Nevin Manimala

Cogn Sci. 2025 Jun;49(6):e70073. doi: 10.1111/cogs.70073.

ABSTRACT

Previous research suggests that statistical learning enhances memory for self-related information at the individual level and that individuals exhibit better memory for partner-related items than they do for irrelevant items in joint contexts (i.e., the joint memory effect, JME). However, whether statistical learning improves memory for partner-related information in joint contexts remains unclear. This study investigated memory performance for partner-related words when higher level statistical regularities were embedded in word streams during a joint memory task. Participants performed a word categorization task, followed by a surprise free recall task across four experiments. Experiment 1 replicated the JME, revealing improved memory for partner-related items than for irrelevant items when using Chinese words with increased repetition. Experiment 2 embedded semantic regularities within partners’ word streams; Experiment 3a employed regularities based on non-adjacent fixed temporal positions; and Experiment 3b employed regularities based on adjacent fixed temporal positions. Results showed that the JME was enhanced only when semantic regularities were present (Experiment 2) and not with temporal positional rules (Experiments 3a and 3b). These findings suggest a hierarchical structure of co-representation and show that co-represented statistical regularities facilitate the processing of partner-related words, but only when the regularities align with partners’ intentions. This study advances our understanding of co-representation in joint action by highlighting its hierarchical nature, and the top-down interaction between structural levels.

PMID:40478612 | DOI:10.1111/cogs.70073

Womens Health (Lond). 2025 Jan-Dec;21:17455057251343953. doi: 10.1177/17455057251343953. Epub 2025 Jun 6.

ABSTRACT

BACKGROUND: Postpartum depression is a significant public health challenge. Understanding the predictors of postpartum depression can inform targeted interventions and support systems for new mothers.

OBJECTIVES: To identify and quantify sociodemographic and obstetric predictors of postpartum depression among mothers in Kumasi, Ghana.

DESIGN: A cross-sectional multicenter prospective study.

METHODS: A total of 502 postpartum mothers from five hospitals were included. Bayesian logistic regression analysis was used to assess model uncertainty and complex interactions between sociodemographic, economic, and obstetric factors on postpartum depression.

RESULTS: The pooled prevalence of postpartum depression was 25% (range 13% to 31%). Education attainment [coefficient = -0.43, 95% credible interval: -0.57 to -0.29, (adjusted odds ratio (aOR) = 0.65] and economic support from multiple earning members (coefficient = -0.28, 95% credible interval: -0.33 to -0.22, aOR = 0.75) substantially reduced the likelihood of postpartum depression. Being a single mother (coefficient = 0.34, 95% credible interval: 0.24 to 0.44, aOR = 1.40) increased the risk of postpartum depression. Planned pregnancies (coefficient = -0.25, 95% credible interval: -0.28 to -0.21, aOR = 0.78), doing physical exercise (coefficient = -0.26, 95% credible interval: -0.30 to -0.23, aOR = 0.77), and exclusive breastfeeding (coefficient = -0.23, 95% credible interval: -0.28 to -0.19, aOR = 0.79) were protective factors for postpartum depression. On the other hand, cesarean sections (coefficient = 0.34, 95% credible interval: 0.24 to 0.43, aOR = 1.40) and spontaneous vaginal deliveries (coefficient = 0.56, 95% credible interval: 0.47 to 0.65, aOR = 1.75) increased the risk of postpartum depression.

CONCLUSION: Our findings emphasize the importance of identifying modifiable predictors of postpartum depression, including sociodemographic, economic, and obstetrical factors, in Kumasi, Ghana. Interventions addressing these factors, such as financial support programs, maternal education, and physician training, may significantly reduce the regional burden. Policies tailored to low-resource contexts and exhibiting local cultural sensitivity are needed for enhancing maternal-child health outcomes in Ghana and comparable regions.

PMID:40478594 | DOI:10.1177/17455057251343953

JAMA Netw Open. 2025 Jun 2;8(6):e2512397. doi: 10.1001/jamanetworkopen.2025.12397.

