Tag: statistics

JAMA Netw Open. 2025 Jun 2;8(6):e2513293. doi: 10.1001/jamanetworkopen.2025.13293.

ABSTRACT

IMPORTANCE: Socioeconomic disparities are increasingly recognized as key factors in health outcomes among patients with type 2 diabetes. Understanding how income level and its changes are associated with severe hypoglycemia risk may inform targeted interventions and policy decisions.

OBJECTIVE: To evaluate the association between income level, including changes in income status, and the risk of severe hypoglycemia, and to assess whether this association varies across key subgroups in middle-aged adults.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults aged 40 to 70 years with type 2 diabetes from the Korean National Health Information Database (NHID) who underwent health examinations from 2015 to 2016. Participants aged 40 to 70 years with type 2 diabetes and valid income information were recruited between 2006 and 2010 from the UK Biobank (UKBB) and were included for sensitivity analysis. Data were analyzed from January 2023 to September 2024.

EXPOSURES: Participants were categorized into annual income quartiles (NHID) or self-reported income brackets (UKBB). In the NHID, medical aid beneficiaries (ie, those receiving government medical aid due to income below 40% of the median income and limited assets) were identified, and income changes over a 5-year period were assessed.

MAIN OUTCOMES AND MEASURES: Severe hypoglycemia requiring medical intervention.

RESULTS: Among 1 838 362 adults with type 2 diabetes from the NHID (mean [SD] age, 57.1 [8.1] years; 1 157 263 [63.0%] male) and 17 287 participants from the UKBB (mean [SD] age, 56.9 [6.8] years; 11 522 [66.7%] male), lower income was associated with a higher risk of severe hypoglycemia (NHID: hazard ratio [HR], 2.50; 95% CI, 2.33-2.57; UKBB: HR, 5.38; 95% CI, 1.72-16.85). In the NHID, individuals whose income increased from the lowest quartile or medical aid status to the fourth quartile over 5 years had a significantly lower risk (HR, 0.74; 95% CI, 0.67-0.81; P for trend <.001), whereas receiving medical aid for at least 1 year was associated with a significantly higher risk (HR, 1.71; 95% CI, 1.54-1.89). The association between income and severe hypoglycemia was consistently greater in men, individuals not using insulin, those without chronic kidney disease, and those with a shorter duration of diabetes.

CONCLUSIONS AND RELEVANCE: In this cohort study of adults with type 2 diabetes, low income was found to be a significant factor associated with risk for severe hypoglycemia. Addressing socioeconomic disparities and implementing targeted interventions may help reduce the incidence and severity of hypoglycemia.

PMID:40455444 | DOI:10.1001/jamanetworkopen.2025.13293

JAMA Netw Open. 2025 Jun 2;8(6):e2513361. doi: 10.1001/jamanetworkopen.2025.13361.

ABSTRACT

IMPORTANCE: Sickle cell disease (SCD) is a complex hemoglobinopathy. Vaso-occlusive episodes are the primary cause of emergency department (ED) utilization among individuals with SCD. Literature lacks a standardized definition for high ED utilization.

OBJECTIVE: To explore ED utilization, redefine high ED utilization, and describe factors associated with super-high ED utilization among individuals with SCD.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study analyzed the North Carolina Hospital Discharge Datasets (2013-2019). Participants were included if they had SCD, defined as at least 3 SCD visits (ED, inpatient, or outpatient surgery) in a rolling 5-year period. All age groups, sexes, and payers, regardless of state of residence, were included. Data were analyzed from July 2023 to August 2024.

EXPOSURES: Variables included sex, race, ethnicity, age, age at death, distance (in miles) to the closest SCD center, number of annual ED visits, and social vulnerability index (SVI).

MAIN OUTCOMES AND MEASURES: To determine ED utilization categories, first the distribution of people based on the number of annual ED visits was examined, then the categories across years were identified to determine the data-informed cutoff for each category. Univariate analysis determined differences between participants based on the ED utilization category using χ2 tests of independence or analysis of variance, as applicable. Descriptive statistics were conducted to describe characteristics of utilization in the sample and by ED utilization group. A parsimonious multinomial regression was conducted using significant factors from the univariate analysis.

