Tag: statistics

JAMA Health Forum. 2024 Dec 6;5(12):e244544. doi: 10.1001/jamahealthforum.2024.4544.

ABSTRACT

IMPORTANCE: Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs), but the association of NP practice independence with high-risk opioid prescribing is not well understood.

OBJECTIVE: To assess whether the rates of high-risk opioid prescribing changed in association with NP independence legislation.

DESIGN, SETTING, AND PARTICIPANTS: This difference-in-differences analysis compared rates of high-risk opioid prescribing in 6 states over 2 years following the adoption of NP independence compared with 10 neighboring nonadopting states from January 2012 to December 2021. Prescription insurance claims for 2 874 213 continuously enrolled individuals (members) aged 18 to 64 years from Blue Cross Blue Shield Axis were analyzed. Data analysis was carried out from 2021 to 2024.

EXPOSURE: Timing of the legislative effective date of NP independence in a state.

MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of opioid prescriptions that overlapped with a prescription for a central nervous system (CNS) depressant. Secondary outcomes included the number of days of opioid-CNS depressant overlap, as well as the dosage and days supplied of opioids among all members and among opioid-naive members.

RESULTS: Six states that adopted NP independence legislation and 10 nonadopting neighboring states were similar in terms of demographic characteristics and had comparable pretrends in prescribing. The estimated change in the rate of opioid prescriptions that overlapped with a CNS depressant was -0.03 per 100 members per month (95% CI, -0.11 to 0.05). Changes in the number of days of opioid-CNS depressant overlap and in the dosage and days supplied of opioids among all members and among opioid-naive members were also small and statistically insignificant.

CONCLUSIONS AND RELEVANCE: The results of this difference-in-differences analysis suggest that there was no relative increase in rates of high-risk opioid prescribing during the 2 years following the adoption of independence for NPs.

PMID:39705044 | DOI:10.1001/jamahealthforum.2024.4544

Environ Health Perspect. 2024 Dec;132(12):127003. doi: 10.1289/EHP15200. Epub 2024 Dec 20.

ABSTRACT

BACKGROUND: While water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to improve interventions and remove barriers to diarrheal disease reduction.

OBJECTIVES: We aimed to estimate how sensitive WASH intervention effectiveness was to underlying contextual and intervention factors in the WASH Benefits (WASH-B) Bangladesh cluster-randomized controlled trial.

METHODS: The investigators measured diarrheal prevalence in children enrolled in the WASH-B trial at three time points approximately 1 year apart (n=17,187 observations). We developed a susceptible-infectious-susceptible model with transmission across multiple environmental pathways and evaluated each of four interventions [water (W), sanitation (S), hygiene (H), and nutrition (N) applied individually and in combination], compliance with interventions, and the impact of individuals not enrolled in the study. Leveraging a set of mechanistic parameter combinations fit to the WASH-B Bangladesh trial using a hybrid Bayesian sampling-importance resampling and maximum-likelihood estimation approach, we simulated trial outcomes under counterfactual scenarios to estimate how changes in six WASH factors (preexisting WASH conditions, disease transmission potential, intervention compliance, intervenable fraction of transmission, intervention efficacy, and community coverage) impacted intervention effectiveness.

RESULTS: Increasing community coverage had the greatest impact on intervention effectiveness (e.g., median increases in effectiveness of 34.0 and 45.5 percentage points in the WSH and WSHN intervention arms when increasing coverage to 20%). The effect of community coverage on effectiveness depended on how much transmission was along pathways not modified by the interventions. Intervention effectiveness was reduced by lower levels of preexisting WASH conditions or increased baseline disease burden. Individual interventions had complementary but not synergistic effects when combined.

DISCUSSION: To realize the expected health gains, future WASH interventions must address community coverage and transmission along pathways not traditionally covered by WASH. The effectiveness of individual-level WASH improvements is reduced more the further the community is from achieving the coverage needed for herd protection. https://doi.org/10.1289/EHP15200.

PMID:39705040 | DOI:10.1289/EHP15200

JAMA Netw Open. 2024 Dec 2;7(12):e2451806. doi: 10.1001/jamanetworkopen.2024.51806.

