Tag: statistics

Med Care Res Rev. 2026 Jul 21:10775587261467103. doi: 10.1177/10775587261467103. Online ahead of print.

ABSTRACT

We examined associations between hospital system market share, merger activity, 340B participation and operating margins using data for 2,226 U.S. hospitals. We calculated Metropolitan Statistical Area (MSA)-level health system market share, tracked merger activity from 2017 to 2022, and constructed a commercial price index for 1,336 hospitals with available prices. Hospitals with a greater share were significantly more likely to participate in the 340B Program. Among larger hospitals, a 20 percentage-point increase in MSA-level health system share was associated with a 7.6 percentage-point increase in the likelihood of participation. Recent mergers were linked to an 8.6 percentage-point higher likelihood of 340B participation; 340B participation was associated with 1.1-3.0 percentage-point higher margins for non-merged hospitals and 5.2-7.0 percentage-point higher margins for merged hospitals. Greater market share and outpatient revenues were associated with larger estimated 340B margin effects, consistent with the outpatient-focused design of the program.

PMID:42479453 | DOI:10.1177/10775587261467103

Angle Orthod. 2026 Jul 21:e011126-37.1. doi: 10.2319/011126-37.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the effect of plaque-disclosing tablet (PDT) instructions on periodontal parameters in patients with bonded lingual retainers (LR).

MATERIALS AND METHODS: Forty-two patients with bonded mandibular lingual retainers were randomly allocated to two groups. The traditional oral hygiene instruction (TOHI) group (n = 21; 17 females, four males) received conventional verbal and visual oral hygiene education. The plaque-disclosing tablet instruction (PDTI) group (n = 21; 18 females, three males) received the same instructions as the TOHI group plus specific education on the use of PDT. An additional control group without lingual retainers (n = 21; 14 females, seven males) received identical instructions as the TOHI group. Plaque index (PI), gingival index (GI), calculus index (CI), and bleeding on probing (BOP) were recorded on the mandibular anterior teeth immediately after retainer placement (T0), at 3 months (T1), and at 6 months (T2). Statistical analyses were performed using the Shapiro-Wilk test, one-way analysis of variance (ANOVA), least significant difference test, Tamhane T2 test, chi-square test, and repeated-measures ANOVA.

RESULTS: At T1, TOHI and PDTI groups exhibited significantly higher periodontal scores compared with the control group (eg, PI: TOHI 0.86 ± 0.65, PDTI 0.62 ± 0.65, control 0.27 ± 0.17; P < .05). At T2, periodontal parameters in the PDTI group were significantly lower than in the TOHI group whereas no significant differences were found between the PDTI and control groups (P > .05).

CONCLUSIONS: The use of plaque-disclosing tablets in patients with bonded lingual retainers may improve periodontal health.

PMID:42479443 | DOI:10.2319/011126-37.1

Online J Public Health Inform. 2026 Jul 21. doi: 10.2196/90241. Online ahead of print.

ABSTRACT

BACKGROUND: HEDIS Childhood Immunization Status (CIS) Combination 10 is a pediatric quality measure within a widely used health care performance framework; HEDIS is used by more than 90% of U.S. health plans, covering more than 190 million people in plans that report HEDIS quality results. Because HEDIS immunization measures support population-level monitoring and quality improvement, they are directly relevant to public health practice. However, aggregate reporting limits public health use by obscuring component-level drivers of noncompletion.

OBJECTIVE: To apply explainable machine learning as a public health informatics approach to identify vaccine components associated with CIS Combo 10 completion among U.S. children aged 24-35 months.

METHODS: We analyzed 2021-2023 National Immunization Survey-Child public-use files. The age-eligible cohort included 32,997 children; weighted modeling included 16,021 children. Survey-weighted logistic regression estimated national trends with 95% CIs, and Random Forest modeling with SHAP and cross-validation identified component-level predictors.

RESULTS: CIS Combo 10 completion declined from 53.7% in 2021 to 44.6% in 2023; the survey-weighted regression model was statistically significant (annual OR 0.83, 95% CI 0.831-0.834; P<.001). Influenza and rotavirus had the largest mean absolute SHAP values.

CONCLUSIONS: CIS Combo 10 completion declined substantially from 2021 to 2023. An explainable public health informatics approach identified influenza and rotavirus as actionable targets for immunization quality improvement.

PMID:42479442 | DOI:10.2196/90241

JAMA Netw Open. 2026 Jul 1;9(7):e2624727. doi: 10.1001/jamanetworkopen.2026.24727.

