

OBJECTIVE: To comprehensively assess the association between regional factors and the probability of ACSC hospitalization among older adults and the extent to which regional factors explain this probability.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study in Hokkaido prefecture, Japan, focused on participants aged 65 years or older who were covered by community-based or older-age health insurance (all adults aged 72 years and older) and had at least 2 medical visits between July and December 2022. The patients were followed up until December 2023.

EXPOSURE: Explanatory variables included municipal-level factors of residence categorized according to the Andersen behavioral model, which conceptualizes health service use as a function of predisposing, enabling, and need factors. At the municipal level, 9 predisposing, 11 enabling, and 10 need factors were included.

MAIN OUTCOMES AND MEASURES: The primary outcome was the binary variable of whether an individual was hospitalized for ACSCs between January and December 2023.

RESULTS: Among the 1 272 960 participants (median [IQR] age, 78 [73-84] years; 762 118 [59.9%] women), 51 623 (4.1%) had ACSC hospitalizations: 9492 for acute conditions, 41 271 for chronic conditions, and 3779 for vaccine-preventable conditions. A multilevel logistic regression analysis with individuals for level 1 and municipalities for level 2 revealed that 6.0% of the variance was attributable to municipal factors. Lower odds of hospitalization were associated with more clinics (odds ratio [OR], 0.933; 95% CI, 0.881-0.988), long-term care rehabilitation beds (OR, 0.996; 95% CI, 0.993-0.999), and higher financial power (OR, 0.359; 95% CI, 0.236-0.548); home care support clinics showed a similar direction (OR, 0.807; 95% CI, 0.636-1.024). Higher odds were associated with more nursing home beds (OR, 1.004; 95% CI, 1.000-1.009), a higher proportion of older adults living alone (OR, 1.073; 95% CI, 1.032-1.116), and a higher income (OR, 1.0004; 95% CI, 1.0001-1.0006).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults in Japan, ACSC hospitalizations were less likely in municipalities with more outpatient, in-home, and rehabilitation care resources and stronger financial capacity and more likely in those with more nursing home beds, greater social isolation, and higher income levels.

PMID:41385224 | DOI:10.1001/jamanetworkopen.2025.49457

JAMA Netw Open. 2025 Dec 1;8(12):e2549463. doi: 10.1001/jamanetworkopen.2025.49463.

ABSTRACT

IMPORTANCE: There is widespread enthusiasm about generative artificial intelligence (AI), but no systematic evidence on its implementation across health care organizations.

OBJECTIVE: To describe adoption of generative AI integrated with the electronic health record (EHR) by nonfederal acute care hospitals, how adoption relates to experience using and evaluating predictive AI, and hospital characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This survey study of nonfederal acute care US hospitals used the 2024 American Hospital Association (AHA) Information Technology (IT) Supplement survey. The survey was completed by individuals most knowledgeable about health IT at the participating hospitals.

EXPOSURES: Experience with predictive AI, source of predictive AI, local evaluation practices (evaluation for accuracy and bias as well as postdeployment evaluation), and EHR developer were collected from the 2024 AHA IT Supplement. Hospital characteristics, including critical access hospital status, multihospital system membership, and teaching status, were collected from the 2024 AHA Annual Survey. Hospital operating margins, uncompensated care burden, and percentage of discharges from Medicaid were collected from the 2022 Medicare Cost Report.

MAIN OUTCOMES AND MEASURES: Whether the hospital was an early adopter of generative AI integrated with their EHR (currently used generative AI), fast follower (planned to use in the next year), or delayed adopter (planned to use in 5 years, no plans, or do not know).

