Tag: pubmed

JAMA Netw Open. 2026 Jan 2;9(1):e2546800. doi: 10.1001/jamanetworkopen.2025.46800.

ABSTRACT

IMPORTANCE: The Neighborhood Atlas Area Deprivation Index (NA-ADI) has been widely used in health policy research and incorporated into Medicare payment models such as the Accountable Care Organization Realizing Equity, Access, and Community Health model. However, calculation errors have been independently identified by multiple groups, showing that the NA-ADI contains distorted deprivation estimates that pose risks to equitable funding allocation and outcome adjustment.

OBJECTIVE: To develop the Reproducible ADI (ReADI) as a corrected, transparent replacement aligned with the original ADI methodology and to compare its agreement with established deprivation indices, including the Social Vulnerability Index (SVI), Social Deprivation Index, French Deprivation Index, and Neighborhood Stress Score, and its performance for estimating mortality.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2011-2015 and 2018-2022 data from the American Community Survey (ACS), a population-based US sample across census block groups, tracts, and counties. US geographic levels with sufficient data included 235 952 block groups, 83 722 census tracts, and 3214 counties. Census tract-level 2011-2015 mortality data were obtained from the US Small-Area Life Expectancy Estimates Project. Data from the 2015 NA-ADI were accessed March 7, 2024, and data from the 2022 NA-ADI, December 1, 2024.

EXPOSURES: The ReADI was constructed using corrected methods described in the original work developing the ADI. The NA-ADI was downloaded and aggregated to tract and county levels. The SVI was from the Centers for Disease Control and Prevention. Other indices were independently constructed from the ACS.

MAIN OUTCOMES AND MEASURES: The primary outcomes were ReADI and NA-ADI comparisons against each other, other deprivation indices, and mortality.

RESULTS: The ReADI more closely aligned with other deprivation indices (R2 range, 0.609 [95% CI, 0.586-0.630] to 0.932 [95% CI, 0.931-0.933]) compared with the NA-ADI (R2 range, 0.331 [95% CI, 0.300-0.362] to 0.710 [95% CI, 0.692-0.727]). ReADI scores also better reflected component weights (R2 ≥ 0.999 [95% CI, 0.996-1.000]; RMSE ≤ 0.042 [95% CI, 0.029-0.053]) compared with the NA-ADI (R2 range, 0.832 [95% CI, 0.574-0.932] to 0.844 [95% CI, 0.601-0.937]; RMSE range, 0.346 [95% CI, 0.279-0.414] to 0.405 [95% CI, 0.334-0.470]), consistent with correct computation. In 3332 high-discrepancy census tracts representing approximately 13 million individuals, the ReADI explained more variance in life expectancy (R2 difference, 0.064; 95% CI, 0.039-0.090), particularly in underresourced urban areas.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the ReADI was correctly calculated and should replace the flawed NA-ADI for future health policy applications. Its open-source methods support transparency, adaptability, and further development.

PMID:41525076 | DOI:10.1001/jamanetworkopen.2025.46800

JAMA Netw Open. 2026 Jan 2;9(1):e2551553. doi: 10.1001/jamanetworkopen.2025.51553.

ABSTRACT

IMPORTANCE: Increasing germline genetic testing rates may impact contralateral prophylactic mastectomy (CPM) rates in patients with newly diagnosed breast cancer.

OBJECTIVE: To quantify the impact of a personalized contralateral breast cancer (CBC) risk counseling tool that incorporates genetic testing results.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial recruited participants from a single tertiary referral center between June 8, 2020, and December 31, 2022. Patients aged 18 to 80 years with unilateral breast cancer who underwent genetic counseling and surgery were eligible. Exclusion criteria were prior or metastatic breast cancer or prior multigene panel testing. Follow-up was completed June 30, 2023.

INTERVENTION: Personalized age-specific CBC risks were estimated based on the presence or absence of pathogenic variants associated with breast cancer and were incorporated into a visual decision support tool. Patients were randomized 1:1 to quantitative counseling via the tool vs standard counseling without personalized CBC risk estimates.

