Nevin Manimala

JAMA Netw Open. 2025 Feb 3;8(2):e2462277. doi: 10.1001/jamanetworkopen.2024.62277.

ABSTRACT

IMPORTANCE: Racial and ethnic minority groups disproportionately experience food insecurity. During the COVID-19 pandemic, the US enacted temporary food assistance policies, including emergency allotments for Supplemental Nutrition Assistance Program (SNAP) benefits. The effects of the pandemic and these policies on food insecurity by race and ethnicity are unclear.

OBJECTIVE: To examine prevalence trends in food insecurity by racial and ethnic groups and SNAP use before and during the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study analyzed National Health Interview Survey data before (January 2019 to March 2020) and during the COVID-19 pandemic (April 2020 to December 2022). Participants were noninstitutionalized US adults (≥18 years) with low income (<200% federal poverty level). Statistical analysis was performed from September 25, 2023, to February 27, 2024.

EXPOSURE: COVID-19 pandemic time period.

MAIN OUTCOMES AND MEASURES: Food insecurity was measured using the 10-item US Department of Agriculture Adult Food Security Survey module, categorizing participants as food secure (high or marginal food security) or insecure (low or very low food security). Survey-weighted Poisson regressions were modeled to examine changes in food insecurity prevalence over time by race and ethnicity (Asian, Black, Hispanic, and White) and by race and ethnicity and SNAP use (yes or no) including a 3-way interaction term (time × race and ethnicity × SNAP).

RESULTS: Among 30 396 adults with low income, approximately one-half were female (56.0% [95% CI, 54.7%-57.2%] during the pre-COVID-19 time period; 57.4% [95% CI, 56.4%-58.4%] during the COVID-19 time period). Food insecurity prevalence decreased from 20.9% (95% CI, 19.9%-22.0%) before the COVID-19 pandemic to 18.8% (95% CI, 17.9%-19.7%) during the pandemic (P < .001). SNAP use prevalence increased overall (from 31.5% [95% CI, 30.1%-32.9%] to 36.0% [95% CI, 34.8%-37.3%]; P < .001) and for each racial and ethnic group. There were no significant differences in food insecurity changes over time by racial and ethnic group (Wald test F = 1.29; P = .28 for 2-way interaction). Among SNAP participants, food insecurity decreased for Asian, Hispanic, and White adults but did not change for Black adults; among non-SNAP participants, food insecurity did not change for Black, Hispanic, and White adults but increased for Asian adults (Wald test F = 4.43; P = .02 for 3-way interaction).

CONCLUSIONS AND RELEVANCE: During the COVID-19 pandemic, food insecurity decreased among SNAP participants in most racial and ethnic groups but did not decrease among non-SNAP participants in any group. These results suggest that during the pandemic, increased SNAP benefit amounts were associated with ameliorating food insecurity for many US adults who were able to access SNAP but did not reduce racial and ethnic disparities in food insecurity.

PMID:40019759 | DOI:10.1001/jamanetworkopen.2024.62277

JAMA Netw Open. 2025 Feb 3;8(2):e2462360. doi: 10.1001/jamanetworkopen.2024.62360.

ABSTRACT

IMPORTANCE: Given the disparities in access to primary care and the growing nurse practitioner (NP) workforce, it is important to understand the distribution of primary care practices with NPs across communities of varying socioeconomic characteristics.

OBJECTIVE: To compare the socioeconomic characteristics of communities that have primary care practices with or without NPs.

DESIGN, SETTING, AND PARTICIPANTS: This secondary, cross-sectional analysis of 79 743 primary care practices used 4 merged data sources: the IQVIA 2023 OneKey database, the 2020 US biennial Census, the 2017-2022 American Community Survey, and the 2021 Area Deprivation Index (ADI). US Census Tracts and Divisions from 2023 were used to examine differences in socioeconomic characteristics across communities.

EXPOSURE: Primary care practices with NPs vs without NPs.

MAIN OUTCOMES AND MEASURES: Socioeconomic characteristics of Census Tracts and Block Groups, including racial and ethnic composition, median household income, percentage below the federal poverty level, educational attainment, and the ADI (an ordinal percentile ranking of Census Block Groups from 1 to 100, with 1 being least disadvantaged and 100 being most disadvantaged).