ABSTRACT

IMPORTANCE: Childhood adverse experiences have been linked with long-term risk of cardiovascular disease (CVD), yet the transgenerational associations between interparental behaviors and CVD remain poorly understood.

OBJECTIVES: To explore the association between exposure to childhood interparental physical violence and the subsequent risk of CVD and to examine whether the association is modified by adult depressive symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included data from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing study recruiting individuals aged 45 years or older, dated between June 1, 2011, and December 31, 2020, with a follow-up duration of 9 years. The data were analyzed from October 1, 2023, to May 10, 2024.

EXPOSURES: An early life exposure questionnaire with information on the frequency of witnessing interparental physical violence was administered. Depressive symptoms were assessed via the validated 10-item Center for Epidemiologic Studies Depression Scale.

MAIN OUTCOMES AND MEASURES: The outcome measures included self-reported physician-diagnosed heart disease (defined as myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems) and stroke. Multivariate Cox proportional hazards regression models using attained age as the time scale were conducted.

RESULTS: Of 10 424 participants, the mean (SD) age was 58.1 (9.0) years, 5332 (51.2%) were female, and 872 (8.4%) reported exposure to interparental physical violence. Exposure to childhood interparental physical violence was associated with increased risks of adult-onset CVD (hazard ratio [HR], 1.36; 95% CI, 1.20-1.55), heart disease (HR, 1.36; 95% CI, 1.17-1.57), and stroke (HR, 1.28; 95% CI, 1.03-1.61). Participants exposed to childhood interparental physical violence had a greater prevalence of depressive symptoms (2371 of 9335 participants [25.4%]), which mediated 11.0% of the association between childhood interparental physical violence and CVD (HR, 1.26; 95% CI, 1.09-1.45).

CONCLUSIONS AND RELEVANCE: In this cohort study, childhood exposure to interparental physical violence was associated with a higher risk of adult-onset CVD, which was partially mediated by adult depressive symptoms. The findings emphasize the need for comprehensive strategies and policy efforts that address the social determinants of interparental violence and provide household education opportunities.

PMID:39705033 | DOI:10.1001/jamanetworkopen.2024.51806

JAMA Netw Open. 2024 Dec 2;7(12):e2451813. doi: 10.1001/jamanetworkopen.2024.51813.

ABSTRACT

IMPORTANCE: Type 2 diabetes and hypertension are obesity-related, noncommunicable diseases becoming increasingly common worldwide. In 2008, Japan launched a nationwide universal health checkup program, Specific Health Checkup (SHC), for the primary prevention of obesity-related diseases, but its effectiveness has been understudied.

OBJECTIVE: To investigate the association of the SHC program with incident diabetes and hypertension, using a target trial emulation framework.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a longitudinal health care database involving both checkup history and medical encounter records in Japan. Individuals aged 40 to 74 years, without diabetes or hypertension, and without a prior checkup history, were eligible. Individuals were repeatedly assessed for eligibility from April 1, 2008, to March 31, 2020, to assemble sequential cohorts of 78 620 SHC participants and 214 554 nonparticipants. Statistical analysis was conducted from June 8 to December 30, 2023.

MAIN OUTCOMES AND MEASURES: The composite risk of incident type 2 diabetes or hypertension over a period of up to 10 years, defined as the combination of a newly documented diagnosis and use of relevant medications. A propensity score-weighted survival analysis was conducted to adjust for baseline variables. A series of sensitivity analyses and a negative outcome control analysis were conducted using depression as a benchmark.

RESULTS: Sequential cohorts consisted of 78 620 SHC participants (median age, 46 years [IQR, 41-53 years]; 62.7% women) and 214 554 nonparticipants (median age, 49 years [IQR, 44-55 years]; 82.0% women) from 153 084 unique persons, each of whom entered the study cohort a mean (SD) of 1.9 (1.5) times. Within a median follow-up of 4.2 years (IQR, 2.7-6.3 years), the primary end point occurred among 11.2% of all individuals (10.6% of the SHC participants and 11.4% of the nonparticipants), with a lower hazard ratio (HR) among the SHC recipients (HR, 0.90; 95% CI, 0.89-0.92); the difference in cumulative incidence at 10 years was -1.6% (95% CI, -1.8% to -1.3%). The sensitivity analyses showed similar results. The negative control analysis suggested the potential for residual confounding (HR, 1.05; 95% CI, 1.02-1.07); the bias-calibrated HR was 0.86 (95% CI, 0.84-0.89) for the primary outcome.