MAIN OUTCOMES AND MEASURES: Co-primary end points included patients’ personal CBC risk knowledge and propensity to undergo CPM, before and after counseling, by randomization arm. The secondary end point was CPM rate. Sample size calculations assumed postcounseling CBC risk self-assessments would be 5% different from baseline (SD, 20%). A total of 199 patients in each arm would achieve 80% power and 5% type I error (based on a 2-sample t test). Univariate and multivariate analyses were performed for each end point.

RESULTS: A total of 400 patients were randomized (mean [SD] age, 54 [11] years), and 54 were excluded after randomization, leaving 346 patients. Among 341 patients with data available, 21 (6.2%) were Asian or Pacific Islander, 18 (5.3%) were Black, 295 (86.5%) were White, and 7 (2.1%) were of other race; 33 of 330 patients with available data (10.0%) were of Ashkenazi Jewish ancestry. Seventy-five of 346 patients (21.7%) had a first-degree relative with breast cancer. Patients who received quantitative counseling more accurately reported their CBC risk estimates than those who received standard counseling by univariate (coefficient, -9.39; 95% CI, -14.86 to -3.93; P < .001) and multivariate (coefficient, -9.52; 95% CI, -16.50 to -2.51; P = .008) analyses. The type of counseling did not significantly impact perception of risk, self-reported propensity to undergo CPM, or CPM rates.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, patients more accurately described their calculated CBC risk after quantitative counseling. This improved knowledge did not impact decisions to undergo CPM. The CBC risk assessment tool is publicly available and can be used for preoperative discussions.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04245176.

PMID:41525075 | DOI:10.1001/jamanetworkopen.2025.51553

JAMA Netw Open. 2026 Jan 2;9(1):e2551563. doi: 10.1001/jamanetworkopen.2025.51563.

ABSTRACT

IMPORTANCE: Alcohol use disorder (AUD) is a major public health concern; medications for AUD (MAUD) are an effective form of treatment but remain underused. Identifying MAUD access trends and the characteristics of counties with limited availability can inform targeted efforts to expand treatment capacity.

OBJECTIVE: To examine trends in geographic availability of MAUD at US substance use disorder treatment facilities (SUDTFs) from 2017 to 2023 and assess county characteristics associated with SUDTFs offering MAUD.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide cross-sectional study used data from the Mental Health and Addiction Treatment Tracking Repository, which includes longitudinal data on licensed SUDTFs and whether they offer MAUD (acamprosate, disulfiram, or naltrexone), to quantify trends in MAUD availability at SUDTFs from January 2017 to December 2023.

MAIN OUTCOMES AND MEASURES: The primary outcome was a county-year indicator for whether at least 1 SUDTF in the county offered MAUD. Explanatory county variables included rurality, percentage of traffic fatalities involving alcohol, percentage of the population that drank excessively, percentage of uninsured individuals, poverty rate, percentage of individuals over age 65 years, and percentage of non-Hispanic White individuals. Univariate logistic regressions with state and year fixed effects were used to explore associations between county characteristics and the probability that a county had any SUDTFs offering MAUD.

RESULTS: Across 22 000 county-years in a total of 3153 counties, the mean (SD) percentage of counties with at least 1 SUDTF offering MAUD increased from 34.12% (47.42%) in 2017 to 43.88% (49.63%) in 2021, but growth plateaued after 2021. Lower MAUD presence in a county was associated with rural-adjacent (difference, -22.40 percentage points [pp]; 95% CI, -24.43 to -20.38 pp) and rural-remote (-23.64 pp; 95% CI, -25.72 to -21.56 pp) relative to metropolitan county status as well as with a higher poverty rate (-0.66 pp; 95% CI, -0.93 to -0.38 pp), greater percentage of individuals aged 65 years or older (-2.33 pp; 95% CI, -3.02 to -1.65 pp), and higher proportion of non-Hispanic White individuals (-0.58 pp; 95% CI, -0.71 to -0.46 pp), whereas greater prevalence of binge drinking (difference, 1.90 pp; 95% CI, 1.26-2.54 pp) and a higher percentage of college-educated individuals (1.28 pp; 95% CI, 1.13-1.43) were associated with higher MAUD presence.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the proportion of SUDTFs offering MAUD increased from 2017 to 2021, but growth then plateaued. Policies supporting the expansion of MAUD-providing facilities, particularly in underserved counties, may be needed to address persistent gaps in access.