ABSTRACT

IMPORTANCE: Patients from socially disadvantaged backgrounds experience disproportionately worse health care outcomes. Nurses provide most care to patients in hospitals and are informants of health care quality and equity.

OBJECTIVE: To understand what hospital nurses say helps or hinders their ability to provide quality care to socially disadvantaged populations.

DESIGN, SETTING, AND PARTICIPANTS: This qualitative study involved a directed content analysis of open-text responses from the RN4CAST-NY/IL survey, which was conducted between April and June 2021. Participants were registered nurses licensed to work in 58 New York and Illinois hospitals identified as high-performing (25 hospitals) and low-performing (33 hospitals) for COVID-19 mortality outcomes in 2021 from a larger quantitative study. The Social Ecological Model informed the study codebook; inductive and deductive coding of the data and content analysis were conducted from March to October 2024.

EXPOSURE: Direct care hospital nurses who participated in the RN4CAST-NY/IL survey.

MAIN OUTCOMES AND MEASURES: Open-text responses were from nurses who answered the survey question, “What helps (or hinders) your ability to provide quality care to vulnerable populations? (e.g. low SES, housing insecurity/homeless, racial/ethnic minorities, immigrant, limited English proficiency)?”

RESULTS: A total of 1084 nurses (mean [SD] age, 47.1 [18.2] years) responded to the survey. Most respondents identified as female (986 respondents [91.0%]) and were staff or direct care nurses (765 respondents [70.6%]) with at least a bachelor’s degree (968 respondents [89.6%]). With regard to race and ethnicity, 127 respondents (11.8%) were Asian, 156 (14.5%) were Black or African American, 89 (8.3%) were Hispanic, 693 (64.2%) were White, and 97 (8.9%) were other races. They had a mean (SD) of 18.9 (14.0) years of experience. Six themes described what helped or hindered quality care: (1) profits over patients, (2) care continuity and hospital-community partnerships, (3) insufficient staffing and time constraints, (4) technology to address language barriers, (5) patients’ determinants of health, and (6) individual nurses’ beliefs and backgrounds. Nurses proposed improving health care workforce diversity, strengthening community resources for patients, and advancing tailored cultural competency education as solutions to improve care for socially disadvantaged patients.

CONCLUSIONS AND RELEVANCE: In this qualitative study and directed content analysis of 1084 open-text responses, nurses identified systemic, institutional, community, and individual clinician-level approaches to improve care for socially disadvantaged populations for equitable care delivery. Nurses’ direct care experiences can inform hospital strategies to improve care for this population.

PMID:40478576 | DOI:10.1001/jamanetworkopen.2025.12397

JAMA Netw Open. 2025 Jun 2;8(6):e2512681. doi: 10.1001/jamanetworkopen.2025.12681.

ABSTRACT

IMPORTANCE: For breast cancer risk prediction to be clinically useful, it must be accurate and applicable to diverse groups of women across multiple settings.

OBJECTIVE: To examine whether a dynamic risk prediction model incorporating prior mammograms, previously validated in Black and White women, could predict future risk of breast cancer across a racially and ethnically diverse population in a population-based screening program.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included women aged 40 to 74 years with 1 or more screening mammograms drawn from the British Columbia Breast Screening Program from January 1, 2013, to December 31, 2019, with follow-up via linkage to the British Columbia Cancer Registry through June 2023. This provincial, organized screening program offers screening mammography with full field digital mammography (FFDM) every 2 years. Data were analyzed from May to August 2024.

EXPOSURE: FFDM-based, artificial intelligence-generated mammogram risk score (MRS), including up to 4 years of prior mammograms.

MAIN OUTCOMES AND MEASURES: The primary outcomes were 5-year risk of breast cancer (measured with the area under the receiver operating characteristic curve [AUROC]) and absolute risk of breast cancer calibrated to the US Surveillance, Epidemiology, and End Results incidence rates.

