Tag: statistics

JMIR Public Health Surveill. 2024 Apr 5;10:e49527. doi: 10.2196/49527.

ABSTRACT

BACKGROUND: In the United States, both drug overdose mortality and injection-involved drug overdose mortality have increased nationally over the past 25 years. Despite documented geographic differences in overdose mortality and substances implicated in overdose mortality trends, injection-involved overdose mortality has not been summarized at a subnational level.

OBJECTIVE: We aimed to estimate the annual number of injection-involved overdose deaths in each US state from 2000 to 2020.

METHODS: We conducted a stratified analysis that used data from drug treatment admissions (Treatment Episodes Data Set-Admissions; TEDS-A) and the National Vital Statistics System (NVSS) to estimate state-specific percentages of reported drug overdose deaths that were injection-involved from 2000 to 2020. TEDS-A collects data on the route of administration and the type of substance used upon treatment admission. We used these data to calculate the percentage of reported injections for each drug type by demographic group (race or ethnicity, sex, and age group), year, and state. Additionally, using NVSS mortality data, the annual number of overdose deaths involving selected drug types was identified by the following specific multiple-cause-of-death codes: heroin or synthetic opioids other than methadone (T40.1, T40.4), natural or semisynthetic opioids and methadone (T40.2, T40.3), cocaine (T40.5), psychostimulants with abuse potential (T43.6), sedatives (T42.3, T42.4), and others (T36-T59.0). We used the probabilities of injection with the annual number of overdose deaths, by year, primary substance, and demographic groups to estimate the number of overdose deaths that were injection-involved.

RESULTS: In 2020, there were 91,071 overdose deaths among adults recorded in the United States, and 93.1% (84,753/91,071) occurred in the 46 jurisdictions that reported data to TEDS-A. Slightly less than half (38,253/84,753, 45.1%; 95% CI 41.1%-49.8%) of those overdose deaths were estimated to be injection-involved, translating to 38,253 (95% CI 34,839-42,181) injection-involved overdose deaths in 2020. There was large variation among states in the estimated injection-involved overdose death rate (median 14.72, range 5.45-31.77 per 100,000 people). The national injection-involved overdose death rate increased by 323% (95% CI 255%-391%) from 2010 (3.78, 95% CI 3.33-4.31) to 2020 (15.97, 95% CI 14.55-17.61). States in which the estimated injection-involved overdose death rate increased faster than the national average were disproportionately concentrated in the Northeast region.

CONCLUSIONS: Although overdose mortality and injection-involved overdose mortality have increased dramatically across the country, these trends have been more pronounced in some regions. A better understanding of state-level trends in injection-involved mortality can inform the prioritization of public health strategies that aim to reduce overdose mortality and prevent downstream consequences of injection drug use.

PMID:38578676 | DOI:10.2196/49527

J Cereb Blood Flow Metab. 2024 Apr 5:271678X241241895. doi: 10.1177/0271678X241241895. Online ahead of print.

ABSTRACT

A mounting body of research points to cerebrovascular dysfunction as a fundamental element in the pathophysiology of Parkinson’s disease (PD). In the current feasibility study, blood-oxygen-level-dependent (BOLD) MRI was used to measure cerebrovascular reactivity (CVR) in response to hypercapnia in 26 PD patients and 16 healthy controls (HC), and aimed to find a multivariate pattern specific to PD. Whole-brain maps of CVR amplitude (i.e., magnitude of response to CO₂) and latency (i.e., time to reach maximum amplitude) were computed, which were further analyzed using scaled sub-profile model principal component analysis (SSM-PCA) with leave-one-out cross-validation. A meaningful pattern based on CVR latency was identified, which was named the PD CVR pattern (PD-CVRP). This pattern was characterized by relatively increased latency in basal ganglia, sensorimotor cortex, supplementary motor area, thalamus and visual cortex, as well as decreased latency in the cerebral white matter, relative to HC. There were no significant associations with clinical measures, though sample size may have limited our ability to detect significant associations. In summary, the PD-CVRP highlights the importance of cerebrovascular dysfunction in PD, and may be a potential biomarker for future clinical research and practice.

PMID:38578669 | DOI:10.1177/0271678X241241895

JAMA Netw Open. 2024 Apr 1;7(4):e245656. doi: 10.1001/jamanetworkopen.2024.5656.

