Tag: statistics

Health Aff (Millwood). 2026 Apr;45(4):378-386. doi: 10.1377/hlthaff.2025.01324.

ABSTRACT

Maryland hospitals have operated under all-payer global budget models since 2014. Within Medicare, evaluations have estimated the resulting cost savings to be $1.6 billion for the period 2014-22. To understand the aggregate inpatient and outpatient utilization changes underlying these savings and how utilization changed across all ages, we analyzed trends in Maryland relative to other states during the period 2013-23. We used national commercial claims data alongside Medicare fee-for-service claims. After we adjusted for population aging and other demographic changes, hospital utilization in Maryland decreased 11 percentage points more than in other states, primarily driven by outpatient utilization trends, which were 19 percentage points lower in Maryland than elsewhere. These results are nationally relevant, given broad interest in addressing rising hospital outpatient utilization. However, there are risks in such utilization reductions, and global budget designs must consider payment levels that are fair for both payers and providers while embedding mechanisms that maintain quality and discourage stinting on patient care.

PMID:41941672 | DOI:10.1377/hlthaff.2025.01324

Health Aff (Millwood). 2026 Apr;45(4):387-394. doi: 10.1377/hlthaff.2025.01313.

ABSTRACT

It is not currently understood whether the COVID-19 pandemic led to a lengthy period of elevated mortality rates or whether rates have returned to prepandemic trends. To examine this, I calculated age-adjusted excess mortality rates and percent excess mortality overall, by cause, and for population subgroups. COVID-19 death rates in the US fell 93 percent from 2021 to 2024, whereas excess non-COVID-19 death rates declined just 48 percent, with sustained excess mortality likely in the future, particularly for many natural causes. Suicide death rates did not rise, drug and homicide death rates jumped initially but declined relatively quickly, and transport death rates grew more moderately but showed greater persistence. Demographic-group differences were pronounced, with substantial lasting effects for females, American Indian/Alaska Native people, and seniors. This reflects heterogeneity in the prepandemic composition of deaths and in cause-specific percent excess mortality rates across groups. These results indicate important clinical and policy challenges, especially for natural causes of death and for groups facing relatively high cause-specific excess mortality rates.

PMID:41941671 | DOI:10.1377/hlthaff.2025.01313

Health Aff (Millwood). 2026 Apr;45(4):441-447. doi: 10.1377/hlthaff.2025.00644.

ABSTRACT

The Inflation Reduction Act (IRA) of 2022 changed the financing and risk-bearing obligations of Medicare Part D prescription drug plans in 2025. We used the Medicare 2021-25 public use files to construct a counterfactual trend using 2021-24 data to predict 2025 outcomes if the IRA had not implemented substantial benefit changes. We compared actual deductibles, premiums, and utilization management outcomes in 2025 against outcomes predicted by prior trends for both Medicare Advantage prescription drug (MA-PD) plans and Medicare Part D standalone prescription drug plans (PDPs). We found substantial differences between the predicted inflation-adjusted and population-weighted trend and actual deductibles for MA-PD plans (actual mean, $305.42; predicted mean, $187.54) and for PDPs (actual mean, $490.56 per month; predicted mean, $401.42 per month), as well as a decrease in premiums for MA-PD plans (actual mean, $12.76 per month; predicted mean, $15.02 per month) and for PDPs (actual mean, $39.55 per month; predicted mean, $64.07 per month). No changes were observed for prior authorization or step therapy. Formularies became smaller for protected classes and low-tier drugs in 2025 for PDPs relative to prior trend. No changes in the size of the preferred retail pharmacy networks were observed relative to prior trend.

PMID:41941670 | DOI:10.1377/hlthaff.2025.00644

JAMA Netw Open. 2026 Apr 1;9(4):e265061. doi: 10.1001/jamanetworkopen.2026.5061.

ABSTRACT

IMPORTANCE: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer for which current guidelines recommend adjuvant chemotherapy. Data about the benefit of adjuvant chemotherapy in older women with TNBC are scarce.

OBJECTIVE: To assess the survival benefit of adjuvant chemotherapy in older women with nonmetastatic TNBC.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study used the Surveillance, Epidemiology, and End Results database from January 1, 2010, to December 31, 2021. Participants included women 70 years or older with nonmetastatic TNBC who underwent surgical removal of breast tumor and were candidates for adjuvant chemotherapy. The median follow-up was 46 (IQR, 21-83) months. Statistical analysis was conducted on August 4, 2025.

EXPOSURE: Receipt or nonreceipt of adjuvant chemotherapy.

MAIN OUTCOMES AND MEASURES: The primary outcome was breast cancer-specific survival between patients who received chemotherapy and those who did not. Logistic regression models assessed variables associated with chemotherapy use. Machine learning with a generalized boosted model was used to estimate propensity scores. Inverse probability of treatment weighting and Cox proportional hazards regression methods were used to compare breast cancer-specific and overall survival.