RESULTS: Among 206 929 women (mean [SD] age, 56.1 [9.7] years; of 118 093 with data on race, there were 34 266 East Asian; 1946 Indigenous; 6116 South Asian; and 66 742 White women), there were 4168 pathology-confirmed incident breast cancers diagnosed through June 2023. Mean (SD) follow-up time was 5.3 (3.0) years. Using up to 4 years of prior mammogram images in addition to the most current mammogram, a 5-year AUROC of 0.78 (95% CI, 0.77-0.80) was obtained based on analysis of images alone. Performance was consistent across subgroups defined by race and ethnicity in East Asian (AUROC, 0.77; 95% CI, 0.75-0.79), Indigenous (AUROC, 0.77; 95% CI 0.71-0.83), and South Asian (AUROC, 0.75; 95% CI 0.71-0.79) women. Stratification by age gave a 5-year AUROC of 0.76 (95% CI, 0.74-0.78) for women aged 50 years or younger and 0.80 (95% CI, 0.78-0.82) for women older than 50 years. There were 18 839 participants (9.0%) with a 5-year risk greater than 3%, and the positive predictive value was 4.9% with an incidence of 11.8 per 1000 person-years.

CONCLUSIONS AND RELEVANCE: A dynamic MRS generated from both current and prior mammograms showed robust performance across diverse racial and ethnic populations in a province-wide screening program starting from age 40 years, reflecting improved accuracy for racially and ethnically diverse populations.

PMID:40478575 | DOI:10.1001/jamanetworkopen.2025.12681

JAMA Netw Open. 2025 Jun 2;8(6):e2514212. doi: 10.1001/jamanetworkopen.2025.14212.

ABSTRACT

IMPORTANCE: Work-related hazards and stress have been shown to be associated with mental health, with suicide rates among adult workers increasing since 2000.

OBJECTIVE: To determine if self-reported lifetime diagnosed depression, frequent mental distress (FMD), extreme distress prevalences, and mean mentally unhealthy days (MUD) varied among current workers by industry or occupation.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Behavioral Risk Factor Surveillance System (BRFSS) data from 37 states reporting workers’ industry and occupation in 1 or more years between 2015 and 2019. The target population was currently employed civilian adults aged 18 years or older. Analyses were conducted in 2022 and 2023.

EXPOSURES: Workers’ current industry and occupation were the primary exposures of interest. Self-reported sociodemographic covariates included sex, age, race and ethnicity, education, coupled status, and health care coverage.

MAIN OUTCOMES AND MEASURES: Self-reported lifetime diagnosed depression, FMD, extreme distress, and MUD.

RESULTS: Of a total 536 279 workers assessed (unweighted sample, 535 997 workers; 263 007 female [49.1%]; 48 279 Hispanic [9.0%], 40 188 non-Hispanic Black [7.5%], 400 604 non-Hispanic White [74.7%]), 469 129 reported their industry or occupation. Lifetime diagnosed depression was reported by 80 319 of 534 342 workers (14.2% [95% CI, 13.9%-14.4%]). Mean MUD was 9.5 days (95% CI, 9.4-9.7 days) among 530 309 workers, and in all sociodemographic groups the mean MUD was 3 to 5 times higher among workers who reported lifetime diagnosed depression. Higher prevalences than all workers for lifetime diagnosed depression, FMD, and extreme distress were reported by workers who were female (lifetime diagnosed depression, 19.5% [95% 19.1%-19.9%]; FMD, 11.6% [95% CI, 11.3%-11.9%]; extreme distress, 4.8% [95% CI, 4.6%-5.1%]), ages 18 to 34 years (lifetime diagnosed depression, 16.9% [95% CI, 16.4%-17.3%]; FMD, 13.6% [95% CI, 13.1%-14.0%]; extreme distress, 5.5% [95% CI, 5.2%-5.8%]), and no longer or never in a couple (lifetime diagnosed depression, 18.0% [95% CI, 17.6%-18.4%]; FMD, 13.3% [95% CI, 12.9%-13.7%]; extreme distress, 5.7% [95% CI, 5.4%-6.0%]). By industry, retail trade (lifetime diagnosed depression: APR, 1.15 [95% CI, 1.05-1.25]; FMD: APR, 1.23 [95% CI, 1.10-1.39]) and accommodation and food services (lifetime diagnosed depression: APR, 1.13 [95% CI, 1.03-1.25]; FMD: APR, 6.8 [95% CI, 6.0-7.7]) had higher adjusted prevalences of lifetime diagnosed depression and FMD. By occupation, arts, design, entertainment, sports, and media (1.32 [95% CI, 1.09-1.60]); health care support (1.19 [95% CI, 1.03-1.38]); food preparation and serving (1.20 [95% CI, 1.05-1.36]); and sales and related occupations (1.13 [95% CI, 1.01-1.27]) had higher adjusted prevalences of FMD than the comparison group. Health care support (6.6% [95% CI, 5.5%-7.8%]), food preparation and service (6.9% [95% CI, 5.9%-7.8%]), building and grounds cleaning and maintenance (5.2% [95% CI, 4.4%-6.0%]), personal care and service (5.8% [95% CI, 4.9%-6.8%]), and sales and related occupations (4.8% [95% CI, 4.3%-5.3%]) had higher unadjusted extreme distress than all workers.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, poor mental health among workers varied significantly by sociodemographic categories; significant differences among industry and occupation groups remained after adjustment. More research is needed on the effects of work-related factors on mental health, which may inform tailored treatment and prevention strategies.