RESULTS: A total of 2174 hospitals (1003 [weighted percentage, 50.4%] small; 1382 [weighted percentage, 60.8%] urban core-based; 1668 [weighted percentage, 68.8%] part of a multihospital system) responded to questions about their use of AI (51.5% response rate). Overall, 762 hospitals (weighted percentage, 31.5%) were early adopters of generative AI in 2024, 540 (weighted percentage, 24.7%) were fast followers, and 872 (weighted percentage, 43.7%) were delayed adopters. In unadjusted analyses, independent hospitals and critical access hospitals were less likely to be either early adopters or fast followers than delayed adopters. In adjusted analyses, hospitals that used predictive AI were more likely to be early adopters or fast followers than delayed adopters (difference, 26.2 [95% CI, 16.8-35.6] percentage points). Users of Epic were more likely to be early adopters and fast followers than users of other EHRs (eg, likelihood of being an early adopter or fast follower, Epic vs Oracle users: 21.9 [95% CI, 16.3-27.4] percentage points). Hospitals that reported conducting all local evaluation practices (accuracy, bias, postdeployment) were slower to adopt than hospitals that reported only 1 evaluation practice (all local evaluation processes: 12.1 [95% CI, 4.5-19.6] percentage points less likely to be early adopters than fast followers).

CONCLUSIONS AND RELEVANCE: In this survey study of US hospitals, more than half of US hospitals reported that they would likely implement generative AI by the end of 2025. Results indicate the value of providing support to ensure hospitals can adopt beneficial generative AI and the need for developing and disseminating best practices for generative AI evaluation across organizations.

PMID:41385223 | DOI:10.1001/jamanetworkopen.2025.49463

J Biomech Eng. 2025 Dec 12:1-21. doi: 10.1115/1.4070647. Online ahead of print.

ABSTRACT

Anterior cruciate ligament (ACL) reconstruction in pediatric patients has a higher graft failure rate compared to adults. Restoring joint stability and reducing graft failure is essential. However, how graft biomechanical properties change with age and affect reconstruction outcomes remains unclear. This study investigated the biomechanical development of porcine flexor tendons across skeletal growth and evaluated how graft size and stiffness influence knee biomechanics in a pediatric porcine model. Flexor tendons (n = 57) were harvested from pigs at 0.5, 1.5, 5, and 9 months of age to measure cross-sectional area (CSA), stiffness, and failure load. ACLs in nine early adolescent porcine knees were reconstructed using both 1.5- and 5-month-old (1.5mo and 5mo) grafts and tested under anterior-posterior, compressive, and varus-valgus loading at 40° flexion using a robotic system. ACL and graft forces were calculated using the principle of superposition, and in situ properties were derived from force-displacement curves. Tendon CSA, stiffness, and failure load increased with age, and stiffness associated with CSA. The CSA of 5mo tendons was 57% greater than that of 1.5mo tendons, but stiffness increased only 20%. ACL reconstruction with 5mo grafts resulted in 29% less anterior-posterior tibial translation and 44% higher graft force compared to 1.5mo grafts. In situ stiffness of 5mo grafts was 51% higher than 1.5mo grafts. These findings highlight the differences between tendon size and biomechanical development, which together contribute to the improvements in joint function following ACL reconstruction.

PMID:41385220 | DOI:10.1115/1.4070647

Indian J Ophthalmol. 2025 Dec 12. doi: 10.4103/IJO.IJO_733_25. Online ahead of print.

ABSTRACT

PURPOSE: To report TON in indigenous tribal communities of Northeast India, and to explore its association with Tuibur use.

METHOD: Retrospective study undertaken in consecutive patients presenting with unexplained gradual, painless, bilateral diminution of vision. Detailed dietary and medical history was taken. Demographic profile of subjects was noted, including age, gender, ethnicity and occupation. Duration & frequency of Tuibur use per day was noted. Clinical evaluation along with visual fields, color vision, Retinal nerve fibre layer analysis was done. All patients were started on oral Vitamin B complex supplementation, including Vitamin B12 (1500 mcg) once daily for three months. The patients were called for follow up at monthly intervals for 3 months and at 6 months.

RESULT: 39 patients with bilateral involvement, mean age of 39.5 ± 11.6 years were studied. 82% were females; 97.4% belonging to tribal community. There was statistically significant improvement in visual acuity [Oculus Dexter (OD) P=0.002, Oculus Sinister (OS) P=0.007] and visual field indices after treatment.