CONCLUSIONS AND RELEVANCE: In this cohort study, within a median of 4.2 years of follow-up, SHC recipients had a 9.8% lower risk of incident diabetes and hypertension (13.8% in the bias-calibrated analysis). The cost-effectiveness of the SHC and its transportability to other regions are unclear, requiring future investigations.

PMID:39705032 | DOI:10.1001/jamanetworkopen.2024.51813

JAMA Netw Open. 2024 Dec 2;7(12):e2451821. doi: 10.1001/jamanetworkopen.2024.51821.

ABSTRACT

IMPORTANCE: Given the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services.

OBJECTIVE: To examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: This serial cross-sectional study included national Veterans Health Administration (VHA) electronic medical record data from the VHA Corporate Data Warehouse. Adult patients (age ≥18 years) with a current OUD diagnosis (using International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) who received outpatient care at VHA facilities from January 1, 2005, to December 31, 2022, were eligible for inclusion in the analysis.

MAIN OUTCOMES AND MEASURES: The main outcome was OUD diagnoses. To test for changes in prevalence of OUD over time, multivariable logistic regression models were run that included categorical study year and were adjusted for sex, race and ethnicity, and categorical age.

RESULTS: The final sample size ranged from 4 332 165 to 5 962 564 per year; most were men (89.3%-95.0%). Overall, the annual percentage of VHA patients diagnosed with OUD almost doubled from 2005 to 2017 (0.60% [95% CI, 0.60%-0.61%] to 1.16% [95% CI, 1.15%-1.17%]; adjusted difference, 0.55 [95% CI, 0.54-0.57] percentage points) and declined thereafter (2022: 0.97% [95% CI, 0.97%-0.98%]; adjusted difference from 2017 to 2022, -0.18 [95% CI, -0.19 to -0.17] percentage points). This trend was similar among men (0.64% [95% CI, 0.63%-0.64%] in 2005 vs 1.22% [95% CI, 1.21%-1.23%] in 2017 vs 1.03% [95% CI, 1.02%-1.04%] in 2022), women (0.34% [95% CI, 0.32%-0.36%] in 2005 vs 0.68% [95% CI, 0.66%-0.69%] in 2017 vs 0.53% [95% CI, 0.52%-0.55%] in 2022), those younger than 35 years (0.62% [95% CI, 0.59%-0.66%] in 2005 vs 2.22% [95% CI, 2.18%-2.26%] in 2017 vs 1.00% [95% CI, 0.97%-1.03%] in 2022), those aged 35 to 64 years (1.21% [95% CI, 1.19%-1.22%] in 2005 vs 1.80% [95% CI, 1.78%-1.82%] in 2017 vs 1.41% [95% CI, 1.39%-1.42%] in 2022), and non-Hispanic White patients (0.44% [95% CI, 0.43%-0.45%] in 2005 vs 1.28% [95% CI, 1.27%-1.29%] in 2017 vs 1.13% [95% CI, 1.11%-1.14%] in 2022). Among VHA patients aged 65 years or older, OUD diagnoses increased from 2005 to 2022 (0.06% [95% CI, 0.06%-0.06%] to 0.61% [95% CI, 0.60%-0.62%]), whereas among Hispanic or Latino and non-Hispanic Black patients, OUD diagnoses decreased from 2005 (0.93% [95% CI, 0.88%-0.97%] and 1.26% [95% CI, 1.23%-1.28%], respectively) to 2022 (0.61% [95% CI, 0.59%-0.63%] and 0.82% [95% CI, 0.80%-0.83%], respectively).

CONCLUSIONS AND RELEVANCE: This serial cross-sectional study of national VHA electronic health record data found that the prevalence of OUD diagnoses increased from 2005 to 2017, peaked in 2017, and declined thereafter, a trend primarily attributable to changes among non-Hispanic White patients and those younger than 65 years. Continued public health efforts aimed at recognizing, treating, and preventing OUD are warranted.