PMID:40478574 | DOI:10.1001/jamanetworkopen.2025.14212

JAMA Netw Open. 2025 Jun 2;8(6):e2514248. doi: 10.1001/jamanetworkopen.2025.14248.

ABSTRACT

IMPORTANCE: Interactions between race and county-level factors associated with mortality, such as employment, education, income, and population density, are understudied among Asian American and Pacific Islander populations.

OBJECTIVE: To compare all-cause, cancer, and heart disease mortality rates between Pacific Islander and Asian American adults across county-level factors.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined National Center for Health Statistics death certificate data on non-Hispanic Asian American and Pacific Islander adults (aged 20-84 years) between January 1, 2018, and December 31, 2020. County-level socioeconomic data were obtained from the American Community Survey, and population density was determined using Rural-Urban Continuum Codes. Analyses were conducted between August 1, 2023, and September 4, 2024.

EXPOSURES: County-level unemployment, educational attainment, median household income, and population density.

MAIN OUTCOMES AND MEASURES: Age-standardized all-cause, cancer, and heart disease mortality rates and mortality rate ratios (MRRs), comparing Pacific Islander with Asian American individuals by sex and age. Interactions between race and county-level factors associated with MRRs were evaluated using P value for trend across county-level factors.

RESULTS: During 2018 to 2020, 43 221 696 Asian American and 1 281 221 Pacific Islander adults resided in the US. A total of 148 939 Asian American individuals (16.7% aged 20-54 years, 17.2% aged 55-64 years, and 66.1% aged ≥65 years; 57.5% male) and 9628 Pacific Islander individuals (29.9% aged 20-54 years, 23.0% aged 55-64 years, and 47.1% aged ≥65 years; 57.2% male) died of any cause. Across all county-level factors, Pacific Islander adults had elevated all-cause, cancer, and heart disease mortality rates compared with Asian American adults (female: MRR range from 1.82 [95% CI, 1.67-1.98] for population <250 000 to 2.93 [95% CI, 2.73-3.14] for lowest unemployment tertile; male: MRR range from 1.64 [95% CI, 1.50-1.78] for lowest income tertile to 2.47 [95% CI, 2.31-2.63] for lowest unemployment tertile). Across all county-level factors, the largest relative all-cause mortality differences between Pacific Islander and Asian American adults occurred in counties with the lowest unemployment (female: MRR, 2.93 [95% CI, 2.73-3.14]; male: MRR, 2.47 [95% CI, 2.31-2.63]), highest educational attainment (female: MRR, 2.71 [95% CI, 2.53-2.90]; male: MRR, 2.39 [95% CI, 2.25-2.54]), highest median household income (female: MRR, 2.67 [95% CI, 2.56-2.79]; male: MRR, 2.25 [95% CI, 2.17-2.33]), and highest population density (female: MRR, 2.79 [95% CI, 2.67-2.92]; male: MRR, 2.37 [95% CI, 2.28-2.47]). No trends in relative cancer mortality differences between Pacific Islander