CONCLUSION: TON may cause severe visual loss; however, timely management gives favourable results. Treatment involves replacing deficient nutrients and eliminating offending toxins. It is also important to consider contributory cultural and dietary practices. This is the first study linking a hitherto unheard-of toxic agent, liquid tobacco (Tuibur/Hidakphu) to optic neuropathy.

PMID:41385215 | DOI:10.4103/IJO.IJO_733_25

JAMA Health Forum. 2025 Dec 5;6(12):e255597. doi: 10.1001/jamahealthforum.2025.5597.

ABSTRACT

IMPORTANCE: Food insecurity (FI) is associated with poor health and has risen in the US. The Supplemental Nutrition Assistance Program (SNAP) is the largest US food-purchasing assistance program. Policies related to eligibility assessment and administrative burden that impact SNAP participation vary between states. How such policies influence FI is not well known.

OBJECTIVES: To evaluate the association between changes in state SNAP policies and county FI rates.

DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study used annual county-level FI estimates from the Feeding America Map the Meal Gap dataset, state-level SNAP policy data from the US Department of Agriculture from 2009 to 2019, and data on economic and demographic measures from the US Census Bureau for county residents. Data were analyzed from August 2024 to August 2025.

EXPOSURES: Changes in state SNAP policies from 2009 to 2019. Due to incomplete policy data, the analysis was not extended beyond 2019.

MAIN OUTCOMES AND MEASURES: County-level FI rates for individuals. An annual index of SNAP policy adoption was calculated, scaled from 0.1 to 10, with a higher level indicating a greater adoption of policies associated with SNAP participation. G-computation, a robust causal inference methodology, was used to evaluate the association between change in the SNAP index and state-level SNAP participation rates and county-level FI rates. The model accounted for demographic and clinical factors, state and year fixed effects, and baseline SNAP index levels.

RESULTS: Of a total of 3143 US counties, 3134 were included in the analysis. A 1-point increase in the SNAP policy index was associated with a 0.7-percentage point (pp; 95% CI, 0.3-1.2 pp; P = .002) higher state-level SNAP participation rate and a 0.1-pp (95% CI, 0.02-0.2 pp; P = .02) lower county-level FI rate from 2009 to 2019. In 2019, an estimated 6.5 million (95% CI, 3.8-9.1 million) fewer individuals would have experienced FI if all states had adopted policies equivalent to the most generous state in each year compared to if all states had adopted policies equivalent to the least generous state.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, adoption of state-level policies associated with higher SNAP participation was also associated with lower county-level FI rates. Policies that lower barriers to SNAP participation may help address rising FI rates observed in 2022 and 2023.

PMID:41385208 | DOI:10.1001/jamahealthforum.2025.5597

JAMA Health Forum. 2025 Dec 5;6(12):e255605. doi: 10.1001/jamahealthforum.2025.5605.

ABSTRACT

IMPORTANCE: The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to community-based health care for veterans enrolled in the Veterans Affairs (VA) Health Care System. At the same time, the COVID-19 pandemic created unprecedented demand for intensive care unit (ICU) care. The combined impact of these changes on critical care delivery, outcomes, and spending remains unclear.

OBJECTIVE: To describe patterns in ICU admissions, case complexity, 90-day mortality, and VA spending for VA-delivered vs VA-purchased community ICU care from 2019 to 2023.

DESIGN, SETTING, AND PARTICIPANTS: Repeated cross-sectional study of 1 151 915 ICU admissions among veterans treated at 99 VA medical centers (VAMCs) and 4288 community hospitals reimbursed through the VA Community Care Network from January 1, 2019, to December 31, 2023. Stratified time series analyses were used to illustrate trends across 4 periods: pre-MISSION, post-MISSION, COVID-19 emergency, and post-COVID-19 stabilization. Interrupted time series analyses were then applied using unified regression models with interaction terms to assess differences across these periods.