RESULTS: Of 79 743 primary care practices, 42 601 (53.4%) employed NPs in 2023. Practices with NPs, compared with those without, were significantly more likely to be in communities classified as low income (23.3% vs 17.0%; P < .001) and rural (11.9% vs 5.5%; P < .001). On average, these communities had a higher proportion of the population living below the federal poverty level (14.4% [95% CI, 14.3%-14.5%] vs 12.8% [95% CI, 12.7%-12.9%]; P < .001) and without a high school diploma (19.8% [95% CI, 19.7%-19.9%] vs 18.5% [95% CI, 18.4%-18.6%]; P < .001). Communities with practices with NPs also had significantly higher mean ADI percentiles than communities with practices without NPs (53.3% [95% CI, 53.1%-53.6%] vs 42.5% [95% CI, 42.2%-42.7%]; P < .001). As the number of primary care practices decreased in disadvantaged areas, the proportion of practices with NPs increased. In most US Census Divisions, there were more primary care practices with NPs than without, a difference that was marked in low-income communities.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of primary care practices in the US found that primary care practices with NPs, compared with those without NPs, were more likely to be located in communities with lower income and educational attainment and greater levels of overall socioeconomic disadvantage. This finding suggests that NPs are key to ensuring access to primary care in communities with socioeconomic disadvantage.

PMID:40019758 | DOI:10.1001/jamanetworkopen.2024.62360

JAMA Netw Open. 2025 Feb 3;8(2):e2462365. doi: 10.1001/jamanetworkopen.2024.62365.

ABSTRACT

IMPORTANCE: Women with a history of breast cancer (BC) experience greater physical health decline compared with age-matched women without cancer. However, whether this decline differs in patients who received chemotherapy and endocrine therapy is not well understood.

OBJECTIVE: To investigate physical health decline in BC survivors who received chemotherapy or endocrine therapy compared with age-matched women without cancer.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted as part of the Cancer Prevention Study-3, a prospective US cohort study that enrolled participants in 35 states, the District of Columbia, and Puerto Rico between 2006 and 2013. Follow-up for this analysis was through April 1, 2020. Statistical analyses were conducted between May 2023 and December 2024. Female participants diagnosed with nonmetastatic BC who returned a survey at least 90 days after their diagnosis were matched on age and year of survey return with up to 5 women without cancer.

EXPOSURE: Cancer status and treatment information.

MAIN OUTCOMES AND MEASURES: Outcomes of interest were measures of physical health, assessed using the Patient-Reported Outcomes Measurement Information System Global Health Scale instrument. Linear regression was used to estimate associations (β) and 95% CIs of treatment with physical health.

RESULTS: This analysis included 2566 individuals diagnosed with BC and 12 826 age-matched women without cancer. Median (IQR) age at diagnosis was 56.3 (49.9-61.9) years. Of women with BC, 1223 (47.7%) received endocrine therapy, 276 (10.8%) received chemotherapy, and 634 (24.7%) received both. Compared with women without cancer, there was a greater physical health decline within 2 years of diagnosis for BC survivors receiving endocrine therapy (β = -1.12; 95% CI, -1.64 to -0.60), chemotherapy (β = -3.13; 95% CI, -4.19 to -2.07), or both (β = -3.26; 95% CI, -3.97 to -2.55). The decline among endocrine therapy users was restricted to women receiving aromatase inhibitors. More than 2 years after diagnosis, the decline was only observed in women who received chemotherapy.

CONCLUSIONS AND RELEVANCE: In this cohort study of 15 392 BC survivors and age-matched women without cancer, BC survivors who received chemotherapy had a long-lasting physical health decline, unlike survivors who received endocrine therapy without chemotherapy. Further studies are needed to confirm these results and to better understand the health consequences of these treatments.

PMID:40019757 | DOI:10.1001/jamanetworkopen.2024.62365

JAMA Netw Open. 2025 Feb 3;8(2):e250056. doi: 10.1001/jamanetworkopen.2025.0056.

ABSTRACT

IMPORTANCE: Social determinants of health (SDOH) are associated with health outcomes. Thus, providing referrals for unmet social needs within clinical settings may improve the health of children.

OBJECTIVE: To examine the prevalence and demographic characteristics of pediatric families with unmet social needs and their association with families accepting help from a pediatric clinical practice.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data from a comprehensive SDOH screening and referral program at a large academic pediatric practice in the US. Participants were caregivers of patients younger than 17 years and indicated at least 1 social need. Data were collected from April 16, 2018, through September 29, 2019, and analyzed from November 18, 2019, through December 17, 2019. The data review was finalized December 20, 2023.

EXPOSURE: Screening for SDOH in primary care.