ABSTRACT

IMPORTANCE: Youths with type 2 diabetes are at higher risk for complications compared with peers with type 1 diabetes, though few studies have evaluated differences in access to specialty care.

OBJECTIVE: To compare claims with diabetes specialists for youths with type 1 vs type 2 diabetes and the association between specialist claims with multidisciplinary and acute care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Optum Clinformatics Data Mart commercial claims. Individuals included in the study were youths younger than 19 years with type 1 or 2 diabetes as determined by a validated algorithm and prescription claims. Data were collected for youths with at least 80% enrollment in a commercial health plan from December 1, 2018, to December 31, 2019. Statistical analysis was performed from September 2022 to January 2024.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of ambulatory claims from an endocrine and/or diabetes physician or advanced practice clinician associated with a diabetes diagnosis code; secondary outcomes included multidisciplinary and acute care claims.

RESULTS: Claims were analyzed for 4772 youths (mean [SD] age, 13.6 [3.7] years; 4300 [90.1%] type 1 diabetes; 472 [9.9%] type 2 diabetes; 2465 [51.7%] male; 128 [2.7%] Asian, 303 [6.4] Black or African American, 429 [9.0%] Hispanic or Latino, 3366 [70.5%] non-Hispanic White, and 546 [11.4%] unknown race and ethnicity). Specialist claims were lower in type 2 compared with type 1 diabetes (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]; P < .001) in propensity score-weighted analyses. The presence of a comorbidity was associated with increased specialist claims for type 1 diabetes (IRR, 1.07 [95% CI, 1.03-1.10]) and decreased claims for type 2 diabetes (IRR, 0.77 [95% CI, 0.67-0.87]). Pooling diagnosis groups and adjusted for covariates, each additional specialist claim was associated with increased odds of a claim with a diabetes care and education specialist (odds ratio [OR], 1.31 [95% CI, 1.25-1.36]), dietitian (OR, 1.14 [95% CI, 1.09-1.19]), and behavioral health clinician (OR, 1.16 [95% CI, 1.12-1.20]). For acute care claims, each additional specialist claim was associated with increased odds of admission (OR, 1.17 [95% CI, 1.11-1.24]) but not for emergency claims (OR, 1.03 [95% CI, 0.98-1.82]).

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that youths with type 2 diabetes were significantly less likely to have specialist claims despite insurance coverage, indicating other barriers to care, which may include medical complexity. Access to diabetes specialists influences engagement with multidisciplinary services. The association between increasing ambulatory clinician services and admissions suggests high utilization by a subgroup of patients at greater risk for poor outcomes.

PMID:38578636 | DOI:10.1001/jamanetworkopen.2024.5656

Transl Vis Sci Technol. 2024 Apr 2;13(4):11. doi: 10.1167/tvst.13.4.11.

ABSTRACT

BACKGROUND: The purpose of this study was to explore the protective effect of a shape memory polymeric shield on corneal endothelium during phacoemulsification in rabbits.

METHODS: Poly-(glycerol dodecanedioate) (PGD) with a transition temperature of 24.416°C was prepared to make a shape memory shield with a thickness of 100 µm, an arc length of 14 mm, and a radius of curvature of 8.8 mm. In the control group, a phaco-tip with bevel-down was used to simulate injury to the corneal endothelium by phacoemulsification in rabbits. In the experimental group, the pre-cooled and curled shape memory shield was injected into and removed from the anterior chamber before and after phaco-power release. Anterior segment optical coherence tomography (AS-OCT), confocal microscope, trypan blue/alizarin red staining, and scanning electron microscope were performed to measure endothelial damage after surgery.

RESULTS: One day postoperatively, the lost cell ratio of the control group and the experimental group were 28.08 ± 5.21% and 3.50 ± 1.43%, respectively (P < 0.0001), the damaged cell ratios were 11.83 ± 2.30% and 2.55 ± 0.52%, respectively (P < 0.0001), and the central corneal thicknesses (CCT) were 406.75 ± 16.74 µm and 340. 5 ±13.48 µm, respectively (P < 0.0001). Seven days postoperatively, the endothelial cell density (ECD) of the control group and the experimental group were 1674 ± 285/mm2 and 2561 ± 554/mm2, respectively (P < 0.05). The above differences were all statistically significant.