MAIN OUTCOMES AND MEASURES: Main outcomes were monthly ICU admission volume, Case Mix Index weight, Charlson Comorbidity Index, 90-day all-cause mortality, and VA expenditures on community ICU care. Models were adjusted for demographic, clinical, and temporal covariates.

RESULTS: Of 1 151 915 ICU admissions among VA-enrolled veterans, including 270 237 at 99 VAMCs and 881 678 at 4288 community hospitals reimbursed through the VA community care network, 881 678 occurred in community hospitals. From 2019 to 2023, ICU admissions decreased by 21.3% in VAMCs and increased by 46.8% in community hospitals. Interrupted time series models showed increased mortality during the COVID-19 period in both settings and decreased mortality in VAMCs following the pandemic. Stratified time series models showed a postpandemic adjusted mortality rate of 18.4% (95% CI, 18.2%-18.7%) at VAMCs compared with 20.0% (95% CI, 19.8%-20.2%) in the community. Community hospitals had higher median Case Mix Indices, and total inflation-adjusted VA spending on community ICU care increased by 50% from $2.70 billion in 2019 to $4.04 billion in 2023, driven by increased admission volume.

CONCLUSIONS AND RELEVANCE: This study found that VA-purchased community ICU care expanded markedly while incurring higher costs and slightly worse outcomes. These shifts underscore growing reliance on external critical care infrastructure and raise policy concerns around VA capacity planning, care integration, and quality oversight for veterans with high-acuity needs.

PMID:41385207 | DOI:10.1001/jamahealthforum.2025.5605

Przegl Epidemiol. 2025 Dec 12;79(3):462-472. doi: 10.32394/pe/213582. Epub 2025 Oct 28.

ABSTRACT

BACKGROUND: Measles remains one of the most contagious viral diseases, spreading rapidly in populations with insufficient vaccination coverage. Despite the availability of an effective vaccine, cases continue to occur worldwide. The World Health Organization (WHO) has set goals of regional elimination and, ultimately, global eradication. Essential elements include ≥95% vaccination coverage, sensitive epidemiological surveillance, and laboratory confirmation. In Poland, these functions are coordinated by the National Institute of Public Health NIH – National Research Institute (NIPH NIH – NRI).

OBJECTIVE: To assess the epidemiological situation of measles in Poland in 2022-2023, with particular focus on vaccination coverage, progress in implementing the WHO elimination programme, and the impact of the COVID-19 pandemic.

MATERIAL AND METHODS: The analysis was based on case reports submitted to NIPH-NIH by Provincial Sanitary and Epidemiological Stations, data from the national bulletins Infectious diseases and poisoning in Poland (2022-2023) and Vaccinations in Poland (2022-2023), and individual epidemiological interviews registered in the EpiBaza system.

RESULTS: In 2022, 27 cases of measles were reported (incidence 0.07/100,000), and in 2023 – 35 cases (0.09/100,000). Compared to 2021 (13 cases, 0.03/100,000), this represented a 107.7% increase, although the incidence remained 97.7% lower than in 2019 (1,502 cases, 3.31/100,000). The highest rates were recorded among children: in 2022 in the 0-4 age group (0.61/100,000) and in 2023 in the 5-9 group (0.61/100,000). Hospitalisations increased from 7 patients in 2022 (25.9%) to 11 in 2023 (31.4%). No deaths were reported.

CONCLUSIONS: In 2022-2023, Poland saw a rise in measles cases compared to 2021, but incidence remained much lower than in the pre-pandemic period. The predominance of cases among children and suboptimal vaccination coverage (<95%) highlight the ongoing risk of outbreaks. Strengthening epidemiological surveillance, systematic monitoring of vaccination rates, and public education are key to meeting WHO elimination targets.

PMID:41385201 | DOI:10.32394/pe/213582

Przegl Epidemiol. 2025 Dec 12;79(3):451-461. doi: 10.32394/pe/213328. Epub 2025 Oct 22.

