Category: Statistics

JAMA Netw Open. 2025 Sep 2;8(9):e2530787. doi: 10.1001/jamanetworkopen.2025.30787.

ABSTRACT

IMPORTANCE: As obesity rates rise in the US, managing associated metabolic comorbidities presents a growing burden to the health care system. While bariatric surgery has shown promise in mitigating established metabolic conditions, no large studies have quantified the risk of developing major obesity-related comorbidities after bariatric surgery.

OBJECTIVE: To identify common metabolic phenotypes for patients eligible for bariatric surgery and to estimate crude and adjusted incidence rates of additional metabolic comorbidities associated with bariatric surgery compared with weight management program (WMP) alone.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, multicenter cohort study used data from the Veterans Health Administration (VHA) Corporate Data Warehouse, which incorporates data from 128 VHA centers. Participants were adults 18 years or older with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or higher and at least 1 of 5 metabolic comorbidities or with a BMI of 35 or higher who underwent bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) or enrolled in the WMP (called MOVE!) between January 1, 2008, and December 31, 2023. Patients with all 5 comorbidities at baseline or missing key data were excluded.

EXPOSURE: Bariatric surgery vs WMP.

MAIN OUTCOME AND MEASURES: Incident diagnosis of any of 5 metabolic comorbidities: type 2 diabetes (T2D), hypertension, hyperlipidemia, obstructive sleep apnea (OSA), and metabolic dysfunction-associated steatotic liver disease (MASLD).

RESULTS: Among 269 470 veterans, 263 657 were enrolled in the WMP and 5813 underwent bariatric surgery. Patients included 232 196 males (87.1%) and had a median (IQR) age of 57 (47-64) years. Median (IQR) follow-up time was 112.9 (79.5-145.4) months. At 5 years, incidence rates per 1000 person-years were 8.89 for hypertension, 9.67 for hyperlipidemia, 4.29 for T2D, 3.99 for OSA, and 2.44 for MASLD in the WMP group. For the bariatric surgery group, incidence rates per 1000 person-years were 3.35 for hypertension, 4.85 for hyperlipidemia, 1.06 for T2D, 3.43 for OSA, and 2.01 for MASLD. Bariatric surgery was associated with a statistically significant lower risk of incident T2D (79.2% lower; hazard ratio [HR], 0.21 [95% CI, 0.18-0.26]), hypertension (58.8% lower; HR, 0.41 [95% CI, 0.33-0.51]), hyperlipidemia (50.5% lower; HR, 0.49 [95% CI, 0.42-0.58]), OSA (56.9% lower; HR, 0.43 [95% CI, 0.35-0.52]), and MASLD (40.4% lower; HR, 0.60 [95% CI, 0.49-0.73]) compared with the WMP. Results were consistent in a subgroup analysis of only female veterans.

CONCLUSIONS AND RELEVANCE: In this cohort study, bariatric surgery was associated with a significantly lower risk of developing major metabolic comorbidities compared with the medical WMP. This finding supports the relevance of bariatric surgery as a durable approach for obesity-related risk mitigation.

PMID:40924423 | DOI:10.1001/jamanetworkopen.2025.30787

JAMA Netw Open. 2025 Sep 2;8(9):e2530980. doi: 10.1001/jamanetworkopen.2025.30980.

ABSTRACT

IMPORTANCE: Patients with advanced cancer frequently receive broad-spectrum antibiotics, but changing use patterns across the end-of-life trajectory remain poorly understood.

OBJECTIVE: To describe the patterns of broad-spectrum antibiotic use across defined end-of-life intervals in patients with advanced cancer.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide, population-based, retrospective cohort study used data from the South Korean National Health Insurance Service database to examine broad-spectrum antibiotic use among patients with advanced cancer who died between July 1, 2002, and December 31, 2021. Data extraction and analysis were conducted between September 2023 and August 2024.

EXPOSURE: A diagnosis of lung cancer, liver cancer, stomach cancer, colorectal cancer, pancreatic cancer, prostate cancer, gallbladder and biliary tract cancer, breast cancer, non-Hodgkin lymphoma, leukemia, or multiple myeloma.