and Asian American adults across county-level factors were observed overall except for greater population density among women (<250 000 population: MRR, 1.49 [95% CI, 1.25-1.76; >1 000 000 population, 2.13 [95% CI, 1.95-2.32]). The largest heart disease MRRs for Pacific Islander compared with Asian American individuals occurred among those younger than 65 years, with the greatest relative mortality among those aged 20 to 54 years in counties with the lowest unemployment (female: MRR, 14.21 [95% CI, 9.89-20.04]; male: MRR, 5.75 [95% CI, 4.58-7.15]) and highest educational attainment (female: MRR, 13.69 [95% CI, 9.68-18.94]; male: MRR, 6.17 [95% CI, 5.00-7.54]), median household income (female: MRR, 11.97 [95% CI, 9.55-14.91]; male: MRR, 5.16 [95% CI, 4.49-5.91]), and population density (female: MRR, 11.77 [95% CI, 9.39-14.62]; male: MRR, 5.48 [95% CI, 4.76-6.29]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, all-cause mortality disparities between Asian American and Pacific Islander populations worsened in counties with higher socioeconomic status and greater population density. Historical aggregation of Pacific Islander with Asian American individuals may have misled health improvement efforts, especially for Pacific Islander adults who lived in high socioeconomic and more populated areas.

PMID:40478573 | DOI:10.1001/jamanetworkopen.2025.14248

JAMA Netw Open. 2025 Jun 2;8(6):e2514289. doi: 10.1001/jamanetworkopen.2025.14289.

ABSTRACT

IMPORTANCE: Previous studies in low-resource settings have emphasized the risks of childhood weight gain for increased body mass index (BMI) and systolic blood pressure (SBP) in adulthood. However, these studies have not directly compared the risk of extra weight against the benefit of increased adult height.

OBJECTIVE: To test the hypothesis that a continuous 1-SD increase in weight from age 1 to 10 years was associated with taller stature in adulthood but not with increased risk for obesity or hypertension.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study, called the Dogon Longitudinal Study, is a 21-year population-based multigenerational cohort study conducted from 1998 to 2019 in 9 Dogon villages on the Bandiagara Escarpment in Mali. A mediation analysis was conducted in 2024 to calculate the estimated total effect on adult SBP of a 1-SD weight increase over the mean throughout the first decade of childhood. This estimated total effect was decomposed into estimated direct and indirect effects. Children aged 5 years or younger on April 15, 1998, as well as all children born from that date to July 2, 2000, were eligible to participate in the F1 generation.

EXPOSURES: Weight and height trajectories from age 1 to 10 years.

MAIN OUTCOMES AND MEASURES: For the mediation analysis, adult SBP was the outcome, and the mediators were height and BMI at age 21 years. The mediation analysis used linear mixed models for SBP, adult height, and adult BMI.