RESULTS: A total of 5730 women (median age, 76 [IQR, 73-81] years) were included in the analysis; 2509 received chemotherapy and 3221 did not. Patients who received chemotherapy were younger (median age, 74 [IQR, 71-77] vs 79 [IQR, 74-84] years) and had more advanced disease (stage II-III, 1388 [54%.5] vs 1664 [51.7%]) than those who did not. Adjuvant chemotherapy was associated with improved breast cancer-specific survival (hazard ratio [HR], 0.69; 95% CI, 0.58-0.82) and overall survival (HR, 0.55; 95% CI, 0.49-0.62). Similar results were observed across subgroups. Increasing age (odds ratio [OR] for 80-89 years, 0.15 [95% CI, 0.13-0.17]; OR for ≥90 years, 0.02 [95% CI, 0.01-0.04]) was associated with lower odds of receiving adjuvant chemotherapy.

CONCLUSIONS AND RELEVANCE: In this cohort study of older women with TNBC, adjuvant chemotherapy was associated with improved survival outcomes. Underutilization of adjuvant chemotherapy in older women may contribute to worse outcomes. Geriatric assessment tools may help guide individualized treatment decisions and promote equitable care.

PMID:41941187 | DOI:10.1001/jamanetworkopen.2026.5061

Psychol Methods. 2026 Apr 6. doi: 10.1037/met0000829. Online ahead of print.

ABSTRACT

In recent years, there has been a growing call to advance psychological theorizing through formal modeling. We answer this by introducing a methodology for developing psychological theories using probabilistic network models (PNMs). Originating in statistical mechanics, PNMs describe networks of interacting elements and have already shaped prominent theories in attitude, emotion, and decision research. We present a systematic guide on how to develop, analyze, and validate PNMs. Central to our framework is a review of nine foundational models that researchers can start from, extend, and adapt to their specific contexts. For each of these models, we discuss existing applications and analyze them using two newly developed tools: a NetLogo model for simulations and an R package for visualizing mean-field dynamics. As a case study, we demonstrate the application of PNMs in theory development before discussing the assumptions and limitations of the framework. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41941158 | DOI:10.1037/met0000829

Psychol Methods. 2026 Apr 6. doi: 10.1037/met0000820. Online ahead of print.

ABSTRACT

Semantic richness refers to the number of distinct features people associate with a concept, a key indicator of how knowledge is represented and accessed in memory. It is typically measured through free-generation tasks-such as the property listing task-where participants list properties of everyday concepts (e.g., a BANANA might be described as “yellow,” “soft,” or something you “peel”). However, most studies simply count the observed features, ignoring sampling variability and leading to biased comparisons across groups. To address this limitation, we adapted the Chao2 estimator-originally developed in ecology-to infer the total number of features associated with a concept, including those not observed in a given sample. We validated this approach for psychological research through extensive Monte Carlo simulations based on empirical data from three languages. Results show that Chao2, and especially its bias-corrected version (Chao2BC), yield more accurate and interpretable estimates than simple counts. This framework reframes semantic richness as a problem of statistical inference, providing a principled basis for comparing conceptual data across languages, populations, and experimental contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41941157 | DOI:10.1037/met0000820

Infect Dis (Lond). 2026 Apr 6:1-12. doi: 10.1080/23744235.2026.2651975. Online ahead of print.

ABSTRACT

OBJECTIVES: Research on Severe Fever with Thrombocytopenia Syndrome (SFTS) in Qingdao, an emerging public health threat, remains limited. This study aimed to systematically characterise its epidemiological features, identify spatiotemporal clustering patterns and develop a time-series prediction model to inform targeted prevention and control strategies.

METHODS: SFTS case data in Qingdao from 2014 to 2025 were acquired from the China Information System for Disease Control and Prevention. Spatial autocorrelation analysis, encompassing both global and local assessments, was performed using ArcGIS 10.8. The identification of spatiotemporal clusters was carried out with SatScan version 9.6. Furthermore, a Seasonal Autoregressive Integrated Moving Average (SARIMA) model was developed utilising R software (version 4.4.2) for time-series forecasting.

RESULTS: From 2014 to 2025, 711 SFTS cases were reported in Qingdao, corresponding to an average annual incidence of 0.61 per 100,000 population. There were 28 deaths, yielding a case fatality rate of 3.94%. Cases showed strong seasonality, with 99.16% occurring between April and October, predominantly among elderly farmers. Incidence exhibited positive spatial autocorrelation, with high-high clusters primarily concentrated in Huangdao District in the southern part of Qingdao. Spatiotemporal scan analysis identified three significant clusters located in the southern, northeastern and southwestern regions. The SARIMA model indicates that the number of cases is projected to exhibit an increasing trend beyond 2025.

CONCLUSION: SFTS in Qingdao exhibits obvious spatiotemporal clustering, and the number of cases continues to show an increasing trend.

PMID:41941155 | DOI:10.1080/23744235.2026.2651975

Psychol Trauma. 2026 Apr 6. doi: 10.1037/tra0002178. Online ahead of print.