MAIN OUTCOMES AND MEASURES: The use of broad-spectrum antibiotics (ie, antipseudomonal β-lactams, carbapenems, or glycopeptides) was evaluated using 2 metrics according to end-of-life trajectory: (1) prescription proportion (percentage of patients receiving antibiotics) and (2) consumption amount (days of therapy per 1000 patient-days). The end-of-life trajectory was divided into 5 intervals: T1 (6 months to 3 months before death), T2 (3 months to 1 month before death), T3 (1 month to 2 weeks before death), T4 (2 weeks to 1 week before death), and T5 (final week before death). Logistic regression was performed to calculate odds ratios and 95% CIs for antibiotic prescription proportion without adjustment for multiple comparisons, and Poisson regression was used to calculate adjusted relative risks.

RESULTS: Among the 515 366 decedents included, the mean (SD) age was 68.8 (11.7) years, and 347 327 (67.4%) were male. A total of 483 405 patients (93.8%) had solid tumors, with lung cancer (122 142 patients [23.7%]) being the most common type. Overall, 288 151 patients (55.9%) received broad-spectrum antibiotics during the last 6 months of life. The proportion of patients receiving broad-spectrum antibiotics peaked during T2, with 144 920 (28.1%) receiving at least 1 dose, and declined to 68 564 (13.3%) during T5. In contrast, total consumption peaked during T3, reaching 190.0 days of therapy per 1000 patient-days. These patterns were consistent across antibiotic classes and cancer types. During the last week of life, patients with leukemia had the highest exposure to broad-spectrum antibiotics compared with those with lung cancer, both for prescription proportions (crude odds ratio, 1.50; 95% CI, 1.43-1.58) and total consumption (adjusted relative risk, 1.21; 95% CI, 1.19-1.23).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with advanced cancer, broad-spectrum antibiotic use increased from 3 months to 2 weeks before death, suggesting that this may be a key period for optimizing use and aligning care with patient goals.

PMID:40924422 | DOI:10.1001/jamanetworkopen.2025.30980

JAMA Netw Open. 2025 Sep 2;8(9):e2531166. doi: 10.1001/jamanetworkopen.2025.31166.

ABSTRACT

IMPORTANCE: Caregivers of community-dwelling older adults play a protective role in emergency department (ED) care transitions. When the demands of caregiving result in caregiver burden, ED returns can ensue.

OBJECTIVE: To develop models describing whether caregiver burden is associated with ED revisits and hospital admissions up to 30 days after discharge from an initial ED visit.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study nested within the LEARNING WISDOM longitudinal cohort study included dyads of community-dwelling patients aged 65 years or older and their caregivers. Included patients were triaged to an observation unit stretcher on their index visit to 1 of 4 EDs within an integrated health multisite organization of 4 acute care hospitals in Québec, Canada, between January 1, 2019, and December 21, 2021, and underwent a transition of care when discharged back to the community. Analyses were conducted in May 2024.

EXPOSURE: Caregiver burden, collected using the brief 12-item Quebec French version of the Zarit Burden Interview (ZBI; score range, 0-48, with higher scores indicating higher burden).

MAIN OUTCOMES AND MEASURES: Revisits to the ED, defined as a return to any ED in the 4-hospital network, within 3, 7, or 30 days of the index visit and return visits to the ED resulting in hospitalization within 30 days of the index visit. Moderation of outcomes by wave of the COVID-19 pandemic at the index visit was also assessed.

RESULTS: Among 1409 caregiver-patient dyads, 711 patients (50.5%) and 980 caregivers (69.6%) were women; mean (SD) age was 77.06 (7.39) years for patients and 63.87 (12.04) years for caregivers. The mean (SD) ZBI score was 7.33 (7.11). Caregivers were most often spouses of patients (667 [48.0%]) or children of patients (534 [37.9%]). Among all patients, 75 (5.3%) returned to the ED within 3 days, 133 (9.4%) returned within 7 days, 292 (20.7%) returned within 30 days, and 88 (6.2%) were admitted to the hospital within 30 days. Each point increase on the ZBI scale was associated with an increase in the odds of a 30-day revisit to the ED (odds ratio [OR], 1.03; 95% CI, 1.00-1.05; P = .03), but associations were not found in models with shorter time windows (3 days: OR, 1.01; 95% CI, 0.98-1.04; P = .69; 7 days: OR, 1.01; 95% CI, 0.98-1.03; P = .55) or for revisits with hospital admissions (OR, 1.02; 95% CI, 0.99-1.05; P = .24). Associations between ZBI scores and 30-day ED revisits may have been moderated by the COVID-19 pandemic waves: the first interwave period (between waves 1 and 2) reversed the association (OR, 0.89; 95% CI, 0.78-0.97).