RESULTS: The cohort included 9964 unique patients (5364 [53.83%] female; mean [SD] age, 24.49 [17.54] years), including 9355 Black patients (93.89%), with 100 188 total ED visits from 2013 to 2019. ED visits were categorized into 4 levels: low (0-1 visits per year), moderate (2-9 visits per year), high (10-32 visits per year), and super high (≥33 visits per year). A small subset (178 patients [1.79%]) exhibited super-high ED utilization, contributing disproportionately to the total number of ED visits. Older age, younger age for in-facility deaths, and higher SVI were significantly associated with higher ED utilization. Patients with high utilization were more likely to die, die younger (eg, median [IQR] age at death, 33.0 [30.0-44.0] years in the super-high utilization group vs 50 [38.0-61.0] years in the moderate utilization group), use multiple EDs (eg, 93.8% of participants in the super-high utilization group vs 40.08% of participants in the moderate utilization group), and reside in counties more disadvantaged on socioeconomic and transportation characteristics.

CONCLUSIONS AND RELEVANCE: This cohort study of 7 years of North Carolina Hospital Discharge Data described 4 new categories of ED utilization in SCD. These categories could be used to reframe how high ED use is determined.

PMID:40455443 | DOI:10.1001/jamanetworkopen.2025.13361

JAMA Netw Open. 2025 Jun 2;8(6):e2513384. doi: 10.1001/jamanetworkopen.2025.13384.

ABSTRACT

IMPORTANCE: Dementia is a significant public health challenge, with its prevalence expected to increase as life expectancy continues to extend globally.

OBJECTIVE: To estimate generational differences in age-specific dementia prevalence across the US, Europe, and England.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from 1994 to 2021 from the United States Health and Retirement Study (HRS), from 2004 to 2020 from the Survey of Health, Ageing and Retirement in Europe (SHARE), and from 2002 to 2019 from the English Longitudinal Study of Ageing (ELSA). Statistical analysis was performed from May 2023 to February 2025.

MAIN OUTCOMES AND MEASURES: First, 2 different methods-the validated algorithm and machine learning techniques as the robustness check-were used to identify respondents with probable dementia. Then the status of dementia was used to estimate the association of cohort with dementia status by age-period-cohort methodology.

RESULTS: Of the 99 420 individuals (mean [SD] age, 79.1 [6.2] years; 59.2% women) in the HRS dataset, 21 069 (21.2%) were included in this study; of the 83 580 individuals (mean [SD] age, 78.6 [5.9] years; 54.7% women) in the SHARE dataset, 32 490 (38.9%) were included in this study; and of the 31 384 individuals (mean [SD] age, 77.9 [5.6] years; 55.8% women) in the ELSA dataset, 8878 (28.3%) were included in this study. Focusing on people aged 71 years or older and controlling for age and period effects, birth cohorts born more recently were less likely to develop dementia in all 3 regions, albeit at different rates (point estimate for 1944-1948 vs 1919-1923 cohorts: US, -0.55 [95% CI, -0.77 to -0.34] vs -0.18 [95% CI, -0.25 to -0.10]; Europe, -1.49 [95% CI, -1.72 to -1.27] vs -0.24 [95% CI, -0.35 to -0.13]; and England, -0.48 [95% CI, -0.89 to -0.08] vs -0.23 [95% CI, -0.38 to -0.07]). This decreasing trend was more pronounced among women than men (point estimate in 1944-1948 for women vs men: US, -0.55 [95% CI, -0.86 to -0.30] vs -0.48 [95% CI, -0.84 to -0.13]; Europe, -1.50 [95% CI, -1.80 to -1.21] vs -1.34 [95% CI, -1.70 to -0.99]; and England, -0.76 [95% CI, -1.30 to -0.23] vs -0.07 [95% CI, -0.69 to 0.54]); the point estimates for men in England were not statistically significant.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study examining generational differences in age-specific dementia prevalence across the US, Europe, and England, we found that individuals from more recent birth cohorts had lower proportions of people with dementia. Work of this kind is relevant to plan for health and long-term care policy and workforce requirements across these regions now and into the future.