PMID:41525074 | DOI:10.1001/jamanetworkopen.2025.51563

JAMA Netw Open. 2026 Jan 2;9(1):e2553228. doi: 10.1001/jamanetworkopen.2025.53228.

ABSTRACT

IMPORTANCE: Prior research conducted in private for-profit health care systems has suggested that social determinants of health (SDOH) play a role in adverse postoperative outcomes. Whether these findings translate to universal health care systems is unknown.

OBJECTIVE: To quantify the association of SDOH with risk of 30-day mortality after scheduled inpatient surgery.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted in Ontario, Canada’s most populous province. The cohort included consecutive adult patients (aged ≥18 years) who were eligible for Ontario’s universal health insurance and underwent a scheduled inpatient surgical procedure between January 1, 2017, and December 31, 2023. Diagnostic and procedural, demographic, vital statistics, and other data were obtained from linked health administrative databases.

EXPOSURES: SDOH including neighborhood income, immigration status, and migration recency.

MAIN OUTCOME AND MEASURE: Death within 30 days of index surgery. Logistic regression models were used to estimate the adjusted and unadjusted odds ratios (AORs and ORs) of the association of each SDOH with 30-day mortality.

RESULTS: Overall, 1 036 759 patients (median [IQR] age, 66 [56-74] years; 526 158 females [50.8%]) who underwent a range of scheduled inpatient surgical procedures were included. Of these patients, 1780 (0.9%) from the lowest-income areas died, as did 1307 (0.6%) from the highest-income areas. Patients from the lowest-income areas were at 52.0% increased odds of death (OR, 1.52; 95% CI, 1.42-1.64) compared with those from the highest-income areas. This association persisted with models partially adjusted for demographic and procedural factors (AOR, 1.54; 95% CI, 1.44-1.66) and fully adjusted for comorbidities (AOR, 1.43; 95% CI, 1.33-1.54). A dose-response association was demonstrated between neighborhood income and mortality, with odds of death increasing with diminishing income (eg, quintile 3 vs quintile 5: AOR, 1.18 [95% CI, 1.10-1.27]; quintile 2 vs quintile 5: AOR, 1.32 [95% CI, 1.22-1.42]). There was evidence of effect modification of the association between neighborhood income and mortality by procedure complexity (eg, effect estimate for quintile 4 and high complexity: -0.0776 [95% CI, -0.2722 to 0.1169]; P = .002). Immigrant and refugee status and recent migration (<5 years) demonstrated reduced odds of mortality in unadjusted analyses, but these associations diminished with risk adjustment.

CONCLUSIONS AND RELEVANCE: In this cohort study, residency in lowest-income neighborhood was associated with increased risk of postoperative mortality despite adjustment for patient, procedure, and hospital factors. Improving postoperative outcomes likely requires addressing underlying SDOH disparities.

PMID:41525072 | DOI:10.1001/jamanetworkopen.2025.53228

JAMA Netw Open. 2026 Jan 2;9(1):e2553244. doi: 10.1001/jamanetworkopen.2025.53244.

ABSTRACT

IMPORTANCE: Public reporting of outcomes increases transparency. Research on the association between public reporting programs and quality of care and outcomes is needed.