CONCLUSIONS AND RELEVANCE: The findings suggest caregiver burden may be associated with ED revisits within 30 days of discharge from an initial ED visit among community-dwelling older adults. Future studies could enhance the management of ED revisits by demonstrating the longitudinal impact of caregiver burden on ED use in older adults.

PMID:40924417 | DOI:10.1001/jamanetworkopen.2025.31166

Age Ageing. 2025 Aug 29;54(9):afaf247. doi: 10.1093/ageing/afaf247.

ABSTRACT

BACKGROUND: Little is known about how ambulatory care sensitive condition (ACSC)-related readmissions can be reduced in acute care settings.

OBJECTIVE: This study examined the association between transitional care for hospitalised older patients with ACSC and ACSC-related readmissions.

METHODS: This retrospective observational cohort study included patients aged 65 years and older admitted with ACSC as the primary diagnosis from 1 April 2022 to 31 January 2023, using linked data from the Diagnosis Procedure Combination and the medical functions of the hospital beds database. The primary outcomes were cumulative readmissions within 1-7, 1-14, 1-21, 1-30 and 1-60 days, analysed using inverse probability treatment weighting regression models.

RESULTS: Among 85 582 patients from 711 hospitals, 39 916 (46.6%) were female, with a median age of 82 years (interquartile range: 75-88); 57 127 (66.8%) patients received transitional care. The overall readmission rates were 2.9%, 6.0%, 8.7%, 11.4% and 17.5% among total hospitalisations within 7, 14, 21, 30 and 60 days, respectively. Overall, transitional care was associated with reduced odds of ACSC-related readmission, with odds ratios ranging from 0.72 (95% CI: 0.65-0.78) within 7 days to 0.91 (95% CI: 0.87-0.95) within 60 days. The association between transitional care and readmission varied by ACSC category. In chronic ACSC, the association was strongest for 7-day readmission, followed by a downward trend. In acute and vaccine-preventable ACSC, the association was strongest for 7-day readmission but levelled off after 21 days.

CONCLUSIONS: Transitional care in acute care hospitals may be associated with a reduced risk of early readmissions due to ACSC when older patients are hospitalised.

PMID:40924407 | DOI:10.1093/ageing/afaf247

Patient. 2025 Sep 9. doi: 10.1007/s40271-025-00768-0. Online ahead of print.

ABSTRACT

BACKGROUND: Migraine care is often suboptimal owing to undertreatment, variation in clinical outcomes and administration methods among existing treatments, and between- and within-individual heterogeneity in the clinical course of migraine. In response to these challenges, preference studies have been increasingly conducted to inform treatment decision-making and development. However, gaps remain in understanding how treatment preferences have been assessed across different migraine studies.

OBJECTIVE: The aim was to synthesize existing evidence to inform the design and conduct of future preference migraine research. This review examined treatment attributes included in preference studies, focusing on how attributes were developed, framed, and presented; how their values were analyzed and reported; and whether these values differed by respondent characteristics.

METHODS: A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025614690). Embase, MEDLINE, and the Cochrane Library were searched for relevant stated preference studies on migraine treatments (October 2024). Two researchers independently screened studies, and data were extracted using a predefined template. Extracted information included study characteristics, methods for attribute and instrument development, choice task design, attribute framing, and analytical approaches. Narrative synthesis and descriptive statistics were used to summarize findings. Attribute importance was assessed by deriving relative rankings of attributes from marginal utilities or importance scores across studies.

