Tag: statistics

J Med Econ. 2026 Dec;29(1):994-1011. doi: 10.1080/13696998.2026.2644119. Epub 2026 Mar 31.

ABSTRACT

AIMS: The CIARA (Cost Impact Analysis in Rheumatoid Arthritis patients) study in Spain aimed to assess societal costs (€2022) associated with adult patients with moderate-to-severe rheumatoid arthritis (RA) starting advanced therapies after failing conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or a first biologics (bDMARD). Costs included those incurred by the Spanish National Health System, indirect costs due to productivity losses, and patient out-of-pocket expenses. Secondary objectives were to compare costs according to patients’ disease activity and treatment subgroups, identify variables associated with costs, and conduct a cost-utility analysis (CUA) of switching strategies.

METHODS: This prospective, non-interventional, multicenter cohort included adults with active RA (Disease Activity Score in 28 joints with erythrocyte sedimentation rate ≥3.2) starting a bDMARD or a targeted synthetic DMARD (tsDMARD) and followed for 12 months. Total and disaggregated mean costs per patient were estimated across three periods: 6 months before, and 0-to-6 months and 6-to-12 months post-switch. Costs for the 6-month pre-switch were compared with those for the 6-to-12 post-switch.

RESULTS: A total of 118 patients (mean age: 54.9 years; 78% women) were included. Mean total cost per patient increased from €6,882 pre-switch to €9,927 at 6-12 months (+44.3%;p < 0.001), primarily driven by pharmacological costs (+191%), while out-of-pocket expenses (-55%;p = 0.001) and productivity losses (-25%;p = 0.394) decreased. Switching from a csDMARD was dominant vs. switching from a first bDMARD (-€11,281/quality-adjusted life year [QALY] gained). Patients who achieved remission at 12 months had lower costs than those with moderate-high activity. The Work Productivity and Activity Impairment (WPAI) productivity impairment subscale and patient satisfaction with care were independently associated with total costs.

LIMITATIONS: Observational design, limited power for subgroups, official-actual price gap, and a 1-year horizon.

CONCLUSIONS: Switching to advanced therapies reduced out-of-pocket expenses and productivity losses. Although this reduction did not offset higher pharmaceutical spending, it may reflect clinical improvements.

PMID:41915412 | DOI:10.1080/13696998.2026.2644119

Food Funct. 2026 Mar 31. doi: 10.1039/d5fo05613f. Online ahead of print.

ABSTRACT

Growing evidence supports the hypoglycemic potential of blueberry anthocyanins, though clinical data remain limited. This study aimed to evaluate the effects of blueberry anthocyanin extract (BAE) supplementation on glycemic control and gut microbiota composition in patients with type 2 diabetes mellitus (T2DM). This 6-month pilot study included 15 elderly T2DM patients, who received either 400 mg day^-1 BAE (n = 8) or no supplement (n = 7). Glycemic parameters, gut microbiota (analyzed via 16S rRNA sequencing), and fecal short-chain fatty acids (SCFAs) were assessed at the baseline and after 1, 3, and 6 months. While statistically significant improvements in glycemic parameters were not achieved, favorable trends in fasting glucose and HbA1c were observed upon BAE intervention. Notably, BAE supplementation significantly altered gut microbiota composition by reducing the relative abundance of Firmicutes and increasing Bacteroidota (P < 0.05) and elevated SCFA levels, though the latter change was not statistically significant. Correlation analysis further revealed associations between specific bacterial genera, glucose metabolism indicators, and SCFAs. These findings suggest that BAE may modulate the gut microbiota and improve glucose metabolism in T2DM, supporting its potential as a dietary adjunct for glycemic management, although larger trials are needed for confirmation.

PMID:41915410 | DOI:10.1039/d5fo05613f

Health Serv Res. 2026 Apr;61(2):e70110. doi: 10.1111/1475-6773.70110.

ABSTRACT

OBJECTIVE: To examine whether Medicare beneficiaries with opioid use disorder (OUD) encounter limited access to hospitals’ highest-volume (i.e., “preferred”) or high-quality skilled nursing facilities (SNFs) compared to beneficiaries without OUD.