OBJECTIVE: To evaluate whether hospital voluntary participation in the Get With The Guidelines (GWTG)-Stroke public reporting program is associated with quality of care and clinical outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used GWTG-Stroke registry data from January 1 to December 31, 2021. Clinical characteristics associated with hospital participation in public reporting were identified, and differences in patient quality of care and outcomes were compared between hospitals that participated in public reporting of outcomes and those that did not. The primary data analysis was completed on December 27, 2024, and revised November 15, 2025.

EXPOSURE: Hospital participation in public reporting.

MAIN OUTCOMES AND MEASURES: The primary quality metric was defect-free care, a composite of 7 ischemic stroke quality measures (intravenous thrombolysis for patients arriving by 3.5 hours and treated by 4.5 hours, early antithrombotic use within 48 hours of admission, venous thromboembolism prophylaxis, antithrombotics at hospital discharge, anticoagulation for atrial fibrillation or flutter, smoking cessation counseling, and intensive statin therapy at discharge). Component measures were evaluated as secondary outcomes. The primary clinical outcome was independent ambulation at discharge. Secondary clinical outcomes included discharge to home, in-hospital mortality, and a composite of in-hospital mortality or discharge to hospice. Associations were measured using multivariable models adjusted for patient- and hospital-level variables.

RESULTS: There were 501 763 patients admitted for acute ischemic stroke (mean [SD] age, 69.8 [3.8] years; mean [SD] male, 51.5% [10.3%]) at 2423 hospitals; 1582 hospitals (65.3%) participated in public reporting. High-volume hospitals (quartile 4 [highest] vs 1 [lowest]: adjusted odds ratio [OR], 2.07 [95% CI, 1.43-2.99]) and high-performing hospitals measured by 2018 GWTG-Stroke quality awards (silver or gold: OR, 3.32 [95% CI, 2.63-4.20]) were more likely to participate in public reporting. In fully adjusted models, patients treated at participating hospitals were more likely to receive defect-free care (OR, 1.31 [95% CI, 1.27-1.35]) and more likely to receive all 7 of the individual components of defect-free care, although absolute differences between groups were small. There were minor differences in independent ambulation at discharge (OR, 1.02 [95% CI, 1.01-1.04]) and the composite of in-hospital mortality or discharge to hospice (OR, 1.05 [95% CI, 1.02-1.08]). There were no differences in discharge to home or in-hospital mortality.

CONCLUSIONS AND RELEVANCE: In this cohort study of hospitals in the GWTG-Stroke program in 2021, patients at hospitals participating in voluntary public reporting were more likely to receive guideline-based care but had similar clinical outcomes compared with patients at nonreporting hospitals. More research is needed to evaluate whether public reporting could improve clinical outcomes.

PMID:41525071 | DOI:10.1001/jamanetworkopen.2025.53244

JAMA Netw Open. 2026 Jan 2;9(1):e2553413. doi: 10.1001/jamanetworkopen.2025.53413.

ABSTRACT

IMPORTANCE: During out-of-hospital cardiac arrest (OHCA), initial airway device choice as well as final device choice in the event of failure may both influence overall procedural success and patient outcomes. Understanding national practice patterns in airway device placement may inform resuscitation strategies and system-level quality improvement.

OBJECTIVE: To assess patterns in the order of advanced airway device use for adults in the United States receiving OHCA treatment during emergency medical service (EMS) activations.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used data from the National EMS Information System (NEMSIS) database from January 2018 to December 2023. During this period, NEMSIS included more than 256 million EMS activations from nearly 14 000 agencies across 54 states and territories. Activations for 911 responses during adult OHCA with advanced airway device attempts after EMS arrival, with documented success (yes or no) and number of attempts, were included.

EXPOSURES: Advanced airway devices documented by EMS clinicians.

MAIN OUTCOME AND MEASURES: Order of advanced airway device use, measured by EMS clinician documentation.