CONCLUSIONS: This PGD based shape memory shield has a protective effect on corneal endothelium during phacoemulsification. It reduces postoperative corneal edema and ECD decrease in the short term after surgery.

TRANSLATIONAL RELEVANCE: The shape memory PGD “shield” in this study may have a use in certain human patients with vulnerable corneas of low endothelial cell count or shallow anterior chambers.

PMID:38578634 | DOI:10.1167/tvst.13.4.11

JAMA Health Forum. 2024 Apr 5;5(4):e240302. doi: 10.1001/jamahealthforum.2024.0302.

ABSTRACT

IMPORTANCE: Direct-acting antivirals (DAAs) are safe and highly effective for curing hepatitis C virus (HCV) infection, but their high cost led certain state Medicaid programs to impose coverage restrictions. Since 2015, many of these restrictions have been lifted voluntarily in response to advocacy or because of litigation.

OBJECTIVE: To estimate how the prescribing of DAAs to Medicaid patients changed after states eased access restrictions.

DESIGN, SETTING, AND PARTICIPANTS: This modified difference-in-differences analysis of 39 state Medicaid programs included Medicaid beneficiaries who were prescribed a DAA from January 1, 2015, to December 31, 2019. DAA coverage restrictions were measured based on a series of cross-sectional assessments performed from 2014 through 2022 by the US National Viral Hepatitis Roundtable and the Center for Health Law and Policy Innovation.

EXPOSURE: Calendar quarter when states eased or eliminated 3 types of DAA coverage restrictions: limiting treatment to patients with severe liver disease, restricting use among patients with active substance use, and requiring prescriptions to be written by or in consultation with specialists. States with none of these restrictions at baseline were excluded.

MAIN OUTCOMES AND MEASURES: Quarterly number of HCV DAA treatment courses per 100 000 Medicaid beneficiaries.

RESULTS: Of 39 states, 7 (18%) eliminated coverage restrictions, 25 (64%) eased restrictions, and 7 (18%) maintained the same restrictions from 2015 to 2019. During this period, the average quarterly use of DAAs increased from 669 to 3601 treatment courses per 100 000 Medicaid beneficiaries. After states eased or eliminated restrictions, the use of DAAs increased by 966 (95% CI, 409-1523) treatment courses per 100 000 Medicaid beneficiaries each quarter compared with states that did not ease or eliminate restrictions.

CONCLUSIONS AND RELEVANCE: The results of this study suggest that there was greater use of DAAs after states relaxed coverage restrictions related to liver disease severity, sobriety, or prescriber specialty. Further reductions or elimination of these rules may improve access to a highly effective public health intervention for patients with HCV.

PMID:38578628 | DOI:10.1001/jamahealthforum.2024.0302

JAMA Health Forum. 2024 Apr 5;5(4):e240430. doi: 10.1001/jamahealthforum.2024.0430.

ABSTRACT

IMPORTANCE: Policy changes and the COVID-19 pandemic affected health coverage rates, and the “unwinding” of Medicaid’s continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues.

OBJECTIVE: To assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzes nationally representative survey data for all US residents in the American Community Survey (ACS) from 2019 to 2022 compared with administrative data on Medicaid and the Children’s Health Insurance Program from the Centers for Medicare & Medicaid Services (CMS). Data analysis was conducted between June 2023 and January 2024.

EXPOSURES: The COVID-19 pandemic, the Medicaid continuous coverage provision, and policy efforts to increase Marketplace coverage.

MAIN OUTCOMES AND MEASURES: Medicaid coverage (self-reported [ACS] and administratively recorded [CMS]), survey-reported uninsured, Medicare, and private insurance status.

RESULTS: A nationally representative sample consisted of 12 506 584 US residents of all ages (survey-weighted 59.7% aged 19-64 years and 50.6% female). CMS statistics showed an increase in Medicaid coverage of 5.2 percentage points as a share of the population from 2019 to 2022. However, changes in the uninsured rate and survey-reported Medicaid were smaller: -1.2 (95% CI, -1.3 to -1.2) percentage points and 1.3 (95% CI, 1.2-1.4) percentage points, respectively. There was a 3.9 percentage point increase in the ACS’s “undercount” of Medicaid enrollment, compared with CMS data, from 2019 to 2022. This undercount was larger among children than adults but smaller in states that recently expanded Medicaid. Rates of additional forms of coverage (such as private insurance) among those in Medicaid also grew during this time.