STUDY SETTING AND DESIGN: We estimated within-hospital disparities in access to preferred and high-quality SNFs by OUD status using linear probability models and discrete choice models (McFadden-style conditional logistic regression). We defined preferred status using shared hospital-SNF discharge volume and quality using CMS star ratings. In choice models, we matched patients with and without OUD 1:1 on discharging hospital and date, and applied inverse probability weighting and propensity score subclassification to address confounding.

DATA SOURCES AND ANALYTIC SAMPLE: We used 2017-2021 Medicare inpatient claims to identify Medicare beneficiaries ages 18+ discharged to a SNF following hospitalization.

PRINCIPAL FINDINGS: In the full sample (N = 6,490,593), patients with OUD were 2.5 and 3.6 percentage points (pp) less likely to enter preferred and high-quality SNFs, respectively. Among those discharged to preferred SNFs, patients with OUD were 2.0 pp less likely to enter high-quality preferred SNFs. In the matched subsample (n = 156,610), the marginal effect of preferred status on a person being discharged to their closest SNF was 1.1 pp lower for patients with OUD than those without OUD (p < 0.05), but with no significant disparity after inverse probability weighting. When the closest SNF’s quality rating increased by 1 star, the probability of entry increased by 0.7 pp for people without OUD but decreased by 0.2 pp for people with OUD (difference = 0.9 pp, p < 0.001), a difference that persisted after weighting.

CONCLUSIONS AND RELEVANCE: Publicly-reported star ratings had weaker associations with the SNF placements of Medicare beneficiaries with OUD compared to those without OUD, and preferred referral networks alone did not eliminate these gaps. Regulatory and reimbursement reforms that support SNFs in developing OUD-related care capacity and that promote equitable admissions deserve attention.

PMID:41915406 | DOI:10.1111/1475-6773.70110

Clin Transplant. 2026 Apr;40(4):e70520. doi: 10.1111/ctr.70520.

ABSTRACT

INTRODUCTION: The purpose of our study was to assess UTD status of routine childhood vaccinations at the time of organ transplant among our institution’s pediatric SOT recipients and assess the reasons behind underimmunization.

MATERIALS AND METHODS: We reviewed vaccination records of pediatric recipients of heart, kidney, and liver transplants at Mayo Clinic, Rochester, MN who received a transplant between January 2011 and December 2024. All immunizations received prior to date of transplantation were included. Once immunization status was determined, the EMR was further reviewed to assess reasons why patients were not UTD.

RESULTS: A total of 204 patients were included in the study after meeting inclusion criteria: 68 kidney, 80 heart, and 55 liver transplant recipients; one patient received both a liver and kidney transplant. Seventy-seven patients (37.7%) were UTD at the time of SOT. When excluding live vaccines, 90 patients (44.1%) were UTD. The series most commonly not UTD was HPV (59 patients not UTD, 28.9%); the most UTD series was pneumococcal vaccine (six patients not UTD, 2.9%). Among 127 patients not UTD, 30 (23.6%) patients were not UTD due to time-based factors, followed by 27 (21.3%) due to patient-based factors, 25 (19.7%) due to provider-based, 14 (11%) due to medically contraindicated, and 14 (11%) due to hospital policy factors. Seventeen patients (13.4%) were classified as multi-category.

CONCLUSIONS: Less than 40% of pediatric SOT recipients were UTD on routine immunizations at time of transplant. This was due to a variety of factors. Strategies to increase uptake of immunizations prior to transplant among this vulnerable group should be further explored.

PMID:41915405 | DOI:10.1111/ctr.70520

JAMA Netw Open. 2026 Mar 2;9(3):e263398. doi: 10.1001/jamanetworkopen.2026.3398.

ABSTRACT

IMPORTANCE: Significant incidental findings (SIFs) not related to lung cancer have been widely reported in patients undergoing lung cancer screening with low-dose computed tomography (LDCT). It is unclear whether SIFs are associated with extrapulmonary cancer diagnoses.