MAIN OUTCOME AND MEASURES: The main outcome was interest in assistance among patient families with at least 1 social need. Factor analyses categorized social needs as basic needs, stress, challenges to economic mobility, and marginalization. χ2 Tests and multivariable Poisson regression were used to examine the associations between patient characteristics and caregiver interest in assistance.

RESULTS: There were 758 caregivers (median [IQR] age, 34 [29-40] years; 614 mothers [81.0%]) reporting at least 1 unmet social need, such as food or utility insecurity or unemployment. The median age of children was 23 months (IQR, 4-70 months), and 163 (21.5%)were of Asian, Pacific Islander, or Native Hawaiian ; 213 (28.1%) of Black; 156 (20.6%) of Latino or Hispanic; 37 (4.9%) of White ; and 122 (16.1%) of other race and ethnicity. A total of 315 caregivers (41.6%) were not interested in assistance. Families with basic needs (adjusted prevalence ratio [PR], 5.56; 95% CI, 3.33-10.00), stress (adjusted PR, 1.75; 95% CI, 1.43-2.17), challenges to economic mobility (adjusted PR, 2.17; 95% CI, 1.67-2.86), or marginalization (adjusted PR, 1.41; 95% CI, 1.15-1.72) were more likely to be interested in assistance. Additionally, Black race (adjusted PR, 1.23; 95% CI, 1.01-1.49), other race and ethnicity (adjusted PR, 1.22; 95% CI, 1.01-1.47), and inadequate social support (adjusted PR, 1.85; 95% CI, 1.32-2.63) were associated with acceptance of referral services.

CONCLUSIONS AND RELEVANCE: These findings suggest that the implementation of referral programs may help to achieve health equity, especially among marginalized populations, and improve the referral process for families who have social needs but are not interested in assistance.

PMID:40019756 | DOI:10.1001/jamanetworkopen.2025.0056

JAMA Health Forum. 2025 Feb 7;6(2):e245523. doi: 10.1001/jamahealthforum.2024.5523.

ABSTRACT

IMPORTANCE: Nonprofit hospitals receive substantial tax exemptions to provide a community benefit. However, little is known about the distribution of community benefit spending (CBS) across US communities with varying degrees of social vulnerability beyond the hospital’s immediate geographic area.

OBJECTIVE: To assess associations of CBS per capita with community-level characteristics and social determinants of health.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Internal Revenue Service Series 990 Tax Forms from 2018 to 2023, to create a dataset of CBS for nonprofit hospitals in the US. Facility-level CBS allocation to counties was based on inpatient utilization to more accurately reflect a hospital’s community. Data were analyzed from January to December 2024.

EXPOSURES: County-level race and ethnicity characteristics and socioeconomic factors, including educational attainment, proportion living below 138% of the federal poverty level (FPL), and the Social Vulnerability Index (SVI) score.

MAIN OUTCOMES AND MEASURES: The primary outcome was total CBS per capita. Generalized linear regression models with a γ log-link function were used to assess the association of CBS per capita with community-level social determinants of health characteristics.

RESULTS: A total of 2465 nonprofit hospitals across 3140 US counties were included. Allocation of CBS varied significantly across communities, with the counties in the highest quintile receiving a mean (SD) of $540 ($250) per capita compared with counties in the lowest quintile with $22 ($16) per capita. Communities in the highest quintile of CBS had a higher proportion of White residents, while communities in the lowest quintile had a higher proportion of residents who were non-Hispanic Black or Hispanic, had lower educational attainment, and were living with incomes below 138% of the FPL. For every 1% proportional increase in non-Hispanic Black or Hispanic residents in a community, there was 1.61% (95% CI, 1.38%-1.84%) and 0.88% (95% CI, 0.63%-1.14%) less CBS per capita, respectively. In addition, there was less allocation of CBS per capita among counties with a greater proportion of people with low educational attainment, greater levels of poverty, or higher SVI scores. These results were consistent before and during the COVID-19 pandemic.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that nonprofit hospitals’ CBS was regressively allocated across US communities, with more socially vulnerable or racially and ethnically minoritized communities receiving less benefit than more affluent, non-Hispanic White communities, suggesting that the nonprofit tax system may be structurally discriminatory and contributing to health disparities.

PMID:40019742 | DOI:10.1001/jamahealthforum.2024.5523

JAMA Health Forum. 2025 Feb 7;6(2):e245565. doi: 10.1001/jamahealthforum.2024.5565.

ABSTRACT

IMPORTANCE: Rising out-of-pocket costs of maternal health care for people with commercial insurance may affect use of health care and outcomes. There are stark racial and ethnic disparities in outcomes, but little is known about differences in spending.

