Tag: statistics

Stat Med. 2026 Jun;45(13-14):e70606. doi: 10.1002/sim.70606.

ABSTRACT

Racial disparities in healthcare expenditures are well-documented, yet the underlying drivers remain complex. This study develops a framework to decompose such disparities through shifts in the distributions of mediating variables, rather than treating race itself as a manipulable exposure. We define disparities as differences in covariate-adjusted outcome distributions across racial groups, and decompose the total disparity into a component attributable to differences in mediator distributions, and a residual component that remains after equalizing those distributions. Using data from the medical expenditures panel survey (MEPS), we examine the extent to which expenditure disparities would persist or be reduced if mediators such as socioeconomic status (SES), insurance access, health behaviors, or health status were equalized across racial groups. To ensure valid inference, we derive asymptotically linear estimators based on influence-function techniques and flexible machine learning, including super learners and a two-part model designed for the zero-inflated, right-skewed nature of expenditure data. Applying this framework to MEPS data from 2009 to 2016, substantial disparities were observed across all pairwise racial comparisons, with the largest gaps observed between non-Hispanic Whites and Hispanics in both years. Differences in SES and health status were the largest contributors to these disparities, with insurance access also playing a meaningful role, particularly for Hispanic populations, whereas health behaviors contributed minimally. Residual disparities persisted, especially in comparisons involving non-Hispanic Whites, suggesting the influence of unmeasured or structural factors.

PMID:42201641 | DOI:10.1002/sim.70606

Cardiol Ther. 2026 May 27. doi: 10.1007/s40119-026-00450-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Timely diagnosis and treatment are essential for improving outcomes and quality of life in patients with transthyretin (ATTR) amyloidosis. Early multisystem manifestations are often unrecognized, leading to diagnostic delays and misdiagnosis. Large-scale, multicountry, observational studies are needed to better characterize the real-world trajectory of these patients.

METHODS: OverTTuRe, an ANTHOLOGY study, is a retrospective, observational, descriptive, longitudinal, multicountry study using secondary data from claims databases, electronic health records, and healthcare registries. The primary aim of this analysis was to characterize baseline characteristics, early clinical manifestations, and outcomes in patients with hereditary transthyretin (ATTRv) amyloidosis from the United States (US), United Kingdom (UK), Japan, Denmark, and Sweden.

RESULTS: Of 1502 patients identified, the predominant phenotype across countries was ATTRv amyloidosis with polyneuropathy (ATTRv-PN 51.3-63.7%); however, many patients had ATTRv with mixed phenotype (ATTRv mixed 36.3-48.8%). Compared to patients with ATTRv mixed, patients with ATTRv-PN were younger, and a higher proportion were female (36.6-64.1% vs. 19.3-56.4%). Median (interquartile range) time from any initial cardiac or noncardiac manifestation to diagnosis varied across countries; time from any noncardiac manifestation to diagnosis was longest for both phenotypes in the US (ATTRv-PN 2.9 [1.0-4.0] years; ATTRv mixed 2.4 [0.8-3.7] years). Following diagnosis, treatment was not available for most patients. Mortality (ATTRv-PN 14.6-36.2%; ATTRv mixed 21.0-73.0%) and hospitalization (ATTRv-PN 23.5-66.2%; ATTRv mixed 20.8-70.5%) risk varied across countries in the 5 years following diagnosis. Pre- and post-diagnosis healthcare resource utilization was high for both phenotypes.

CONCLUSIONS: These findings highlight the heterogeneity of clinical manifestations and outcomes of ATTRv amyloidosis across phenotypes and countries. Patients frequently experience diagnostic delays and numerous healthcare interactions. Elevated clinical suspicion to facilitate earlier diagnosis, together with a multidisciplinary care approach and timely access to targeted therapies, is needed to improve outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT06355934.

PMID:42201638 | DOI:10.1007/s40119-026-00450-y

Eur Phys J E Soft Matter. 2026 May 27;49(6):43. doi: 10.1140/epje/s10189-026-00587-7.