OBJECTIVE: To examine the association between an SIF considered to be potentially indicative of extrapulmonary cancer (cancer SIF) detected at LDCT lung cancer screening and diagnosis of an extrapulmonary cancer within 1 year of the screen.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed data from National Lung Screening Trial (NLST) participants. The NLST participants were randomly assigned to either LDCT or chest radiography to determine whether LDCT was associated with a reduction in lung cancer mortality compared with chest radiography alone. Participants aged 55 to 74 years were recruited between August 2002 and April 2004. They received up to 3 rounds of screening and were followed up for 5 to 7 years. The study concluded December 31, 2009. This analysis was restricted to participants in the LDCT arm and was conducted between June and December 2025.

EXPOSURE: Detection of a cancer SIF (ie, SIF potentially indicative of a cancer) at any lung cancer screening round in the NLST.

MAIN OUTCOMES AND MEASURES: The primary outcome was diagnosis of an extrapulmonary cancer within 1 year of a screening round. Extrapulmonary cancers were classified using Surveillance, Epidemiology, and End Results (SEER) Program organ system categories. Cancer SIFs were mapped to specific SEER cancer categories. Multilevel logistic regression was used to assess the association between detection of a cancer SIF and diagnosis of an extrapulmonary cancer.

RESULTS: The study included 75 104 LDCT screening rounds performed in 26 445 participants (mean [SD] age, 61.4 [5.0] years; 59.0% male). Cancer SIFs were reported for 2265 screening rounds (3.0%) in 1807 participants (6.8%) across the 3 screening rounds. An extrapulmonary cancer was diagnosed following a screening round with a cancer SIF (n = 2265) for 67 participants (3.0%). The marginal risk difference, after covariates and participant-specific adjustments, was 13.89 (95% confidence limit [CL], 7.03-20.75) per 1000 participants. The marginal risk differences were significantly higher for urinary cancers (17.03 [95% CL, 8.55-25.50] per 1000 participants) and other SEER cancer categories, including lymphoma and leukemia (13.83 [95% CL, 3.46-24.21] per 1000 participants).

CONCLUSIONS AND RELEVANCE: This cohort study found that cancer SIFs were associated with an increased risk of an extrapulmonary cancer diagnosis in the year following an LDCT lung cancer screening examination. These findings suggest that certain SIFs should be evaluated as potential indicators of undiagnosed cancers.

PMID:41915394 | DOI:10.1001/jamanetworkopen.2026.3398

JAMA Netw Open. 2026 Mar 2;9(3):e263852. doi: 10.1001/jamanetworkopen.2026.3852.

ABSTRACT

IMPORTANCE: In preterm neonates supported with continuous positive airway pressure (CPAP), early caffeine administration and less invasive surfactant administration (LISA) results in a lower frequency of endotracheal intubation. It is unknown whether this regimen improves outcomes at a corrected age of 2 years in this population.

OBJECTIVE: To determine whether LISA improves neurodevelopmental impairment (NDI) and pulmonary outcomes at a corrected age of 2 years.

DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis and follow-up of a randomized clinical trial was performed at 3 academic medical centers in California. Participants included infants born at gestational ages ranging from 24 weeks 0 days to 29 weeks 6 days with follow-up assessments available. Follow-up visits occurred from May 2, 2022, to April 3, 2025.

INTERVENTIONS: Infants received intravenous caffeine by 2 hours of life followed by either less invasive surfactant administration (intervention group) or CPAP without initial surfactant administration (control group).

MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of death or moderate to severe NDI at a corrected age of 2 years, as measured by the Bayley Scales of Infant Development (BSID). Secondary outcomes included components of the BSID composite; the third edition of the Ages and Stages Questionnaire (ASQ-3); developmental screening; pulmonary outcomes of bronchodilator use, oral and/or inhaled corticosteroid use, or hospitalizations with respiratory diagnoses after discharge; and results of an autism screen.