RESULTS: From 2018 to 2023, EMS reported 2 365 224 activations involving adults having an OHCA, with 650 440 patients (0.3%) receiving either endotracheal intubation (ETI) and/or supraglottic airway (SGA). Most patients received a successful initial airway device attempt (503 774 [77.4%]). Although ETI was the most common initial airway device (458 546 [70.5%]), SGA had a higher first-pass success rate (93.0% vs 71.0%). Among patients whose first ETI attempt failed (133 177 of 458 546 [29.0%]), the final documented device remained ETI in 72 167 cases (72.3%) and changed to SGA in 27 651 (27.7%). Among patients whose first SGA attempt failed, 13 480 (61.9%) remained with SGA and 3388 (38.1%) were switched to ETI.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, most patients with OHCA received ETI as the first advanced airway procedure, despite higher SGA first-pass success. Among patients whose initial attempt failed, most continued with the same device. However, switching from ETI to SGA had a higher final success rates. These findings highlight the importance of airway device sequence in prehospital care and may inform training and protocols for airway management.

PMID:41525070 | DOI:10.1001/jamanetworkopen.2025.53413

Int J Gynaecol Obstet. 2026 Jan 12. doi: 10.1002/ijgo.70721. Online ahead of print.

ABSTRACT

OBJECTIVE: The randomized trial of azithromycin to reduce maternal and neonatal sepsis (the A-PLUS Trial) found substantial reduction in maternal sepsis among women receiving azithromycin and substantial non-study antibiotic use. This secondary analysis explored the effect modification of non-study antibiotics on azithromycin versus placebo on maternal and newborn infection among A-PLUS participants.

METHODS: Women ≥28 weeks gestation in labor and planning a vaginal delivery at a study hospital in seven low- and middle-income countries (Bangladesh, India [two sites], Pakistan, Guatemala, Kenya, Democratic Republic of Congo, and Zambia) were eligible for inclusion. Non-study antibiotic use was collected prospectively. We estimated the interaction of non-study antibiotics with azithromycin versus placebo on maternal and newborn sepsis.

RESULTS: A total of 29 287 participants were randomized (14 590 to azithromycin; 14 688 to placebo). Maternal infection was reduced among the azithromycin group compared to placebo among those who did not receive non-study antibiotics, with estimated relative risk (RR) 0.58 (95% confidence interval [CI] 0.48, 0.70), and among those who received non-study antibiotics, with RR 0.80 (95% CI 0.70, 0.91). Similar results were observed for maternal sepsis. Neonatal infection was not significantly reduced in any group. These results were similar when stratified by African and Asian region but not statistically significant.

CONCLUSION: Our results suggest a benefit of azithromycin in reducing maternal infection or sepsis across all groups, with a larger reduction in risk among participants who had not received other antibiotics. Given the concerns of inappropriate use of antibiotics, further research is warranted to determine the most effective strategies of reducing risk of infection.

PMID:41524099 | DOI:10.1002/ijgo.70721

Rev Cardiovasc Med. 2025 Dec 19;26(12):39373. doi: 10.31083/RCM39373. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Mitral commissural prolapse or flail, characterized by intricate and diverse anatomical features, poses a significant challenge in mitral transcatheter edge-to-edge repair (M-TEER). Previous studies have largely focused on central mitral regurgitation with favorable valve anatomy or a general broad spectrum of complex mitral regurgitation. However, no established approach is currently available for M-TEER in commissural degenerative mitral regurgitation (DMR).

METHODS: Therefore, this study aimed to evaluate the efficacy and safety of a novel morphology classification-guided M-TEER strategy for treating commissural DMR using the MitraClip system. This prospective, multicenter, single-arm, objective performance criteria study involved 12 experienced centers in Asia, primarily located in China. Patients with symptomatic moderate-to-severe (3+) and severe (4+) native DMR and commissural involvement were stratified into three morphological categories based on an echocardiographic core laboratory analysis, and tailored M-TEER strategies were proposed. The primary endpoint is the proportion of patients achieving a mitral regurgitation (MR) grade of ≤1+ without repeat mitral intervention at one-year follow-up. Clinical, echocardiographic, functional, and quality-of-life outcomes were assessed over one year.