PMID:39705031 | DOI:10.1001/jamanetworkopen.2024.51821

JAMA Netw Open. 2024 Dec 2;7(12):e2451837. doi: 10.1001/jamanetworkopen.2024.51837.

ABSTRACT

IMPORTANCE: It remains unclear how socioeconomic status (SES) is related to the association between diet and health, as well as the role of behavioral factors, in explaining socioeconomic disparities in health outcomes.

OBJECTIVE: To investigate the associations of neighborhood and individual SES factors, as well as behavioral factors, particularly dietary pattern, with health outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included US health professionals without chronic diseases at baseline who were enrolled in the Health Professionals Follow-Up Study (calendar years 1988-2018), the Nurses’ Health Study (calendar years 1992-2018), and the Nurses’ Health Study II (calendar years 2001-2019). Data analysis was performed in September 2023.

EXPOSURES: Repeated questionnaires were used to assess neighborhood and individual SES factors and behavioral factors, including dietary pattern (assessed using the Alternative Healthy Eating Index 2010), alcohol intake, body mass index, cigarette smoking, physical activity, sedentary television-viewing time, and sleep duration.

MAIN OUTCOMES AND MEASURES: The main outcomes were incident major cardiovascular disease (CVD), type 2 diabetes (T2D), and total mortality. The associations of SES and behavioral factors with outcomes were analyzed using multivariable Cox proportional hazards regression models with hazard ratios (HRs) per 10th- to 90th-percentile increments.

RESULTS: The study analyzed 152 192 participants for major CVD (mean [SD] age, 52.0 [8.7] years; 125 959 female [82.8%]), 151 217 participants for T2D (mean [SD] age, 52.0 [8.6] years; 125 231 female [82.8%]), and 141 145 participants for mortality (mean [SD] age, 51.6 [8.5] years; 117 627 female [83.3%]). A healthy dietary pattern was inversely associated with risk for major CVD (HR, 0.87 [95% CI, 0.82-0.93]), T2D (HR, 0.79 [95% CI, 0.75-0.84]), and total mortality (HR, 0.84 [95% CI, 0.81-0.88]). Without adjusting for neighborhood and individual SES factors, the HRs were 0.85 (95% CI, 0.80-0.91) for risk for major CVD, 0.78 (95% CI, 0.74-0.82) for T2D, and 0.82 (95% CI, 0.79-0.85) for total mortality. Neighborhood SES was inversely associated with risk for major CVD (HR, 0.90 [95% CI, 0.85-0.95]), T2D (HR, 0.92 [95% CI, 0.88-0.97]), and total mortality (HR, 0.91 [95% CI, 0.88-0.94]). Behavioral factors accounted for a large proportion of the associations with risk for major CVD (46.3% [95% CI, 32.5%-60.6%]), T2D (77.4% [95% CI, 64.5%-86.6%]), and total mortality (42.8% [95% CI, 32.9%-53.3%]).

CONCLUSIONS AND RELEVANCE: In this prospective cohort study of health professionals, associations between diet and health outcomes remained similar without adjusting for SES factors, while health behaviors, including diet, accounted for a large proportion of the associations between neighborhood SES and health. These findings highlight the importance of health behaviors, particularly high-quality diets, in promoting individual health and possibly reducing health disparities associated with SES.

PMID:39705030 | DOI:10.1001/jamanetworkopen.2024.51837

JAMA Netw Open. 2024 Dec 2;7(12):e2453976. doi: 10.1001/jamanetworkopen.2024.53976.

ABSTRACT

IMPORTANCE: Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.

OBJECTIVE: To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.

DESIGN, SETTING, AND PARTICIPANTS: This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.

INTERVENTION: The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.

RESULTS: Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.

CONCLUSIONS AND RELEVANCE: This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.

TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.

PMID:39705029 | DOI:10.1001/jamanetworkopen.2024.53976

Ann Med. 2025 Dec;57(1):2443256. doi: 10.1080/07853890.2024.2443256. Epub 2024 Dec 20.

ABSTRACT

BACKGROUND: Malnutrition is prevalent in patients with inflammatory bowel disease (IBD); however, its ability to predict the disease activity in IBD remains unexplored. Therefore, this study aimed to explore the association between malnutrition and disease activity in IBD.