CONCLUSION AND RELEVANCE: In this cross-sectional study, the uninsured rate declined considerably from 2019 to 2022 but was just one-fourth as large as the growth in administrative Medicaid enrollment under the pandemic continuous coverage provision. Survey-based Medicaid growth was far smaller than administrative growth. This suggests that many people who remained enrolled in Medicaid during the pandemic did not realize that their coverage had continued. These findings have implications for projecting uninsured changes during unwinding, as well as the effect of continuous coverage policies on continuity of care.

PMID:38578627 | DOI:10.1001/jamahealthforum.2024.0430

Invest Ophthalmol Vis Sci. 2024 Apr 1;65(4):14. doi: 10.1167/iovs.65.4.14.

ABSTRACT

PURPOSE: This study aims to examine the short-term peripheral choroidal thickness (PChT) response to signed defocus blur, both with and without native peripheral aberrations. This examination will provide insights into the role of peripheral aberration in detecting signs of defocus.

METHODS: The peripheral retina (temporal 15°) of the right eye was exposed to a localized video stimulus in 11 young adults. An adaptive optics system induced 2D myopic or hyperopic defocus onto the stimulus, with or without correcting native peripheral ocular aberrations (adaptive optics [AO] or NoAO defocus conditions). Choroidal scans were captured using Heidelberg Spectralis OCT at baseline, exposure (10, 20, and 30 minutes), and recovery phases (4, 8, and 15 minutes). Neural network-based automated MATLAB segmentation program measured PChT changes from OCT scans, and statistical analysis evaluated the effects of different optical conditions over time.

RESULTS: During the exposure phase, NoAO myopic and hyperopic defocus conditions exhibited distinct bidirectional PChT alterations, showing average thickening (10.0 ± 5.3 µm) and thinning (-9.1 ± 5.5 µm), respectively. In contrast, induced AO defocus conditions did not demonstrate a significant change from baseline. PChT recovery to baseline occurred for all conditions. The unexposed fovea did not show any significant ChT change, indicating a localized ChT response to retinal blur.

CONCLUSIONS: We discovered that the PChT response serves as a marker for detecting peripheral retinal myopic and hyperopic defocus blur, especially in the presence of peripheral aberrations. These findings highlight the significant role of peripheral oriented blur in cueing peripheral defocus sign detection.

PMID:38578621 | DOI:10.1167/iovs.65.4.14

J Am Med Inform Assoc. 2024 Apr 5:ocae067. doi: 10.1093/jamia/ocae067. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the consistency and reliability of medication recommendations provided by ChatGPT for common dermatological conditions, highlighting the potential for ChatGPT to offer second opinions in patient treatment while also delineating possible limitations.

MATERIALS AND METHODS: In this mixed-methods study, we used survey questions in April 2023 for drug recommendations generated by ChatGPT with data from secondary databases, that is, Taiwan’s National Health Insurance Research Database and an US medical center database, and validated by dermatologists. The methodology included preprocessing queries, executing them multiple times, and evaluating ChatGPT responses against the databases and dermatologists. The ChatGPT-generated responses were analyzed statistically in a disease-drug matrix, considering disease-medication associations (Q-value) and expert evaluation.

RESULTS: ChatGPT achieved a high 98.87% dermatologist approval rate for common dermatological medication recommendations. We evaluated its drug suggestions using the Q-value, showing that human expert validation agreement surpassed Q-value cutoff-based agreement. Varying cutoff values for disease-medication associations, a cutoff of 3 achieved 95.14% accurate prescriptions, 5 yielded 85.42%, and 10 resulted in 72.92%. While ChatGPT offered accurate drug advice, it occasionally included incorrect ATC codes, leading to issues like incorrect drug use and type, nonexistent codes, repeated errors, and incomplete medication codes.

CONCLUSION: ChatGPT provides medication recommendations as a second opinion in dermatology treatment, but its reliability and comprehensiveness need refinement for greater accuracy. In the future, integrating a medical domain-specific knowledge base for training and ongoing optimization will enhance the precision of ChatGPT’s results.

PMID:38578616 | DOI:10.1093/jamia/ocae067

J Orthop Trauma. 2024 Apr 2. doi: 10.1097/BOT.0000000000002808. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to perform a network meta-analysis (NMA) of level I and II evidence comparing different management techniques to define the optimum treatment method for humeral shaft fractures (HSF).