RESULTS: Of 180 randomized infants, 147 (81.7%) had follow-up assessments available (74 in the LISA group and 73 in the CPAP group); 75 infants (51.0%) were male. The mean (SD) gestational age at the time of the Bayley assessment was 24.6 (1.5) months corrected age for the LISA group and 24.7 (2.2) months corrected age for the CPAP group. The mean (SD) chronological age for the ASQ-3 was 28.1 (2.4) months for both groups. Death or moderate to severe NDI occurred in 17 of 74 children (23.0%) in the LISA group and 23 of 70 (32.9%) in the control group (odds ratio [OR], 1.56 [95% CI, 0.77-3.17]; P = .22). On the screening ASQ-3, infants in the LISA group had no statistically significant differences in rates of typical development (22 of 69 [31.9%] vs 12 of 67 [17.9%]; OR, 0.47 [95% CI, 0.21-1.04]; P = .06) and scores indicating possible delay (43 of 69 [62.3%] vs 47 of 67 [70.1%]; OR, 1.42 [95% CI, 0.70-2.90]; P = .34) compared with the control group. Children in the LISA group were more likely to have a mean (SD) fine motor z score in the reference range (-0.59 [1.10] vs -1.00 [1.01]; P = .03). There were no differences between the LISA and CPAP groups in bronchodilator use, oral and/or inhaled corticosteroid use, or postdischarge hospitalizations with respiratory diagnoses.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial of preterm infants supported with CPAP, early caffeine administration plus LISA did not reduce the incidence of death or moderate to severe NDI noted on the BSID. Infants who received LISA were more likely to have a fine motor domain score in the reference range on ASQ-3 developmental screen.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04209946.

PMID:41915392 | DOI:10.1001/jamanetworkopen.2026.3852

JAMA Netw Open. 2026 Mar 2;9(3):e264037. doi: 10.1001/jamanetworkopen.2026.4037.

ABSTRACT

IMPORTANCE: Information on the burden of postacute sequelae of SARS-CoV-2 infection (or long COVID) in patients with cancer during endemicity is limited.

OBJECTIVE: To evaluate the risk of postacute diagnoses and/or symptoms compatible with long COVID in a population-based cohort of patients with cancer and high rates of vaccination and/or boosting who were infected during Omicron predominance compared with those with negative test results (hereinafter, noninfected patients). Results were additionally stratified by COVID-19 severity and receipt of therapeutics.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study used health care claims databases to construct cohorts of adult patients with cancer in Singapore who were infected with SARS-CoV-2 during Omicron predominance (January 1 through December 31, 2022), and contemporaneous noninfected patients. Patients were followed up to 300 days from the index date and data were analyzed from February 1, 2022, through October 27, 2023.

EXPOSURE: SARS-CoV-2 infection.

MAIN OUTCOMES AND MEASURES: Competing risks regression (death as a competing risk), with overlap weights applied, was used to estimate risks of new-incident diagnoses and/or symptoms compatible with long COVID following SARS-CoV-2 infection in patients with cancer compared with noninfected patients. Risks of postacute sequelae following COVID-19 hospitalization in patients with cancer were further contrasted against influenza hospitalizations (January 1, 2017, to December 31, 2022).