ABSTRACT

Calanoid copepods are key components of marine and estuarine food webs. Exposure to various classes of pollutants induces changes in their swimming behavior. This raises concerns about potential effects on critical processes such as feeding, mating, predator avoidance and vertical migration. The effect of pollution by microplastics is not well known. We investigated in a large experimental tank the effects of the smallest size fraction of microplastics on the swimming behavior of the estuarine copepod Eurytemora affinis. Because the motion of zooplankton is intrinsically linked to that of the ambient fluid, we recorded copepods moving freely in calm water and in grid-generated turbulence to recreate some of the hydrodynamic conditions they experience in their natural environment. Using an advanced implementation of 3D Lagrangian particle tracking velocimetry, we simultaneously measured copepod trajectories and the surrounding flow field at high temporal resolution. In calm water, copepods alternated between periods of cruising and sudden relocation jumps. In turbulence, copepod motion was dominated by transport by the flow, yet jumps allowed copepods to deviate from the flow streamlines. The measurement of the relative velocity of copepods with respect to the underlying flow enabled us to characterize the statistics of these jumps. Turbulence significantly increased jump frequency without modifying their amplitude or duration. Following a 12-hour exposure to polyethylene fragments at 300 $\mu$ g/L, copepods showed increased jump frequency in calm water corresponding to 40 % increase in energetic cost. In contrast, exposure to microplastics produced weak additional effects on swimming behavior under turbulent conditions. These results confirm the existence of an active response to turbulence in E. affinis and are consistent with a hyperactive behavior triggered by exposure to microplastic pollution.

PMID:42201637 | DOI:10.1140/epje/s10189-026-00587-7

Intern Emerg Med. 2026 May 27. doi: 10.1007/s11739-026-04407-w. Online ahead of print.

NO ABSTRACT

PMID:42201621 | DOI:10.1007/s11739-026-04407-w

Eur J Health Econ. 2026 May 27. doi: 10.1007/s10198-026-01940-5. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological condition predominantly affecting individuals over 65 years of age. Despite its treatability through cerebrospinal fluid (CSF) shunting-with clinical improvement in up to 80% of appropriately selected patients-iNPH remains substantially underdiagnosed, with only approximately 13% of affected individuals in Europe receiving appropriate care. This study evaluates the long-term epidemiological and economic burden of iNPH underdiagnosis in Italy over the decade 2024-2033, quantifying potential savings achievable through systematic diagnosis and surgical treatment.

METHODS: A dual-scenario epidemiological modeling approach was employed using Italian demographic projections from ISTAT for the population aged ≥ 65 years, stratified into two age cohorts (65-79 years and ≥ 80 years). Scenario 1 applied a conservative pooled prevalence of 1.30% derived from an international systematic review; Scenario 2 applied realistic age-stratified rates from a prospective Swedish population-based study (2.1% for ages 65-79; 8.9% for ≥ 80 years). Per-patient annual care costs (€35,866) and surgical intervention costs (€11,803) were modeled with an annual inflation adjustment of 1.78%. The Incremental Cost-Effectiveness Ratio (ICER) was calculated using a reported QALY gain of 1.7 following shunt surgery.

RESULTS: The Italian population aged ≥ 65 years is projected to grow by 16.7% over the study period, reaching 16.77 million by 2033. Estimated iNPH cases range from 186,812 (Scenario 1, conservative) to 611,435 (Scenario 2, realistic) in 2024, increasing to 217,967-707,882 by 2033. Cumulative ten-year costs to the Italian National Health System (INHS) and families without intervention ranged from €145.53 billion (Scenario 1, conservative) to €475.19 billion (Scenario 2, realistic). Systematic shunt surgery could generate cumulative savings ranging from €113.21 billion to €369.74 billion across all four modeled scenarios. The ICER was consistently -€14,166.47/QALY across all scenarios, establishing CSF shunt surgery as an economically dominant intervention.

CONCLUSIONS: iNPH underdiagnosis represents a major and escalating economic and clinical challenge for Italy’s aging healthcare system. Even under the most conservative scenario, the magnitude of avoidable costs is substantial. The consistently negative ICER confirms that CSF shunt surgery simultaneously reduces healthcare expenditure and improves patient outcomes. Urgent investment in standardized screening programs, enhanced clinical awareness among physicians, and integrated care pathways is required to address this preventable burden.

PMID:42201617 | DOI:10.1007/s10198-026-01940-5

J Robot Surg. 2026 May 27;20(1):543. doi: 10.1007/s11701-026-03511-5.