RESULTS: Overall, 18 studies were reviewed from the 186 that were screened. Stated preference methods comprised discrete choice experiment (n = 12), conjoint analysis (n = 1), contingent valuation method (n = 3), thresholding (n = 1), and time trade-off (n = 1). In total, 13 studies reported their attribute development methods, using literature review only (n = 2), expert consultation only (n = 1), and multi-method approaches combining literature reviews with qualitative research and/or expert or payer consultation (n = 10). In addition, 17 studies included at least 1 benefit attribute, resulting in 26 unique attributes grouped into seven overarching concepts. Risk attributes were included in 11 studies, with injection site reactions (n = 5), gastrointestinal effects (n = 4), and cognitive effects (n = 3) as the most common adverse events. Administration-related attributes appeared in ten studies, with mode and/or frequency of administration being the most common (n = 10). Eight studies used visual aids to illustrate attributes. Preference heterogeneity was explored in 14 studies, primarily on the basis of sex (n = 9), monthly migraine days (n = 8), and treatment experience (n = 7).

CONCLUSIONS: This review reveals substantial variation in how treatment attributes were selected, framed, and analyzed across studies. Greater methodological consistency in attribute development, framing, and reporting, along with more robust exploration of preference heterogeneity, is needed to enhance the comparability, validity, and application of future preference research in migraine care.

PMID:40924386 | DOI:10.1007/s40271-025-00768-0

Curr Atheroscler Rep. 2025 Sep 9;27(1):88. doi: 10.1007/s11883-025-01339-2.

ABSTRACT

PURPOSE OF REVIEW: This review examines cardiovascular disease (CVD) risk prediction models relevant to older adults, a rapidly expanding population with elevated CVD risk. It discusses model characteristics, performance metrics, and clinical implications.

RECENT FINDINGS: Some models have been developed specifically for older adults, while several others consider a broader age range, including some older individuals. These models vary in terms of predictors, outcomes, horizon, and statistical approaches, with some accounting for competing risks and considering age-predictor interactions. Discrimination is generally acceptable and more modest in older versus younger individuals. Calibration shows great variation across populations. Accurate CVD risk prediction is essential to guide individualized prevention strategies and support shared decision-making in older adults. CVD risk prediction in this population is challenged by age-related CVD risk heterogeneity, elevated competing risk due to non-CVD mortality, and comorbidities. Further refinement by incorporating geriatric-specific factors may help to enhance discrimination.

PMID:40924377 | DOI:10.1007/s11883-025-01339-2

J Behav Med. 2025 Sep 9. doi: 10.1007/s10865-025-00598-3. Online ahead of print.

ABSTRACT

Indigenous Peoples experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the U.S. Though the management of type 2 diabetes requires regular healthcare visits, North American Indigenous individuals with diabetes do not always utilize the healthcare available to them, and this lack of utilization may lead to poor health outcomes over time. Drawing on literature showing that North American Indigenous patients experience discrimination in healthcare and that experiencing discrimination in healthcare is associated with healthcare avoidance and/or delay, the current study conceptualized unmet healthcare utilization as healthcare avoidance and used path analysis with longitudinal data (four points of data collection) to examine the relationships between healthcare discrimination, healthcare avoidance, and self-rated health in a sample of 192 Indigenous adults with type 2 diabetes from the northern Midwest U.S. We found that healthcare avoidance was negatively associated with baseline self-rated health, and that healthcare avoidance partially explained the negative effect of lifetime healthcare discrimination on self-rated health at the final follow-up of the study. These results show that healthcare avoidance statistically mediates the relationship between healthcare discrimination and self-rated health and suggest that healthcare avoidance is an important mechanism linking healthcare discrimination to worse self-rated health over time. Ultimately, we argue that creating more inclusive and less microaggressive healthcare spaces is important for individual health outcomes and macro-level health inequities. Continued efforts to understand instances of and to diminish healthcare mistreatment of Indigenous Peoples are recommended.

PMID:40924353 | DOI:10.1007/s10865-025-00598-3

J Behav Med. 2025 Sep 9. doi: 10.1007/s10865-025-00595-6. Online ahead of print.

ABSTRACT

Estimating statistical power is essential for designing behavioral medicine studies efficiently and conserving finite resources. Sometimes behavioral medicine researchers are interested in calculating power for 1-sided z-tests of individual parameters (e.g., slopes) in complex models such as multilevel structural equation models or multilevel mixture regression models. For such models, calculating power for 1-sided z-tests is cumbersome because: (a) online z-test power calculator tools are inapplicable, (b) commonly-used power analysis software provides power only for 2-sided z-tests and does not allow changing alpha, and (c) published power tables typically provide power results only for 2-sided z-tests. Hence, here we introduce straightforward and resource-efficient conversion formulas to estimate the power of 1-sided z-tests of individual parameters in any model by using direct power conversions from the corresponding 2-sided tests. We then implement these conversion formulas in accessible R and Excel software. This brief report thus provides behavioral medicine researchers with a convenient and practical solution for power calculation that minimizes the time, financial, and computational resources typically needed for power estimation.