PMID:40455442 | DOI:10.1001/jamanetworkopen.2025.13384

Clin Ophthalmol. 2025 May 26;19:1709-1720. doi: 10.2147/OPTH.S515743. eCollection 2025.

ABSTRACT

PURPOSE: To compare postoperative outcomes of haptic fixation sites, single versus dual haptics, in capsule-preserving intraocular lens (IOL) intrascleral fixation for zonular weakness.

PATIENTS AND METHODS: This retrospective study analyzed 88 eyes (65 patients) with zonular weakness and at least two additional risk factors for IOL dislocation. Conducted at a single center from May 2019 to July 2023, the study followed patients for 6-56 months (mean: 26.5±16.0 months). Fixation methods included single or dual haptics, selected based on the operator’s subjective assessment of zonular weakness and patient age. Initially, scleral tunnel-style was used, transitioning to flange-style in October 2021. Outcomes assessed included IOL tilt, decentration, refractive error, and complications.

RESULTS: Final assessments showed an average IOL tilt of 6.54±3.14° and decentration of 0.60±0.36mm. Refractive error at six months post-surgery averaged -0.33±0.99D. Dual fixation resulted in greater myopic shifts than single fixation (-0.79±0.93D vs -0.16±0.96D, p<0.01), especially tunnel-dual fixation compared to tunnel-single fixation (-1.31±0.61D vs -0.25±0.89D, p<0.001) and tunnel-dual fixation compared to flange-dual fixation (-1.31±0.61D vs -0.17±0.88D, p=0.001). Large IOL tilts (>10°) occurred in six eyes (6.8%), all with tunnel style, with a refractive error of -0.59±0.78D; not statistically significant, but a correlation was observed between tilt and refractive error (R²=0.851, p=0.0176). Large IOL decentration (>1mm) occurred in 12 eyes (13.6%), with a significant myopic shift of -1.01±0.93D. Capsule damage was noted in 15.9% of cases, vitreous prolapse was infrequent (4.5%), and no cases had iris capture or severe retinal complications.

CONCLUSION: Despite the risk of capsule damage, this method, which preserves the capsule and avoids posterior segment surgery, appears viable for cases with significant zonular weakness and anticipated progression, without iris capture or retinal complications. Improving the T-style or adopting F-style, particularly FD-fixation, may help prevent tilt and decentration, reduce refractive errors, and improve postoperative visual function.

PMID:40454421 | PMC:PMC12124310 | DOI:10.2147/OPTH.S515743

Psychiatr Psychol Law. 2024 May 5;32(3):423-439. doi: 10.1080/13218719.2024.2330046. eCollection 2025.

ABSTRACT

Accurate assessments about medical decision-making capacity (DMC) are vital but could be susceptible to age-bias. We examined if client age impacts on DMC likelihood assessment. One hundred and forty-seven adults were trained to identify four cognitive abilities (i.e., understanding, appreciation, reasoning, expression). Six experimental vignettes described a person making a diabetes treatment decision with systematic variation of client age (unspecified, 50-, or 95-years-old) and abilities (demonstrated vs uncertain). The dependent variable was DMC likelihood. Standardised tests of explicit (Kogan’s Attitudes Toward Old People scale) and implicit age-bias (IAT) were administered. There was a statistically significant effect of abilities on DMC likelihood. DMC was judged more likely when cognitive abilities were demonstrated. There were no other significant effects. Age-bias, measured implicitly and explicitly, did not influence DMC likelihood. Contrary to the hypothesis, DMC likelihood was unaffected by client age. This suggests that training can mitigate age-bias in simulated clinical DMC evaluation.

PMID:40454377 | PMC:PMC12123955 | DOI:10.1080/13218719.2024.2330046

J Tehran Heart Cent. 2024 Oct;19(4):256-263. doi: 10.18502/jthc.v19i4.17610.

ABSTRACT

BACKGROUND: Rheumatic heart disease (RHD) is exacerbated by chronic inflammation that stimulates the release of proinflammatory cytokines, most notably transforming growth factor-beta 1 (TGF-β1), which promotes myofibroblast differentiation. This study aims to determine the optimal dosage of Lisinopril, an angiotensin-converting enzyme inhibitor, for mitigating the fibrotic changes associated with RHD.