ABSTRACT

Robotic-assisted thoracic surgery (RATS) is increasingly being incorporated into contemporary practice across the United Kingdom (UK) and Republic of Ireland (ROI). However, national data on trainee exposure and preparedness is lacking. This study is the first to evaluate cardiothoracic trainees’ experiences and perceptions of training for RATS nationally. A multicentre, cross-sectional survey study was conducted between June and October 2025 of cardiothoracic trainees (ST1-ST8), post-certificate fellows, and equivalent trust appointed doctors. A 30-item, web-based questionnaire assessed institutional exposure, simulation access, operative console experience, and perceived barriers to RATS training. Quantitative data were analysed using descriptive statistics; while free-text responses underwent inductive thematic analysis. Eighty-two responses were received from all 14 training deaneries. RATS was performed in 71% (58/82) of respondents’ units; however only 16% (9/58) reported a structured training programme in place. Dual console systems were absent or unused in 43% (25/58) of robotic units. Over half (54%, 32/59) of respondents had not fully performed a single RATS procedure. Most respondents (83%, 68/82) agreed that more robotic training is required before the completion of training. Key barriers to training included lack of dual-console utilisation, operative exposure limited to bedside assisting only, and restricted simulation access. Despite widespread adoption of RATS, opportunities for structured training remain inconsistent across the UK and ROI. National standards should be developed to incorporate structured robotic training within the cardiothoracic curriculum, including access to simulation, routine dual-console use, and competency-based progression from bedside assistant to primary operator.

PMID:42201609 | DOI:10.1007/s11701-026-03511-5

Health Care Anal. 2026 May 27. doi: 10.1007/s10728-026-00573-2. Online ahead of print.

ABSTRACT

Investments in public health and education are usually examined independently, but in developing countries, both are relevant to Sustainable Economic Development (SED). Within an integrated policy framework, this study aims to examine the complementary relationship between investments in health and education and their relationship with SED. A mixed-method approach was employed, consisting of 465 questionnaire responses from participants, including government officials, and 96 semi-structured interviews. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), quantitative data were analyzed, and to contextualize the statistical results, qualitative findings were involved. Results indicate that healthcare infrastructure, coupled with investment in health and education, communicable disease reduction, mental health services, and coordinated public investment, is positively and statistically related to SED. Explained variance is (R² = 0.100), showing that there is a moderate but meaningful contribution in the broader institution context. Findings contribute to existing literature by incorporating cross-sectoral modeling with qualitative institutional-level findings. It provides a more holistic understanding of the relation between coordinated human capital investments and developmental outcomes. These insights recommend integrating policies between the health and education sectors to support inclusive and sustainable development in low- and middle-income countries.

PMID:42201595 | DOI:10.1007/s10728-026-00573-2

Hernia. 2026 May 27;30(1):233. doi: 10.1007/s10029-026-03732-5.

ABSTRACT

BACKGROUND: Two-dimensional (2D) laparoscopy provides limited depth perception, which may limit performance during technically demanding operations. Three-dimensional (3D) systems offer stereoscopic vision, improving visualization. We compared 3D versus 2D systems in adults for operative time, visualization, and postoperative complications.

METHODS: PubMed, Scopus, Web of Science, and Cochrane were searched through December 2025. We included randomized controlled trials and observational studies of patients undergoing TAPP repair, comparing 3D with 2D laparoscopy. Total operative time was the primary outcome; visualization and postoperative complications were secondary outcomes. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale, and certainty of evidence using GRADE.

RESULTS: Six studies met the inclusion criteria; five were included in the primary meta-analysis (n = 521 patients). Total operative time favored 3D (MD-18.48 min; 95% CI-29.27,-7.69; p = 0.0008), with substantial heterogeneity (I²=94%). Subgroup analysis also favored 3D in RCTs (MD-11.70; 95% CI-17.74,-5.66) and observational studies (MD-26.85; 95% CI-30.55,-23.15). Contrast favored 3D (MD 2.11; 95% CI 0.56, 3.67; p = 0.008), while sharpness was not statistically different (MD 1.49; 95% CI-0.25 to 3.24; p = 0.09). No difference in postoperative complications (MD 1.11; 95% CI 0.75, 1.65; p = 0.59).