OBJECTIVE: To measure differences in out-of-pocket spending for maternity care by race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used administrative data from Blue Cross Blue Shield of Massachusetts from January 1, 2018, through December 31, 2022, for pregnancies, deliveries, and 42-day postpartum care. Participants were continuously enrolled during pregnancy, delivery, and 42 days post partum (collectively termed maternity episode).

EXPOSURES: The primary characteristic of interest was the birthing person’s race and ethnicity.

MAIN OUTCOMES AND MEASURES: The primary outcome was total out-of-pocket spending during the maternity episode. Out-of-pocket spending was measured separately for the pregnancy period, prenatal services, and delivery, by type of cost sharing, and as a percentage of the median household income in the patient’s census tract (using American Community Survey data). Race and ethnicity were measured via self-report and imputation.

RESULTS: The analytic sample included 87 253 maternity episodes among 76 826 unique birthing persons (mean [SD] age, 32.4 [4.7] years; 99.8% female) between 2018 and 2022; among maternity episodes, 8572 birthing persons (9.8%) were Asian, 3331 (3.8%) were Black, 6872 (7.9%) were Hispanic, and 68 478 (78.5%) were White. Mean out-of-pocket spending for the maternity episode was highest among Black birthing people ($2398 [$426]), followed by Hispanic ($2300 [$572]), Asian ($2202 [$603]), and White ($2036 [$1547]) birthing people (P < .001). These differences remained statistically significant after adjusting for health and demographic characteristics. The differences were largest in the prenatal period and for coinsurance payments. Black (1003 [30.1%]) and Hispanic (2302 [33.5%]) birthing people were more likely than Asian (1569 [18.3%]) and White (12 600 [18.4%]) birthing people to be enrolled in plans with high coinsurance, but not plans with high deductibles (3317 [38.7%] for Asian, 1232 [37.0%] for Black, 2350 [34.2%] for Hispanic, and 24 515 [35.8%] for White birthing people).

CONCLUSIONS AND RELEVANCE: In this study, differences in out-of-pocket maternity spending among the commercially insured were associated with differences in coinsurance rates. These costs could lead people to forgo needed health care or other basic needs that support health (eg, food or housing). Changes to health plan benefit design could improve equity in out-of-pocket maternity spending and its consequences.

PMID:40019741 | DOI:10.1001/jamahealthforum.2024.5565

Can J Public Health. 2025 Feb 28. doi: 10.17269/s41997-024-00992-5. Online ahead of print.

ABSTRACT

OBJECTIVES: Although past studies have identified sex differences in child maltreatment experiences and poor mental and physical health‒related outcomes, more research is needed to understand child maltreatment among sexual minorities (i.e., those who identify as other than heterosexual) and how child maltreatment and sexual identity are related to depression, anxiety, and at-risk alcohol and cannabis use among emerging adults.

METHODS: Data were drawn from the longitudinal Well-Being and Experiences (WE) Study collected from 2017 (14 to 17 years) to 2022 (18 to 23 years) from Manitoba, Canada (n = 584). Descriptive statistics and logistic regression models were computed.

RESULTS: Compared to heterosexual or straight sexual identity: homosexual, gay or lesbian; bisexual; and different or other identity were associated with an increased likelihood of experiencing child maltreatment, with the most robust relationships for bisexual identity and all child maltreatment outcomes. Indicating “I don’t know” for sexual identity compared to heterosexual identity was associated with 7.45 increased odds of exposure to intimate partner violence in adjusted models. Bisexual identity compared to heterosexual identity had the most robust association, with increased odds of depression, anxiety, at-risk alcohol use, and at-risk cannabis use. Findings provide some evidence to suggest that trends may be worse for some mental health and substance use outcomes among sexual minorities who also experience child maltreatment.

CONCLUSION: Preventing child maltreatment among all children, including youth identifying as other than heterosexual, is a public health priority. Such efforts will work towards optimizing mental health and reducing substance use in early adulthood.

PMID:40019705 | DOI:10.17269/s41997-024-00992-5

3D Print Med. 2025 Feb 28;11(1):8. doi: 10.1186/s41205-025-00258-x.

ABSTRACT

BACKGROUND: Patients who undergo laparoscopic right hemicolectomy often have vascular anomalies, creating challenges for surgeons. Preoperative identification of vascular anomalies and intraoperative precise navigation can enhance surgical safety and reduce the difficulty of the procedure. Accordingly, this study aimed to explore and evaluate the application of three-dimensional (3D) reconstruction and printing technology in laparoscopic right hemicolectomy and its assistance in preoperative planning and intraoperative navigation.