METHODS: This in vitro, posttest-only control group study involved obtaining valvular interstitial cells from the heart valves of 25 male New Zealand rabbits (Oryctolagus cuniculus). Valvular interstitial cells were divided into 5 groups: a control group exposed to TGF-β1, and 4 experimental groups exposed to various Lisinopril doses (1 μM, 10 μM, and 100 μM) in addition to TGF-β1. The effect of Lisinopril on myofibroblast differentiation was assessed by measuring alpha-smooth muscle actin (αSMA) expression through immunocytochemical methods. Statistical significance was determined using an independent T-test with a P value of less than 0.050.

RESULTS: Independent T-tests conducted on 25 male Oryctolagus cuniculus demonstrated significantly lower αSMA expression in the groups treated with various Lisinopril doses (1 μM, 10 μM, and 100 μM) compared with the TGF-β1-induced control group (P<0.050). The most significant reduction in αSMA expression was observed in the group treated with the highest Lisinopril dose of 100 μM.

CONCLUSION: Lisinopril demonstrates a significant ability to inhibit TGF-β1-induced myofibroblast differentiation in rabbit valve interstitial cells, with the 100 μM dose proving most effective. These results suggest that Lisinopril may have the potential to curb RHD progression, warranting further investigations in vivo.

PMID:40454360 | PMC:PMC12126187 | DOI:10.18502/jthc.v19i4.17610

Risk Manag Healthc Policy. 2025 May 27;18:1761-1771. doi: 10.2147/RMHP.S517386. eCollection 2025.

ABSTRACT

BACKGROUND: Sepsis, a severe medical condition caused by a dysregulated host response to infection, accounts for 20% of global fatalities. While simplifying early sepsis treatment with the Sepsis Six care bundle has been shown to reduce mortality by 46.6%, multiple barriers often prevent clinical nurses from adhering to sepsis care recommendations. Identifying these barriers is essential to eliminating them, and thus the Sepsis Six Care bundle (BLISS-1) questionnaire was developed to identify the barriers to and facilitators of nurses’ implementation of the Sepsis Six care bundle while caring for sepsis patients. The current study assessed the psychometric properties of the BLISS-1 questionnaire to evaluate its validity and reliability.

PURPOSE: This study assessed the psychometric properties of the BLISS-1 questionnaire.

METHODS: A total of 180 clinical nurses working in different critical care units at a selected University Hospital participated in a cross-sectional, descriptive study. Data were collected using the BLISS-1 Questionnaire, used to assess the perceived barriers to and facilitators of Sepsis Six performance. Descriptive statistics, Cronbach’s alpha reliability analysis, and Promax rotation EFA were performed to assess the validity and reliability of the questionnaire.

RESULTS: The BLISS-1 questionnaire has strong internal consistency, with Cronbach’s alpha values of 0.978 for perceived barriers and 0.976 for perceived importance. Factor analysis revealed that key barriers included skepticism about the protocol’s clinical efficacy and operational challenges such as limited training and insufficient resources.

CONCLUSION: This study revealed the BLISS-1 questionnaire to be highly reliable. Focused education, appropriate resource allocation, and supporting policies are needed to increase nurses’ adherence to the Sepsis Six protocol and, hence, improve patient outcomes.

PMID:40454349 | PMC:PMC12126116 | DOI:10.2147/RMHP.S517386

ACS Cent Sci. 2025 Feb 17;11(5):665-671. doi: 10.1021/acscentsci.4c01878. eCollection 2025 May 28.

ABSTRACT

Covalent organic frameworks (COFs) have emerged as promising atmospheric water harvesters, offering a potential solution to the pressing global issue of water scarcity, which threatens millions of lives worldwide. This study presents a series of 2D COFs, including HCOF-3, HCOF-2, and a newly developed structure named COF-309, designed for optimized water harvesting performance with a high working capacity at low relative humidity. To elucidate their water sorption behavior, we introduce a hydrophilicity index directly linked to intrinsic properties, such as the strength and spatial density of adsorptive sites. This index is mathematically correlated to the step of water adsorption isotherms. Our correlation provides a predictive tool that extends to other microporous COFs and metal-organic frameworks, significantly enhancing the ability to predict their onset positions of water adsorption isotherms based on structural characteristics. This advancement holds the potential to guide the development of more efficient materials for atmospheric water harvesting.