ABSTRACT

IMPORTANCE: According to the Neonatal Oxygenation Prospective Meta-Analysis, a higher oxygen saturation as measured by pulse oximetry (Spo2) target range, compared with a lower Spo2 target, may reduce mortality but increase the risk of treated retinopathy of prematurity (ROP). Choosing a target range at an individual center may depend on the local baseline risks and the value placed on prioritizing survival over the risk of severe retinopathy.

OBJECTIVE: To estimate trade-offs between mortality and treated ROP associated with Spo2 targeting and the association between variation in baseline risks and these trade-offs.

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical modeling study used US national birth data and the Vermont Oxford Network database (2019-2023), incorporating gestational age (GA) and 16 performance subgroups (based on quartiles of center-specific mortality and retinopathy risks), to simulate an annual birth cohort of infants born extremely preterm (GA 23-27 weeks). The data were analyzed between January and August 2025.

EXPOSURE: High Spo2 (91%-95%) vs low Spo2 (85%-89%) target ranges.

MAIN OUTCOMES AND MEASURES: The primary outcome was the risk trade-off ratio (RTOR) of additional cases of treated ROP per death averted. Estimates of outcomes comparing universal adoption of the high or low Spo2 targets were summarized using results of a probabilistic sensitivity analysis. Scenarios were also included that incorporated selective adoption of high or low targets based on performance quartiles.

RESULTS: Among 19 050 simulated infants (2372 [12.5%] born at GA 23 weeks, 3253 [17.1%] at GA 24 weeks, 3809 [20.0%] at GA 25 weeks, 4357 [22.9%] at GA 26 weeks, and 5259 [27.6%] at GA 27 weeks), which approximated the distribution of extremely preterm births in the US, universal adoption of the higher Spo2 target range was associated with a mean of 638 fewer deaths (95% uncertainty interval [UI], -363 to -934 deaths) and a mean of 551 additional cases (95% UI, 435-659 additional cases) of treated ROP. The mean RTOR with the high Spo2 target range was 0.91 (95% UI, 0.61-1.43). Across performance subgroups, RTORs were 0.16 (95% UI, 0.00-0.40) in centers with the highest risk of mortality (4th quartile) and lowest risk of treated ROP (1st quartile) and 2.52 (95% UI, 1.39-4.72) for centers with the highest mortality (1st quartile) and lowest risk of treated ROP (4th quartile). Selective adoption of target ranges was favored in 50% of simulations if 2 cases of treated retinopathy per death averted were considered acceptable. Universal adoption of the high target range was favored in more than 90% of simulations if 4 or more cases of treated ROP were acceptable for each death averted.

CONCLUSIONS AND RELEVANCE: This decision analytical modeling study of a US cohort of extremely preterm infants found that the RTOR for treated ROP and mortality during Spo2 targeting varied by GA and local baseline risks. This decision analysis may help inform the choice of Spo2 target ranges in individual clinical centers.

PMID:42479429 | DOI:10.1001/jamanetworkopen.2026.24727

Obes Surg. 2026 Jul 21. doi: 10.1007/s11695-026-08851-7. Online ahead of print.

ABSTRACT

INTRODUCTION: Endoscopic bariatric procedures (EBTs) are associated with a high incidence of postoperative nausea and vomiting (PONV). We describe our experience with an Enhanced Recovery Protocol (ERP) program for EBTs, comparing healthcare utilization metrics before and after adoption.

METHODS: We instated an ERP for all patients undergoing EBT in our institution, which consisted of intravenous fluids, antiemetics, analgesics and antibiotics peri-procedure, oral antiemetics and analgesics post-procedure, and a structured phone visit 24-48 h post-procedure. We performed a retrospective review of patients undergoing EBT before and after implementation of ERP, with the primary outcome of evaluating healthcare utilization. Healthcare utilization was defined as a visit to the Emergency Room (ER) or Infusion Treatment Centers (ITC), or an inpatient admission. Descriptive and comparative statistics were performed.

RESULTS: Our cohort comprised 434 patients (217 pre- and 217 post-implementation of ERP). Baseline characteristics including age, sex, weight and body mass index were similar between groups. Healthcare utilization was significantly lower in the post-implementation group (15.7% vs. 25.8%, p = 0.01), driven by elimination of ITC visits (0% vs. 4.6%, p < 0.01) and elective post-procedural hospitalizations (0% vs. 7.4%, p < 0.01).

CONCLUSIONS: The adoption of an ERP pathway in EBTs resulted in reduced healthcare utilization post-procedure, driven by lower ITC use and elective post-procedural hospitalizations.

PMID:42479411 | DOI:10.1007/s11695-026-08851-7

Ir J Med Sci. 2026 Jul 21. doi: 10.1007/s11845-026-04564-z. Online ahead of print.