METHODS: In this retrospective study, we enrolled 1006 patients diagnosed with IBD from the First Affiliated Hospital of Wenzhou Medical University from 2011 to 2022. Malnutrition was assessed based on the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), and controlling nutritional status (CONUT) scores. Logistic regression analyses were performed to identify predictors for disease activity. Restricted cubic spline analysis was performed to evaluate the possible nonlinear relations, and subgroup analysis was performed to explore potential interactions. Additionally, prediction performances were compared through receiver operating characteristic curves, net reclassification improvement, and integrated discrimination improvement.

RESULTS: The prevalence of malnutrition calculated by the PNI, GNRI, and CONUT scores in IBD was 16.9%, 72.1%, and 75.6%, respectively and significant correlations were observed among them. Multivariate logistic regression analysis showed that PNI, GNRI, and CONUT were independent risk factors for disease activity, and no significant nonlinear relationship was observed between disease activity and all three indexes. No statistically significant interactive effect was found in nearly all the subgroups. GNRI showed the highest predictive value compared with PNI and CONUT. Additionally, combining any of the three indexes improved the ability of C-reactive protein to predict IBD activity.

CONCLUSIONS: All three nutritional indexes evaluated malnutrition to be an independent risk factor for IBD activity.

PMID:39705015 | DOI:10.1080/07853890.2024.2443256

Stomatologiia (Mosk). 2024;103(6):66-72. doi: 10.17116/stomat202410306166.

ABSTRACT

OBJECTIVE: The aim of the study is to perform a systematic search, qualitative synthesis, and a meta-analysis of scientific publications on the prevalence and experience of dental caries among 15-year-old adolescents in the Arctic zone of the Russian Federation.

MATERIALS AND METHODS: A systematic review based on PRISMA guidelines. The review includes sources that describe the prevalence and intensity of caries in 15-year-old adolescents within the Arctic zone of the Russian Federation. Publications from 1998-2023 in English and Russian were searched for using the PubMed and eLIBRARY platforms. In total, 208 publications identified, but only 4 were included in meta-analysis.

RESULTS: The total number of adolescents in the studies included in the review was 1567 with a significant proportion being residents of the Arkhangelsk region. The weighted prevalence of caries was 87.9% (95% CI: 83.7-91.7%). The statistically significant increase was registered only in the city of Norilsk. In Arkhangelsk, the increase in the prevalence of caries was accompanied by a decrease in the activity of the carious process, which was due to a significant decrease in the K component in the structure of the DMFT index.

CONCLUSION: The review provides the evidence on a high prevalence of caries among 15-year-old adolescents in Arctic Russia. Further research of the dental status of adolescents is warranted as well as the development of effective preventive measures on individual and population levels.

PMID:39705001 | DOI:10.17116/stomat202410306166

Stomatologiia (Mosk). 2024;103(6):55-59. doi: 10.17116/stomat202410306155.

ABSTRACT

THE AIM: The of study was to assess the prevalence and features of acute dental trauma in children living in educational institutions.

MATERIALS AND METHODS: 131 medical records of children from orphanages who suffered dental injuries in the period from 2017 to 2021 were studied. The analysis of the relationship of the type of acute dental injury (ADI) with the gender, age of patients, history, and the timing of medical care access was carried out. A dental examination was also performed on 52 healthy pupils of the Center for the Promotion of Family Education in Moscow (study group) with ADI. The control group consisted of healthy children living in families (n=52). The dental aesthetic index DAI was determined in patients of both groups.

RESULTS: Based on a retrospective analysis of the medical histories of children in educational institutions, 38.2% had a tooth luxation, 61.8% had a tooth fracture. The timing for medical care provision was characterized by a large range of values, an asymmetry of distribution (Me=4.5 days). The prevalence of ADI was higher in children from orphanages compared with children of the control group. In the case of a history of tooth injury, the DAI index was on average 5.2 points higher (p=0.016).

CONCLUSION: Dental examination of children in orphanages revealed a higher prevalence of OTD compared to children living in families. The DAI b index in patients of both groups is on average 5.2 points higher (p=0.016) in the case of a history of ADI. The study highlights the need to improve dental care and prevent dental injuries among children in educational institutions.

PMID:39704999 | DOI:10.17116/stomat202410306155