RESULTS: A total of 1348 participants (645 females [47.8%], 703 males [52.2%]) of the F1 generation contributed 10 081 SBP measurements to the analyses. These participants completed the study and had a median (IQR) of 12 (11-14) follow-up visits from enrollment (at median [IQR] age of 1.59 [0.62-3.44] years) to last measurement (at median [IQR] age of 21.14 [19.47-23.14] years). After adjusting for both parents’ height and SBP (F0 generation), analyses included 433 females and 501 males, with 3384 and 3770 SBP measurements, respectively. The total effect on adult SBP of being 1 SD above the mean, instead of at the mean, childhood weight trajectory was 1.9 (95% CI, 0.9-2.8) mm Hg for females and 3.2 (95% CI, 2.3-4.2) mm Hg for males. This total effect was mediated by an indirect effect through adult height of 2.3 (95% CI, 0.9-3.7) mm Hg in females and 3.9 (95% CI, 2.4-5.4) mm Hg in males and by an indirect effect through adult BMI of 2.6 (95% CI, 2.0-3.2) mm Hg in females and 1.4 (95% CI, 0.6-2.2) mm Hg in males. The direct effect on SBP was -3.1 (95% CI, -4.5 to -1.6) mm Hg in females and -2.1 (95% CI, -3.2 to -0.9) mm Hg in males. A 1-SD weight increase in childhood was associated with a 1.6% increase in the prevalence of obesity in females and no increase in the prevalence of obesity in males. The percentage of individuals whose SBP was 130 mm Hg or higher increased by 0.5% in females and 3.7% in males. The mean (SE) height at age 21 years increased by 3.0 (0.5) cm in females and 4.1 (0.6) cm in males.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study of an undernourished population in Mali supported the hypothesis, suggesting that the risks of 1 SD in childhood weight gain for hypertension and obesity in adulthood were small compared with the benefits of taller stature.

PMID:40478571 | DOI:10.1001/jamanetworkopen.2025.14289

JAMA Health Forum. 2025 Jun 7;6(6):e251204. doi: 10.1001/jamahealthforum.2025.1204.

ABSTRACT

IMPORTANCE: Identifying effective and financially viable strategies to meet the care needs of perons with impaired function is a policy challenge for high-income countries with aging populations. The 2022 National Strategy to Support Family Caregivers identified a range of actions to support caregivers, while family-oriented policies to promote the affordability of care were promoted by both candidates in the 2024 presidential election.

OBJECTIVE: To examine public perceptions of federal policies to support older adults, adults living with disabilities, and their family caregivers by political affiliation and caregiving status.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adults in the CLIMB study, a nationally representative, longitudinal panel. Data were collected in March and April 2024. Data analyses occurred from September 2024 to February 2025.

EXPOSURES: Self-reported political party affiliation and caregiving responsibility.

MAIN OUTCOMES AND MEASURES: Endorsement of 6 policies. Responses based on a 5-point Likert scale were dichotomized to contrast “strongly” or “somewhat support” with “strongly oppose,” “somewhat oppose,” and “neither support nor oppose.” The probability of support and differences across political affiliations was presented.

RESULTS: Of 2059 respondents (1035 female individuals [50.9%]; mean [SD] age, 49.0 [18.2] years), 394 (20%) reported having caregiving responsibilities, with no significant difference across political affiliation. Endorsement was highest for policies to make care in facilities (1657 [79.0%]) and homes (1600 [75.4%]) more affordable, expand eligibility for financial access to care (1618 [77.3%]), and increase the capacity of the paid caregiving workforce (1649 [78.3%]) and was lower for expansion of paid family leave (1342 [65.4%]) and payment of family caregivers (1223 [61.2%]). Endorsement by political affiliation was most similar for policies to make care at home more affordable (13.7-percentage point difference; 95% CI, -20.4 to -7.1) and least similar for paid family leave (33.4-percentage point difference; 95% CI, -39.0 to -27.7). While respondents with caregiving responsibilities were more likely to support paying family caregivers, political affiliation was associated with the endorsement of policies to support the care economy that was stronger in magnitude than sociodemographic characteristics (eg, sex) or caregiving experiences.

CONCLUSIONS AND RELEVANCE: The results of this cohort study suggest that, despite some differences by political affiliation, there is high support of policies to support the adult care economy, suggesting a policy window to advance legislation and executive action to address the care needs of aging populations and populations with disabilities.

PMID:40478556 | DOI:10.1001/jamahealthforum.2025.1204

JAMA Health Forum. 2025 Jun 7;6(6):e251215. doi: 10.1001/jamahealthforum.2025.1215.