ABSTRACT

BACKGROUND: Iron deficiency anemia (IDA) is the most prevalent nutritional anemia worldwide and is frequently associated with reactive thrombocytosis. The physiological response to anemia includes increased production of erythropoietin (EPO); however, its role in the development of thrombocytosis in IDA remains unclear and controversial.

AIM: To evaluate serum erythropoietin levels in patients with iron deficiency anemia associated with thrombocytosis and to assess the relationship between hemoglobin concentration, platelet count, and serum erythropoietin levels.

MATERIALS AND METHODS: This hospital-based cross-sectional study was conducted at a tertiary care center over a period of 20 months. A total of 48 newly diagnosed cases of iron deficiency anemia with thrombocytosis were included. Complete blood count, peripheral smear examination, iron profile, serum ferritin, and serum erythropoietin levels were assessed. Anemia and thrombocytosis were graded using standard WHO and Dame-Sutor criteria, respectively. Statistical analysis was performed using SPSS version 24, employing Pearson’s correlation coefficient and Chi-square test.

RESULTS: The study population showed female predominance (77.09%). Severe anemia was observed in 52.09% of cases, and mild thrombocytosis was the most common finding (91.6%). Elevated serum erythropoietin levels were noted in 83.3% of patients. However, no statistically significant correlation was found between hemoglobin concentration and serum erythropoietin levels (r = 0.01; p = 0.35) or between platelet count and serum erythropoietin levels (r = -0.06; p = 0.37).

CONCLUSION: Although serum erythropoietin levels were elevated in the majority of patients with iron deficiency anemia and thrombocytosis, no significant association was observed between erythropoietin levels and platelet count. This suggests that erythropoietin alone does not play a decisive role in the development of thrombocytosis in iron deficiency anemia.

PMID:42479404 | DOI:10.1007/s11845-026-04564-z

Ir J Med Sci. 2026 Jul 21. doi: 10.1007/s11845-026-04556-z. Online ahead of print.

ABSTRACT

BACKGROUND: Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality worldwide. Prognostic stratification is crucial to guide management. Uric acid (UA) and creatinine (Cr) are individually associated with poor outcomes, but their combined value as a ratio (UA/Cr) remains underexplored.

AIMS: Our objective is to evaluate the prognostic significance of UA, Cr, and the UA/Cr ratio in ACS patients for predicting in-hospital severity and complications.

METHODS: A short-term prospective observational cohort study was conducted on 134 patients admitted with ACS (56% NSTEMI, 44% STEMI) between July 2024 and July 2025. Demographic, clinical, and biochemical data were collected. Prognostic value was assessed for severity (Killip, GRACE, CRUSADE) and complications (arrhythmia, hemodynamic instability, mortality) using ROC curves and logistic regression.

RESULTS: The population (mean age 61.8 ± 11.5 years, 89% male) showed significant associations between UA and Cr with severity scores (p = 0.041 and p = 0.006, respectively). The UA/Cr ratio was significantly higher in patients with arrhythmic complications (7.03 ± 2.98 vs. 5.65 ± 2.22, p = 0.024). ROC analysis revealed UA predicted complications (AUC = 0.69, p = 0.006) overall and in NSTEMI (AUC = 0.784, p = 0.004). Multivariate analysis confirmed UA as an independent predictor of severity (OR = 1.138, p = 0.048) and complications (OR = 1.237, p = 0.026) in NSTEMI. UA/Cr ratio predicted complications in NSTEMI patients with preserved renal function (OR = 1.711, p = 0.041).

CONCLUSION: UA is an independent prognostic marker in ACS, especially NSTEMI. The UA/Cr ratio provides incremental prognostic value in patients with preserved renal function and represents a simple, cost-effective tool to improve ACS risk stratification.

PMID:42479402 | DOI:10.1007/s11845-026-04556-z

Infect Dis Ther. 2026 Jul 21. doi: 10.1007/s40121-026-01412-6. Online ahead of print.

ABSTRACT

INTRODUCTION: Tenofovir disoproxil fumarate (TDF) is highly effective for chronic hepatitis B (CHB) but may induce progressive renal impairment and proximal tubular dysfunction. Switching to tenofovir alafenamide (TAF) or entecavir (ETV) may reduce TDF-related nephrotoxicity. This study evaluated renal and metabolic changes before and after switching from TDF to TAF or ETV in a real-world cohort of older patients.

METHODS: This retrospective longitudinal cohort study included adults with CHB who switched from TDF to TAF or ETV at a tertiary center (2012-2023). Eligible patients had ≥ 2 years of TDF treatment and ≥ 2 years of post-switch follow-up. Those with virological failure, major coinfections, or non-HBV-related kidney disease were excluded. Clinical and laboratory data were collected at 6-month intervals from 2 years before to 4 years after switching. Biomarker trajectories were analyzed using linear mixed-effects models with time centered at switch comparing treatments and with multivariable adjustment for key confounders.