ABSTRACT

BACKGROUND: Mumps is a viral disease primarily transmitted by infected individuals. A milestone in controlling mumps in Poland was the introduction of mandatory MMR vaccination in 2003, protecting against measles, mumps, and rubella. Since then, the incidence has decreased substantially, and complications have become rare.

OBJECTIVE: The aim of the study was to conduct an epidemiological assessment of the incidence of mumps in Poland in 2023 compared to previous years, taking into account the impact of the COVID-19 pandemic.

MATERIAL AND METHODS: The analysis of the epidemiological situation of swine fever in Poland in 2023 was conducted based on the interpretation of data from the nationwide epidemiological surveillance system. The percentage of those vaccinated with the first dose was determined based on data for the 2021 cohort (children aged 3 years), and the percentage of those vaccinated with two doses was determined based on data for the 2017 cohort (children aged 6 years). Vaccination effectiveness was estimated using the screening method.

RESULTS: In 2023, 966 cases of swine fever were registered in Poland. This represented a 4.8% increase in the number of cases compared to 2022, when 922 cases were reported. The overall incidence rate was 2.6 per 100,000 inhabitants, which was 5.3% higher than in 2022. The highest incidence rate, 3.6 per 100,000 inhabitants, was recorded in the Śląskie voivodeship, and the lowest, as in previous years, of 1.2 per 100,000 inhabitants in Dolnośląskie voivodeship. The highest incidence(13.7/100,000) was recorded in children aged 0-4 and 5-9 (17.3/100,000). The incidence in men (3.0/100,000) was higher than in women (2.1/100,000). In 2023, the number of hospitalisations due to mumps in Poland was 12, a decrease of 40% compared to 2022, when 20 people were hospitalized.

CONCLUSIONS: In 2023, there was an increase in the number of registered cases of mumps, indicating a general upward trend. The decline in cases in2020-2021was the result of the COVID-19 pandemic, which was accompanied by restrictions significantly limiting the transmission of diseases spread by droplets, including mumps. Despite the increase in the number of cases in 2023, the level remains below that observed in the period before the COVID-19 pandemic.

PMID:41385200 | DOI:10.32394/pe/213328

Przegl Epidemiol. 2025 Dec 12;79(3):444-450. doi: 10.32394/pe/212512. Epub 2025 Oct 13.

ABSTRACT

BACKGROUND: The epidemiological situation of chickenpox in Poland has been stable in recent years, with no significant increase in the number of cases observed. Between 2016 and 2023, the incidence rate ranged from 389.4 to 506.2 cases per 100,000 population, except for 2020 and 2021, when the incidence rate decreased to 186.6 per 100,000 in 2020 and 151.1 per 100,000 in 2021, due to the COVID-19 pandemic. In 2022, an increase in the incidence rate was recorded, reaching 453.9 per 100,000.

OBJECTIVE: The aim of this study was to assess the epidemiological situation of chickenpox in Poland in 2023 compared to previous years.

MATERIAL AND METHODS: To assess the epidemiological situation of chickenpox in Poland, data submitted to the National Institute of Public Health NIH – National Research Institute by District Sanitary and Epidemiological Stations and published in the annual bulletin “Infectious diseases and poisonings in Poland in 2023” and data published in the annual bulletin “Vaccinations in Poland in 2023” were used.

RESULTS: A total of 190,825 cases of chickenpox were registered in 2023, which was 11.13% more than in 2022, and 27.59% more than the median number of cases for the years 2017-2021. The overall incidence was 506.2/100,000 population. In terms of age, the highest incidence was among children in the age groups 0-4 years (4,741.4/100,000) and 5-9 years (4,155.1/100,000), while in adults, the incidence did not exceed 100 cases per 100,000. In 2023, a total of 123,743 people were vaccinated against chickenpox, of whom 95.49% were children under 11 years of age (118,163 people).

CONCLUSIONS: The slowdown in the increase in incidence in 2023 (compared to 2022) may indicate a stabilization of the chickenpox situation, but the increase in the overall incidence rate above 500 per 100,000 is concerning and requires monitoring in next years.

PMID:41385199 | DOI:10.32394/pe/212512