METHOD: 11 3D-reconstructed images and printed models of right hemicolectomy vasculature were preoperatively created to assist in developing individualized surgical plans. Intraoperatively, essential vessels (gastrocolic trunk of Henle, GTH) were identified and located with the help of the 3D printed models. Additionally, 36 cases without the assistance of 3D printing were retrospectively collected for the control group. Statistical analysis was performed to evaluate the impact of the 3D printed models on surgery-related characteristics.

RESULTS: The 3D-printed models accurately depicted anatomical structures, particularly the positions and adjacent relationships of essential vessels, including the superior mesenteric artery (SMA), superior mesenteric vein (SMV), GTH and related arterial/venous branches. The operation time was significantly lower in the 3D printing group (198.6 ± 8.8 min in 3D printing group vs. 230.7 ± 47.5 min in control group, P = 0.025).

CONCLUSIONS: In conclusion, this study represents a novel vascular 3D printed modelfor surgical planning and intraoperative navigation in laparoscopic right hemicolectomy. It underscores the potential clinical applications of 3D printing in this context. Preoperative identification of vascular anomalies and precise intraoperative navigation can feasibly reduce surgical difficulty and enhance safety.

PMID:40019697 | DOI:10.1186/s41205-025-00258-x

J Gastrointest Cancer. 2025 Feb 28;56(1):72. doi: 10.1007/s12029-025-01195-y.

ABSTRACT

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. However, there are limited studies on the latest survival trends and the impact of racial disparities on GIST patients’ outcomes.

METHODS: We obtained 12,808 GIST patients between 2001 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database in 17 original sites. Analysis utilizing the Kaplan-Meier method explored survival disparities and Cox regression was employed to assess the impact of prognostic factors.

RESULTS: Our study revealed an increase in the GIST incidence per 100,000 people over the past two decades, along with a rise in relative survival rate (RSR). Age, gender, social groups, tumor site, size, stage, socioeconomic status, marital status, surgery, and systemic therapy are prognostic factors. Subgroup analysis indicated higher incidence and poorer survival trends among Non-Hispanic Blacks (NHB) (Incidence, 1.88 per 100,000 people; 120 Mo RSR, 61.6%, 2001 to 2020). Colonic GIST has the worst prognosis among different locations, while rectal and anal GIST has the best. Within these groups, Non-Hispanic White (NHW) with colonic GIST have the poorest prognosis (HR, 2.032; 95% CI, 1.476-2.798), whereas NHB with rectal and anal GIST have the best prognosis.

CONCLUSION: The incidence and RSR of GIST both increased during 2001-2020. NHW with colonic GIST showed poorer survival, while NHB with rectal and anal GIST revealed better survival, highlighting the importance of targeted clinical management for GIST.

PMID:40019688 | DOI:10.1007/s12029-025-01195-y

Radiol Med. 2025 Feb 28. doi: 10.1007/s11547-025-01965-5. Online ahead of print.

ABSTRACT

PURPOSE: The distribution analysis of the morphologic characteristics and spatial relations among brain metastases (BMs) to guide screening and early diagnosis.

MATERIAL AND METHODS: This retrospective study analysed 4314 BMs across 30 brain regions from MRIs of 304 patients. This paper proposed a unified analysis model based on persistent homology (PH) and graph modelling to provide a comprehensive portrait of BMs distribution. Spatial relationships are quantified through dynamic multiple-scale graphs constructed with Rips filtration. The multi-scale centrality importance and clustering coefficients are extracted to decode BMs spatial relations. Morphologic BMs characteristics are further analysed by varying radius and volume values that are considered as clinically influential factors. Finally, two-tailed proportional hypothesis testing is used for BM statistical distribution analysis.

RESULTS: For spatial analysis, results have shown a statistical increase in the proportions of high-level centrality BMs at the left cerebellum (p<0.01). BMs rapidly form graphs with high clustering rather than those with high centrality. For demographic analysis, the cerebellum and frontal are the top high-frequency areas of BMs with 0-4 and 5-10 radii. Statistical increases in the proportions of BMs at cerebellum (p<0.01).

CONCLUSION: Results indicate that distributions of both BMs spatial relations and demographics are statistically non-random. This research offers novel insights into the BMs distribution analysis, providing physicians with the BMs demographic to guide screening and early diagnosis.

PMID:40019681 | DOI:10.1007/s11547-025-01965-5