RESULTS: A total of 102 patients were included (TAF n = 82; ETV n = 20), mean age 72 ± 10 years, 72% male. All patients had undetectable HBV-DNA at switch. During TDF therapy, serum creatinine showed a non-significant increasing trend (β = + 0.008 mg/dL/year, p = 0.24), which persisted after switching (β = + 0.009 mg/dL/year, p = 0.07), with no significant difference between groups. Serum phosphate declined during TDF in the ETV group (β = – 0.175 mg/dL/year, p = 0.002) and showed a significant increase after switching (β = + 0.111 mg/dL/year, p = 0.031) while the TAF group remained stable throughout. Total cholesterol ishowed a significant immediate increase at the time of switch (+ 18.3 mg/dL, 95% CI 11.0-25.6, p < 0.001), with no significant difference between TAF and ETV.

CONCLUSIONS: Unlike previous studies reporting clear creatinine improvement after switching from TDF, this cohort did not show a statistically significant reduction in creatinine levels after the switch although an attenuation of creatinine progression and recovery of phosphate levels were observed, suggesting mitigation of TDF-related renal and tubular toxicity.

PMID:42479363 | DOI:10.1007/s40121-026-01412-6

Eur J Health Econ. 2026 Jul 21. doi: 10.1007/s10198-026-01956-x. Online ahead of print.

ABSTRACT

OBJECTIVES: This study provides a comprehensive overview of the Italian framework for the appraisal of drug innovativeness, covering all 294 appraisals conducted by AIFA between 2017 and June 2025. It aims to describe the evolution and application of the 2017 criteria, explore the determinants of innovativeness recognition, and discuss the implications of the 2025 revision for value assessment and market access.

METHODS: All AIFA innovativeness reports available up to June 2025 were systematically reviewed and coded across the three appraisal domains – therapeutic need, added therapeutic value, and quality of evidence – together with contextual and regulatory variables (orphan designation, study design, EMA approval type, accelerated assessment, and PRIME designation). Descriptive and multinomial regression analysis were performed to identify predictors of appraisal outcomes and to explore associations with European and national timelines.

RESULTS: Among 294 appraisals, 27% were fully innovative, 29% conditionally innovative, and 44% non-innovative. ATV and quality of evidence were the strongest determinants, while therapeutic need played a secondary role. Orphan designation, pediatric/mixed populations, and the availability of RCT-based evidence increased the likelihood of a positive outcome. Medicines with EMA accelerated assessment were more often granted full innovativeness but did not achieve shorter national reimbursement timelines (median 432 days). Fully innovative medicines followed shorter EMA pathways (median 330 vs. 448 days), though not necessarily implying faster national access.

CONCLUSIONS: AIFA’s framework proved internal coherence, with ATV as the main driver. The 2025 criteria may enhance methodological rigor but reduce flexibility, requiring continuous monitoring to ensure timely and equitable access.

PMID:42479353 | DOI:10.1007/s10198-026-01956-x

J Occup Rehabil. 2026 Jul 21. doi: 10.1007/s10926-026-10436-1. Online ahead of print.

ABSTRACT

PURPOSE: To (1) examine health- and work-related outcomes among partners of cancer survivors and (2) explore associated factors of these outcomes.

METHODS: In the STEPS prospective cohort study 225 employed partners of cancer survivors in the Netherlands completed questionnaires at baseline, and after 6 and 12 months, on work participation, health-related quality of life (HRQoL), and medical, lifestyle, health, and work factors. Generalized estimating equations and time-lagged regression analyses were used to examine changes over time and associations with measured factors.

RESULTS: Partners worked on average 31.1 h/week at baseline, which remained stable over the 12-month follow-up. Employment status (i.e., whether participants were employed versus not) slightly declined from 91 to 86%. Around 30% were sick listed at least once during the 6 months prior to baseline, which did not change over time. Physical HRQoL declined over time (beta [95% confidence interval]: – 1.65 [- 2.96 to – 0.35]). Mental HRQoL remained below population norms (e.g., on average 45.4 (12.6) at baseline), but did not statistically change over time. Multivariate analyses revealed that factors such as income, educational level, financial necessity to work, breadwinner status, work tasks, work ability, need for recovery and survivors’ disease and treatment characteristics were associated with partners’ work and health outcomes.

CONCLUSION: Although work participation remained stable during our study period, partners of cancer survivors experienced a substantial burden regarding their work and health. Interventions should focus on supporting partners at risk, addressing financial strain, helping them balance work and caregiving demands to sustain health and work participation.

PMID:42479346 | DOI:10.1007/s10926-026-10436-1