RESULTS: A total of 76 807 patients with cancer were included in the analysis (48 279 [62.9%] female); 39 256 had SARS-CoV-2 infection and 37 551 were noninfected patients. The mean (SD) age was 63.9 (13.7) years. The mean (SD) follow-up time was 263.1 (36.2) days for patients infected with SARS-CoV-2 and 264.8 (32.5) days for noninfected patients. Most patients had solid-organ cancer (72 497 of 76 807 [94.4%]) and were boosted (71 550 of 76 807 [93.2%]); only a minority with SARS-CoV-2 infection (3571 of 39 256 [9.1%]) required acute hospitalization. No significant difference in risk of postacute diagnoses compatible with long COVID was observed in patients with SARS-CoV-2 infection (hazard ratio [HR], 0.98; 95% CI, 0.92-1.04) compared with noninfected patients. While risk of postacute symptoms following COVID-19 was modestly increased (HR, 1.09; 95% CI, 1.01-1.19; P = .048), statistical significance was not attained after adjustment for multiple comparisons. However, significantly increased risk of postacute sequelae was observed among patients hospitalized for COVID-19 compared with noninfected patients (HR for any diagnosis, 1.36 [95% CI, 1.18-1.56]; HR for any symptom, 1.48 [95% CI, 1.22-1.76]; P < .001 for both); risks remained elevated even among hospitalized cases receiving COVID-19 therapeutics. Risks of postacute sequelae following COVID-19 hospitalization in patients with cancer did not significantly differ from those associated with seasonal influenza hospitalizations.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that among highly boosted patients with cancer, the overall risk of postacute sequelae following Omicron SARS-CoV-2 infection was not significantly elevated compared with noninfected patients; however, patients who were hospitalized for COVID-19 remained at increased risk of postacute sequelae despite administration of COVID-19 therapeutics. These findings further suggest that COVID-19 vaccination and boosting remain important in mitigating the risk of long COVID among immunocompromised patients during endemicity.

PMID:41915390 | DOI:10.1001/jamanetworkopen.2026.4037

JAMA Netw Open. 2026 Mar 2;9(3):e264114. doi: 10.1001/jamanetworkopen.2026.4114.

ABSTRACT

IMPORTANCE: Autonomy concerns represent one of many contributors to vaccine hesitancy, yet public health messaging often emphasizes government compliance. It is important to study whether alternative message framing is associated with stated vaccine acceptance among hesitant individuals.

OBJECTIVE: To evaluate whether framing vaccines as freedom enhancing is associated with higher vaccine acceptance among vaccine hesitant adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional online discrete choice experiment was conducted from May 1 to 4, 2024. Each respondent completed 12 choice tasks comparing 2 vaccine options and a no-vaccine option, with vaccines described by 6 attributes, including infection prevention and severe disease protection efficacy, minor and major adverse effects, duration of protection, and additional reason to take (message framing).

EXPOSURES: Three levels for message framing, including government compliance (reference), personal freedom, and protect others.

MAIN OUTCOMES AND MEASURES: Hesitancy was measured using vaccine concerns and the Vaccine Adverse Belief Index (VABI). Main outcomes were vaccine preference shifts and estimated vaccine uptake associated with message framing variations examined using hierarchical bayesian analysis, with vaccine concerns and VABI serving as second-level factors.

RESULTS: A total of 907 adults (mean [SD] age, 69.5 [11.0] years; 454 female [50.3%]) participated in the study. Among respondents with high vaccine concern, freedom framing was associated with a preference shift of 33.8 percentage points (95% credible interval [CrI], 21.5-45.8 percentage points) and an increase in uptake of 6.3 percentage points (95% CrI, 2.9-11.5 percentage points), assuming the most favorable vaccine profile (highest efficacy, lowest adverse effects, longest duration). Among respondents with a high VABI, freedom framing was associated with a preference shift of 27.7 percentage points (95% CrI, 14.5-40.5 percentage points) and an increase in uptake of 4.6 percentage points (95% CrI, 1.8-8.8), respectively. Respondents with low vaccine concern or VABI showed no significant preference shifts associated with framing. In contrast, protect-others framing was associated with positive preference shifts and uptake, with no evidence that these associations differed by vaccine hesitancy.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that compared with government recommendation framing, freedom framing was selectively associated with higher vaccine acceptance among adults who were vaccine hesitant. Protect-others framing was associated with higher vaccine acceptance regardless of hesitancy level. Absolute gains in acceptance were modest. These findings highlight how autonomy-consistent framing may influence stated vaccine preferences among hesitant adults.

PMID:41915389 | DOI:10.1001/jamanetworkopen.2026.4114

Radiol Med. 2026 Mar 31. doi: 10.1007/s11547-026-02203-2. Online ahead of print.