ABSTRACT

IMPORTANCE: In Medicare Advantage (MA), the private component of the Medicare program that enrolls more than half of beneficiaries, an increasing share of plans are offering Part B premium givebacks to pay for part or all of the at least $174.70 Part B monthly premium. Millions of dollars of Medicare expenditures are attributable to this benefit, yet little is known about its association with member enrollment or other plan characteristics.

OBJECTIVE: To document trends and expenditures in MA Part B premium givebacks and examine their association with plan enrollment.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal difference-in-differences analysis compared MA plan enrollment before and after the offer of a Part B giveback among plans that offered the giveback vs plans that did not. January MA plan enrollment and characteristics data from 2018 through 2024 were included. Data were analyzed from May 2024 to February 2025.

EXPOSURE: Adoption of a Part B giveback.

MAIN OUTCOMES AND MEASURES: Total plan enrollment.

RESULTS: A sample of 18 627 plan-years representing more than 130 million enrollee-years was included in the analysis. The percentage of MA plans offering a Part B premium giveback increased from 4.3% (93 of 2187) in 2018 to 18.7% (737 of 3940) in 2024. Plans offering Part B premium givebacks had lower median enrollment, belonged to newer, higher rated contracts, had higher cost-sharing, and had lower enrollee risk scores compared with plans that did not offer givebacks. In 2024, the 3.4 million enrollees in plans with Part B givebacks received a mean (SD) of $77 ($42), amounting to as much as approximately $261 million in total monthly expenditures across the MA program. Adoption of a Part B giveback was associated with a 33.3% (95% CI, 9.3-56.9) increase in enrollment, robust to all model specifications. There was a dose-response association between the size of the giveback and enrollment.

CONCLUSIONS AND RELEVANCE: In this study, the adoption of Part B premium givebacks among MA plans was associated with a substantial increase in plan enrollment. Further research will be needed to understand the total value to enrollees of Part B givebacks, which confers hundreds of millions of dollars monthly to Medicare beneficiaries.

PMID:40478555 | DOI:10.1001/jamahealthforum.2025.1215

JAMA Health Forum. 2025 Jun 7;6(6):e251430. doi: 10.1001/jamahealthforum.2025.1430.

ABSTRACT

IMPORTANCE: Evidence is limited regarding the physician characteristics associated with the provision of low-value services in primary care, especially outside of the US.

OBJECTIVE: To measure physician-level use of 10 low-value care services that provide no net clinical benefit and to investigate the characteristics of primary care physicians who frequently provide low-value care in Japan.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used a nationwide electronic health record database linked with claims data in Japan to assess visits by adult patients (age ≥18 years) to a solo-practice primary care physician from October 1, 2022, through September 30, 2023. Data analysis was performed from June 2024 to February 2025.

MAIN OUTCOMES AND MEASURES: Multivariable-adjusted composite rate of low-value care services delivered per 100 patients per year, aggregated across 10 low-value measures, after accounting for case mix and other characteristics.

RESULTS: Among 2 542 630 patients (mean [SD] age, 51.6 [19.8] years; 58.2% female) treated by 1019 primary care physicians (mean [SD] age 56.4 [10.2] years; 90.4% male), 436 317 low-value care services were identified (17.2 cases per 100 patients overall). Nearly half of these low-value care services were provided by 10% of physicians. After accounting for patient case mix, older physicians (age ≥60 years) delivered 2.1 per 100 patients (95% CI, 1.0-3.3) more low-value care services than those younger than 40 years; not board-certified physicians delivered 0.8 per 100 patients (95% CI, 0.2-1.5) more than general internal medicine board-certified physicians; physicians with higher patient volumes delivered 2.3 per 100 patients (95% CI, 1.5-3.2) more than those with low patient volumes; and physicians practicing in Western Japan delivered 1.0 per 100 patients (95% CI, 0.5-1.5) more than those in Eastern Japan.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional analysis suggest that low-value care services were common and concentrated among a small number of primary care physicians in Japan, with older physicians and not board-certified physicians being more likely to provide low-value care. Policy interventions targeting at a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than those targeting all physicians uniformly.

PMID:40478554 | DOI:10.1001/jamahealthforum.2025.1430