RESULTS: Based on statistical power calculations, a total of 148 patients are required to achieve adequate power to test the primary efficacy hypothesis, accounting for an estimated 10% attrition rate at 12 months.

CONCLUSIONS: The morphology classification system enhances M-TEER for commissural DMR by addressing the unique challenges of this approach, enabling tailored interventions that optimize procedural success and patient outcomes.

CLINICAL TRIAL REGISTRATION: ChiCTR2400090258, https://www.chictr.org.cn/showproj.html?proj=239191.

PMID:41524053 | PMC:PMC12781021 | DOI:10.31083/RCM39373

NAR Genom Bioinform. 2026 Jan 10;8(1):lqaf206. doi: 10.1093/nargab/lqaf206. eCollection 2026 Mar.

ABSTRACT

Omics Notebook Interactive (OmNI) is an R-based, open-source, and modular framework engineered for streamlined multi-omics data integration and analysis across diverse data types, incorporating interactive visualizations at each processing step. OmNI performs differential expression analysis utilizing customizable linear models, accommodating various covariates and complex experimental designs. For cross-omic layer integration, OmNI employs a modified S-score statistic, ensuring sensitive detection of differential features. The framework also integrates network and metabolomics data, offering detailed insights into regulatory mechanisms through comprehensive enrichment analysis using multiple pathway databases. Outputs include interactive HTML reports, CSV/TSV files, and Cytoscape-compatible objects. OmNI is readily deployable in both local and high-performance computing environments, enabling scalable data processing. Acknowledging the public health concerns of opioids, we performed TMT18-based deep proteome and phosphoproteome analysis of brains from genetically diverse collaborative cross diversity outbred (CC/DO) founder mouse strains exposed to fentanyl to demonstrate OmNI’s capabilities. The integrative S-score uniquely identified differential signaling and interaction hubs conserved across all strains and revealed strain-specific molecular neuro-responses to fentanyl. OmNI is freely available for download at https://github.com/gracerhpotter/OmNI and is also accessible via a web interface at https://emili-laboratory.shinyapps.io/omni/.

PMID:41524030 | PMC:PMC12789801 | DOI:10.1093/nargab/lqaf206

Int J Ophthalmol. 2026 Jan 18;19(1):63-68. doi: 10.18240/ijo.2026.01.08. eCollection 2026.

ABSTRACT

AIM: To evaluate long-term visual field (VF) prediction using K-means clustering in patients with primary open angle glaucoma (POAG).

METHODS: Patients who underwent 24-2 VF tests ≥10 were included in this study. Using 52 total deviation values (TDVs) from the first 10 VF tests of the training dataset, VF points were clustered into several regions using the hierarchical ordered partitioning and collapsing hybrid (HOPACH) and K-means clustering. Based on the clustering results, a linear regression analysis was applied to each clustered region of the testing dataset to predict the TDVs of the 10^th VF test. Three to nine VF tests were used to predict the 10^th VF test, and the prediction errors (root mean square error, RMSE) of each clustering method and pointwise linear regression (PLR) were compared.

RESULTS: The training group consisted of 228 patients (mean age, 54.20±14.38y; 123 males and 105 females), and the testing group included 81 patients (mean age, 54.88±15.22y; 43 males and 38 females). All subjects were diagnosed with POAG. Fifty-two VF points were clustered into 11 and nine regions using HOPACH and K-means clustering, respectively. K-means clustering had a lower prediction error than PLR when n=1:3 and 1:4 (both P≤0.003). The prediction errors of K-means clustering were lower than those of HOPACH in all sections (n=1:4 to 1:9; all P≤0.011), except for n=1:3 (P=0.680). PLR outperformed K-means clustering only when n=1:8 and 1:9 (both P≤0.020).

CONCLUSION: K-means clustering can predict long-term VF test results more accurately in patients with POAG with limited VF data.

PMID:41524021 | PMC:PMC12782057 | DOI:10.18240/ijo.2026.01.08