ABSTRACT

OBJECTIVE: Posttraumatic growth refers to positive psychological changes following traumatic experiences. As research interest in posttraumatic growth increases, new tools for its measurement are being developed. However, concerns have been raised about the potential for illusory growth, which may inflate self-reported posttraumatic growth levels. To address this issue, the Stress-Related Growth Scale-Revised (SRGS-R) was created, using neutral item wording and a bipolar response scale to reduce response bias. This is the first time that the SRGS-R has been adapted and psychometrically validated outside its original English-language version.

METHOD: The adaptation procedure followed international recommendations and the methodology of the original SRGS-R study. Data were collected online from 636 Polish adults aged 18-72 who had experienced at least one Diagnostic and Statistical Manual of Mental Disorders, fifth edition-defined traumatic event, verified using the Life Events Checklist-5. Participants were randomly divided into two subsamples for exploratory (n = 309) and confirmatory (n = 327) factor analyses. In addition to the SRGS-R-PL, participants completed standardized Polish adaptations of instruments assessing posttraumatic stress disorder symptoms, coping strategies, depressive symptoms, and well-being.

RESULTS: Factor analysis confirmed a unidimensional structure explaining 53.97% of the variance, with good model fit. The SRGS-R-PL demonstrated high internal consistency (Cronbach’s α = .94) and theoretically consistent correlations with mental health measures and coping strategies.

CONCLUSIONS: The Polish version of the SRGS-R shows strong psychometric properties and validity, providing a reliable tool for assessing growth following stress or trauma. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41941139 | DOI:10.1037/tra0002178

Psychol Trauma. 2026 Apr 6. doi: 10.1037/tra0002159. Online ahead of print.

ABSTRACT

OBJECTIVE: Veterans with comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) often experience more severe symptoms, functional impairments, challenges in treatment engagement, and worse treatment outcomes than veterans with either disorder alone. Although topiramate is an effective pharmacotherapy for AUD and has shown promise in reducing PTSD symptoms, concerns about its potential cognitive side effects may deter prescribing providers and contribute to patient hesitancy. This study aimed to determine whether topiramate leads to adverse cognitive side effects that could impede its suitability to be used in tandem with prolonged exposure for PTSD and AUD.

METHOD: Data were analyzed from a double-blind, placebo-controlled trial in which 100 veterans with PTSD and AUD were randomized to receive prolonged exposure with either topiramate or placebo. Cognitive functioning was assessed at baseline and midtreatment, and PTSD symptoms were assessed at baseline and posttreatment.

RESULTS: Results showed no statistically significant differences between treatment groups in verbal learning and memory or processing speed performance at either time point, and all scores were within normal clinical ranges.

CONCLUSIONS: While minor declines in some cognitive domains were observed in both the topiramate and placebo groups, these changes were nonsignificant and not clinically meaningful (<1 standard deviation change). These findings suggest that topiramate does not produce clinically significant cognitive impairment when combined with prolonged exposure and may enhance treatment response. Future research should examine the long-term cognitive and therapeutic effects of topiramate to guide shared decision making and optimize integrated treatment for veterans with PTSD and AUD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:41941133 | DOI:10.1037/tra0002159

J Craniofac Surg. 2026 Apr 6. doi: 10.1097/SCS.0000000000012734. Online ahead of print.

ABSTRACT

Rhinoplasty is the fifth most commonly performed cosmetic surgery globally. While surgical techniques used for rhinoplasty have evolved significantly in the past century, the creation of precise osteotomies remains a cornerstone of the procedure. Recently, piezotomes have been associated with reduced postoperative pain, edema, ecchymosis, complications, and revision rates in rhinoplasty. Despite these clinically significant benefits, there remains a paucity of histologic analysis of osteotomies performed with piezotomes in a large translational preclinical model. In this study, n=12 adult sheep underwent lateral rhinoplasty of the posterior maxilla using each of the three surgical devices: piezotome, manual osteotome, and oscillatory saw. Subjects were randomized to heal for either 3 or 12 weeks postoperatively (n = 6 animals per cohort). En bloc samples were processed and analyzed histologically. A semiquantitative healing scale was used to quantify bony ingrowth into the osteotomy. Wilcoxon signed-rank tests were used to analyze the outcome variable. No statistically significant differences in semiquantitative grades were observed among groups (p > 0.05) at either time point. However, the piezotome was associated with more uniform, reproducible, and smoother osteotomy walls, and smaller bone chips at 3 weeks. At 12 weeks, all osteotomy techniques had complete or near-complete osteogenesis. Use of the piezotome did not completely prevent soft tissue injury. Some osteotomies demonstrated full-thickness penetration and injury to the underlying cartilage. All groups demonstrated comparable healing outcomes after 12 weeks. However, histologic results indicate that reliance solely on device technology may not be sufficient. Clinical judgement of these techniques and relevant case presentations is required to minimize unintended tissue injury.

PMID:41941121 | DOI:10.1097/SCS.0000000000012734