CONCLUSION: 3D laparoscopy has been proposed to improve visualization and shorten operative time; however this should be interpreted with caution due to very low certainty of evidence and variability in surgeon experience.

REGISTRATION/FUNDING: PROSPERO CRD420251272842.

PMID:42201585 | DOI:10.1007/s10029-026-03732-5

J Robot Surg. 2026 May 27;20(1):538. doi: 10.1007/s11701-026-03501-7.

ABSTRACT

During early adoption of robotic surgeries, evidence is primarily descriptive, and how such evidence emerges and accumulates over time remains poorly understood. This study introduces a framework for modeling the temporal dynamics of descriptive evidence on device-level utilities and operational issues accumulated during early adoption of the da Vinci system. We employed a three-step approach comprising systematic dataset acquisition, thematic coding of device utilities and operational issues, and quantitative temporal modeling. A PRISMA-guided search of PubMed and Web of Science identified early clinical studies of the da Vinci system from FDA clearance (July 2000) to the first published randomized controlled trial. Two reviewers independently coded descriptive themes, and cumulative occurrence proportions were modeled over time using exponential and logistic regression to characterize the emergence and saturation patterns. Nineteen studies met inclusion criteria, yielding 16 themes (7 utilities, 9 issues) with high inter-rater reliability (agreement rate 93.1%, Cohen’s κ = 0.85). Utilities, particularly instrument dexterity and stereoscopic depth perception, were reported early and reached saturation rapidly, whereas operational issues, including loss of haptic feedback and workflow-related constraints, emerged more gradually and required greater cumulative clinical experience. Time-series modeling demonstrated a clear saturating pattern, with utilities reaching 80% cumulative occurrence at 13.2 months versus 26.0 months for issues. This study presents a framework for modeling how descriptive evidence emerges and matures in early-stage medical device adoption. The observed asymmetry, rapid recognition of utilities versus delayed emergence of operational issues, highlights the importance of structured, continuous synthesis of early clinical evidence.

PMID:42201559 | DOI:10.1007/s11701-026-03501-7

Eur Spine J. 2026 May 27. doi: 10.1007/s00586-026-10038-8. Online ahead of print.

ABSTRACT

OBJECTIVES: Optimal bone quality is essential for spinal surgery, as it mitigates the risk of multiple serious complications. The purpose of this study was to establish a novel, straightforward, and clinically relevant scoring system to assess vertebral bone fragility and investigate its correlation with conventional dual-energy X-ray absorptiometry (DEXA) measurements.

METHODS: A retrospective analysis was conducted on patients who underwent lumbar spine MRI and DEXA scans at our institution for degenerative lumbar diseases between December 2023 and December 2024. Patients were categorized into normal group and osteopenia/osteoporosis group based on DEXA results. Demographic data were collected and imaging parameters, including vertebral bone quality (VBQ), disc signal intensity (DSI), and vertebral bone fragility (VBF), were calculated. Logistic regression analysis was employed to identify risk factors. Pearson correlation analysis was performed between VBF scores and DEXA T-scores. The diagnostic performance of the VBF score in identifying patients with reduced bone mineral density (BMD) was evaluated using receiver operating characteristic(ROC) curve.

RESULTS: Of the 109 patients included in the study, 73 were diagnosed with osteopenia/osteoporosis. Interobserver reliability for DSI and VBF scores was excellent. There were significant differences in age, sex, VBQ, and VBF scores between the two groups. Logistic regression analysis identified a high VBF score (OR 2.870, 95% CI 1.320-6.240) as a significant risk factor for osteopenia/osteoporosis. The area under the curve (AUC) of predicting osteopenia/osteoporosis was 0.829 (p < 0.001) for VBF score, and the best threshold was 3.51 (sensitivity, 64.4%; specificity, 91.7%). VBF score demonstrated a statistically significant correlation with DEXA T-scores (p < 0.001).

CONCLUSIONS: VBF score is a straightforward, reliable, and accurate method for assessing bone fragility in degenerative lumbar diseases, providing additional screening options for preoperative BMD evaluation.

PMID:42201553 | DOI:10.1007/s00586-026-10038-8