PMID:40454336 | PMC:PMC12123544 | DOI:10.1021/acscentsci.4c01878

Clin Interv Aging. 2025 May 27;20:717-726. doi: 10.2147/CIA.S523457. eCollection 2025.

ABSTRACT

BACKGROUND: The healthy nucleus pulposus (NP) of the intervertebral disc is normally replete with proteoglycans and highly hydrated. With degeneration, the disc loses its capacity to bind water, substantially reducing its ability to cushion physiologic loads. Supplementation of degenerated NP with a commercially available NP allograft represents a promising approach to ameliorating lumbar discogenic pain.

METHODS: This was a prospective, single arm clinical study involving 21 patients at 5 US sites. The magnitude of improvement in back pain severity, back disability and quality of life was evaluated in Medicare-age (≥65 years) patients with chronic axial low back pain treated with intradiscally delivered NP allograft at up to three lumbar vertebral levels (L1-S1). Followup was at 1, 3 and 6 months. Back pain was determined using an 11-point numeric rating scale (NRS), back function by Oswestry disability index (ODI) and quality of life using the PROMIS-29 questionnaire.

RESULTS: There was a 60% reduction in average back pain scores between baseline and 6 months; the difference (4.0, 95% CI [2.9, 5.2]) was statistically significant (p < 0.001). 82% and 71% of participants achieved ≥30% and ≥50% NRS improvement, respectively, at 6 months, and 65% of participants reported a final NRS score ≤3. The 6-month improvement in mean ODI scores was 50% with an average difference of 22.8 (95% CI [14, 31]) (p < 0.001). 68% and 51% realized ≥30% and ≥50% ODI improvements, respectively, at 6 months. All PROMIS-29 domains showed improvements toward the normative mean value of 50 by 6 months. No adverse events related to the NP allograft were reported.

CONCLUSION: These findings show clinically significant pain palliation, functional improvement and quality of life enhancement in older adults following supplementation of the degenerated disc with NP allograft.

PMID:40454303 | PMC:PMC12126140 | DOI:10.2147/CIA.S523457

J Pain Res. 2025 May 27;18:2739-2750. doi: 10.2147/JPR.S512263. eCollection 2025.

ABSTRACT

INTRODUCTION: Recently, increasing research has shown inferior outcomes in patients with respect to specific social determinants of health. Therefore, optimizing diversity training given to pain management providers is imperative for physicians to provide culturally competent healthcare and to improve patient outcomes. In this paper, we attempt to describe trends in the Pacific Spine and Pain Society (PSPS) membership to help discover optimal diversity education paradigms for pain management providers by performing a survey on behalf PSPS.

METHODS: A survey was disseminated to all members of the PSPS at the 2022 annual meeting. Opinions were solicited with respect to respondents’ demographics, diversity training type, diversity training timing, and how this correlates with a respondent’s self-reported confidence in navigating diversity issues in the workplace. Cronbach’s alpha test was used to rate internal consistency while logistic regression models were used for statistical analysis.

RESULTS: Cronbach’s alpha produced a rating of 0.91. A total of 164 individuals responded to the survey, with 115 (70%) being male and 98 (60%) did not consider themselves to be under-represented in medicine. Survey respondents who obtained diversity training post-fellowship (p = 0.004) and with interactive training type (p = 0.010) self-reported to be more confident in handling matters of diversity in the workplace. Respondents who were underrepresented (p = 0.018), females (p = 0.033), practice in the west coast (p = 0.036), academic practice (p=0.031), and non-rural areas (p = 0.033) were also found to be more confident in handling matters of diversity.

CONCLUSION: Practitioners who received diversity training post-fellowship and with interactive and role model formats felt most confident to handle matters of diversity. Underrepresented groups, females, individuals from non-rural practices and individuals from academic practices appear to feel more confident in handling these issues.

PMID:40454301 | PMC:PMC12126138 | DOI:10.2147/JPR.S512263