ABSTRACT

PURPOSE: Sarcopenia has already been widely investigated as a potential indicator of negative outcomes in oncology patients. Our aim was to evaluate the potential predictive role of sarcopenia assessed using an Artificial Intelligence-powered software in response to neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC).

MATERIALS AND METHODS: In this single-centre retrospective study, we enrolled patients diagnosed with non-metastatic MIBC who underwent NAC and had available pre-treatment mpMRI of the bladder and baseline CT scan. The follow-up MRI assessment was performed using the NacVI-RADS algorithm to evaluate response to systematic therapy. AI-based software automatically calculated the skeletal muscle index (SMI) from CT images at the L3 vertebral level. Multivariate logistic regression analysis was performed to assess independent predictors of response to NAC, and a receiver operating characteristic (ROC) analysis was subsequently conducted to provide an additional level of statistical validation.

RESULTS: Fifty-five patients were included (mean age: 67.2 years). Sarcopenia was identified in 36.4% of patients. Multivariate logistic regression revealed sarcopenia (OR: 9.08; 95% CI 1.32-61.92; p = 0.024), comorbidities (OR: 14.63; 95% CI 2.12-100.71; p = 0.006), and high NacVI-RADS scores (4-5) (OR = 2.13 95% CI 1.03-4.42; p = 0.042) as independent predictors of poor response to NAC. Receiver operating characteristic (ROC) curve analysis confirmed the high discriminative ability of SMI for predicting treatment response (AUC = 0.952).

CONCLUSION: Sarcopenia, assessed by AI-powered analysis, was negatively associated with tumor response following NAC in patients with MIBC. These findings support the integration of AI-driven sarcopenia evaluation into clinical staging workflows, enabling tailored nutritional interventions and improved patient stratification. Moreover, our study reinforces the prognostic value of the NacVI-RADS scoring system in predicting NAC outcomes.

PMID:41915371 | DOI:10.1007/s11547-026-02203-2

Int J Implant Dent. 2026 Mar 31;12(1):12. doi: 10.1186/s40729-026-00666-6.

ABSTRACT

INTRODUCTION: Accurate implant placement with computer-assisted implant surgery (CAIS) is critical to ensuring long-term success. Dynamic computer-assisted implant surgery (d-CAIS) enhances surgical precision through real-time feedback; however, its accuracy and procedural efficiency when used by novice operators remain insufficiently investigated. This study evaluated how different registration methods in d-CAIS influence implant placement accuracy and procedural time when performed by novice operators.

MATERIALS AND METHODS: In this in vitro study, three registration methods were assessed (surface-based registration: ND, marker-based registration: XC, and pair-point registration: XM groups). Five novice operators, defined as dentists with less than five years of implant experience, placed 25 implants per group (75 total) in partially edentulous maxillary models. Postoperative cone-beam computed tomography scans were used to measure deviations at the implant entry point, apex, vertical depth, and angle. Statistical analyses were performed to compare group differences.

RESULTS: Mean three-dimensional deviations at the implant entry point were 0.97 mm (ND), 0.68 mm (XC), and 0.72 mm (XM); at the apex: 1.33 mm, 0.78 mm, and 0.90 mm, respectively. Vertical depth deviations at the apex were comparable across groups: 0.62 mm (ND), 0.51 mm (XC), and 0.54 mm (XM). Angular deviation was highest in the ND group (3.16°) compared to the XC (1.18°) and XM (0.97°) groups, with significant differences observed between ND and both XC and XM. Average procedural time was longest in the ND group and shortest in the XM group, with statistically significant differences between ND and the other two groups.

CONCLUSIONS: In novice operators, d-CAIS enabled stable control of implant entry point position and insertion depth regardless of the registration method used. In contrast, angular accuracy and procedural efficiency were influenced by registration strategies and system-related characteristics. These findings suggest that selection of appropriate registration methods may play an important role in optimizing accuracy and workflow efficiency during the early learning phase of d-CAIS.

PMID:41915368 | DOI:10.1186/s40729-026-00666-6