METHODS: Data Sources: A systematic review of the literature using PRISMA guidelines of MEDLINE, EMBASE, and Cochrane Library was screened from 2010-2023.

STUDY SELECTION: Inclusion criteria were evidence level I or II studies comparing nonoperative and/or operative repair techniques including open reduction internal fixation plate osteosynthesis (ORIF-Plate), minimally invasive percutaneous plating (MIPO), and intramedullary nail fixation (IMN) for the management of HSF (AO OTA 12A,B,C).

DATA EXTRACTION: The risk of bias (ROB) and methodologic quality of evidence (MQOE) were assessed according to the guidelines designed by the Cochrane Statistical Methods Group and Cochrane Methods Bias Group.

DATA SYNTHESIS: NMA were conducted with a frequentist approach with a random effects model using the netmeta package version 0.9-6 in R.

RESULTS: A total of 25 studies (1,908 patients) were included. MIPO resulted in the lowest complication rate (2.1%) when compared to ORIF-Plate (16.1%) (OR, 0.13;95%CI,0.04-0.49). MIPO resulted in the lowest nonunion rate (0.65%) compared to all management techniques (OR 0.28; 95%CI, 0.08-0.98), whereas Non-Op resulted in the highest (15.87%) (OR,3.48; 95%CI, 1.98-6.11). MIPO demonstrated the lowest rate of postoperative radial nerve palsy overall (2.2%) and demonstrated a significantly lower rate compared to ORIF-Plate (OR,0.22,95% CI, 0.07-0.71, p=0.02). IMN resulted in the lowest rate of deep infection (1.1%) when compared to ORIF-Plate (8.6%; p=0.013). MIPO resulted in a significantly lower DASH score (3.86±5.2) and higher ASES score (98.2± 1.4) than ORIF-Plate (19.5±9.0 & 60.0±5.4, p<0.05).

CONCLUSION: The results from this study support that surgical management results in better postoperative functional outcomes, leads to higher union rates, reduces fracture healing time, reduces revision rate and decreases malunion rates in patients with HSFs. Additionally, MIPO resulted in statistically higher union rates, lowest complication rate, lowest rate of postoperative radial nerve palsy, and lower intraoperative time, while resulting in better postoperative DASH and ASES scores when compared to nonoperative and operative (ORIF & IMN) treatment modalities.

LEVEL OF EVIDENCE: Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:38578605 | DOI:10.1097/BOT.0000000000002808

J Endocrinol Invest. 2024 Apr 5. doi: 10.1007/s40618-024-02352-z. Online ahead of print.

ABSTRACT

PURPOSE: Risk factors for developing radioiodine refractory thyroid cancer (RAIR-TC) have rarely been analyzed. The purpose of the present study was to find clinical and pathological features associated with the occurrence of RAIR-disease in differentiated thyroid cancers (DTC) and to establish an effective predictive risk score.

METHODS: All cases of RAIR-DTC treated in our center from 1990 to 2020 were retrospectively reviewed. Each case was matched randomly with at least four RAI-avid DTC control patients based on histological and clinical criteria. Conditional logistic regression was used to examine the association between RAIR-disease and variables with univariate and multivariate analyses. A risk score was then developed from the multivariate conditional logistic regression model to predict the risk of refractory disease occurrence. The optimal cut-off value for predicting the occurrence of RAIR-TC was assessed by receiver operating characteristic (ROC) curves and Youden’s statistic.

RESULTS: We analyzed 159 RAIR-TC cases for a total of 759 controls and found 7 independent risk factors for predicting RAIR-TC occurrence: age at diagnosis ≥ 55, vascular invasion, synchronous cervical, pulmonary and bone metastases at initial work-up, cervical and pulmonary recurrence during follow-up. The predictive score of RAIR-disease showed a high discrimination power with a cut-off value of 8.9 out of 10 providing 86% sensitivity and 92% specificity with an area under the curve (AUC) of 0.95.

CONCLUSION: Predicting the occurrence of RAIR-disease in DTC patients may allow clinicians to focus on systemic redifferentiating strategies and/or local treatments for metastatic lesions rather than pursuing with ineffective RAI-therapies.

PMID:38578580 | DOI:10.1007/s40618-024-02352-z