PMID:40924352 | DOI:10.1007/s10865-025-00595-6

Biol Trace Elem Res. 2025 Sep 8. doi: 10.1007/s12011-025-04817-5. Online ahead of print.

ABSTRACT

This study aimed to evaluate fluoride concentrations in a variety of commonly consumed teas and Herbal infusions in Brazil and assess potential Health risks associated with their ingestion. A total of 21 samples were analyzed, including 12 loose-leaf and 9 commercially bagged products. Fluoride quantification was performed using a validated spectrophotometric method, and a deterministic and probabilistic human Health risk assessment was conducted. Fluoride concentrations ranged from 0.5 mg/L (eucalyptus) to 52.8 mg/L (hibiscus) in loose-leaf samples, and from 7.5 mg/L (anis) to 47.9 mg/L (hibiscus) in bagged products. Statistically significant differences (p < 0.05) were observed in six of the nine comparable samples between formats. The non-carcinogenic risk assessment revealed that 3 out of 21 samples, hibiscus (both forms) and boldo (loose-leaf), exceeded the acceptable HQ > 1. Monte Carlo simulation confirmed these findings, with hibiscus infusions showing HQ > 1 in over 90% of the 10,000 iterations. Additionally, the average HI exceeded 1 in six loose-leaf and all bagged samples, with hibiscus reaching a peak HI of 18.06. These findings suggest that the consumption of certain teas and infusions, especially those with high fluoride concentrations, may contribute to excessive fluoride intake and potential health risks. The results support the need for clearer labeling and stricter regulation of fluoride content in tea and infusion products, particularly in countries like Brazil where their consumption is increasing.

PMID:40924350 | DOI:10.1007/s12011-025-04817-5

Odontology. 2025 Sep 9. doi: 10.1007/s10266-025-01196-0. Online ahead of print.

ABSTRACT

This study aimed to investigate the age-related alterations in mesial roots of mandibular first molar in terms of root canal curvature values, dentin thickness, interorifice distance, deviation from apical foramen, and location of apical foramen using a three-dimensional curvature measurement method and micro-computed tomography (micro-CT). Forty-five mesial roots of mandibular first molars from three age groups (Group 1: ≤ 30 years, Group 2: 31-59 years, Group 3: ≥ 60 years) were scanned using micro-CT. The central axis of each mesiobuccal and mesiolingual canal was analyzed using cubic B-spline curves to calculate canal curvature. Dentin thickness, deviation of apical foramen from the anatomical apex, and the location of apical foramen in mesiobuccal and mesiolingual canals were measured and recorded. Statistical analyses, including one-way ANOVA, Mann-Whitney U, Kruskal-Wallis and Pearson’s correlation tests, were performed to assess age-related differences in curvature, interorifice distance, and dentin thickness with a 5% significance threshold. No statistically significant differences in root canal curvature were observed across the three age groups (p > .05), although a slight increase in curvature was noted in Group 3. Interorifice distance was significantly lower in Group 2 (p < .05), but no significant relationship was found between mesiobuccal curvature and interorifice distance. Dentin thickness, however, showed significant variations: Groups 1 and 2 exhibited thinner mesial dentin (2-6 mm levels), while Group 3 demonstrated greater distal dentin thickness (5-8 mm levels) (p < .05). Apical foramen location and deviation remained consistent across age groups (p > .05), predominantly situated centrally on the root surface. While root canal curvature did not vary significantly with age (p > .05), dentin thickness showed notable age-related differences (p < .05). A significant correlation was observed between the mesiolingual canal curvature and interorifice distance, but no such correlation was found for the mesiobuccal canal. A significant age-related increase in dentin thickness in both the mesiobuccal and mesiolingual canals underscores the impact of secondary dentin deposition, which is probably uniform as the root canal curvature seems to remain relatively stable across the lifespan in mandibular first molars.

PMID:40924341 | DOI:10.1007/s10266-025-01196-0