Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.43879
Nelson B Watts
{"title":"What to Do When Denosumab Is Stopped?","authors":"Nelson B Watts","doi":"10.1001/jamanetworkopen.2024.43879","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.43879","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443879"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.45334
Sachin D Shah
{"title":"From Innovation to Inclusion-Tackling Digital Equity Needs in Health Care.","authors":"Sachin D Shah","doi":"10.1001/jamanetworkopen.2024.45334","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.45334","url":null,"abstract":"","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2445334"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.45278
Cihan Atila, Isabelle Straumann, Patrick Vizeli, Julia Beck, Sophie Monnerat, Friederike Holze, Matthias E Liechti, Mirjam Christ-Crain
<p><strong>Importance: </strong>3,4-Methylenedioxymethamphetamine (MDMA, or ecstasy) is a recreational drug being investigated for the treatment of posttraumatic stress disorder. Acute hyponatremia is a potentially serious complication after even a single dose of MDMA. The assumed etiology has been a vasopressin release inducing the syndrome of inappropriate antidiuresis combined with increased thirst, causing polydipsia and water intoxication.</p><p><strong>Objective: </strong>To investigate the incidence and severity of hyponatremia after a single dose of MDMA, underlying neuroendocrine mechanisms of action, and the potential effect of fluid restriction on lowering the incidence of hyponatremia.</p><p><strong>Design, setting, and participants: </strong>This ad hoc secondary analysis pooled data from 4 placebo-controlled crossover randomized clinical trials conducted at the University Hospital Basel, Basel, Switzerland. The 96 participants received experimental doses of MDMA between March 1, 2017, and August 31, 2022.</p><p><strong>Intervention: </strong>A single oral 100- or 125-mg dose of MDMA. Fluid intake was not restricted in 81 participants; it was restricted in 15.</p><p><strong>Main outcomes and measures: </strong>Plasma oxytocin, copeptin (marker of vasopressin), and sodium levels were measured repeatedly within 360 minutes after MDMA intake. The association of plasma oxytocin or copeptin levels with plasma sodium level at 180 minutes (peak concentration of MDMA) was determined.</p><p><strong>Results: </strong>Among the 96 participants, the mean (SD) age was 29 (7) years, and 62 (65%) were men. A total of 39 participants (41%) received a 100-mg dose of MDMA, and 57 (59%) received a 125-mg dose. At baseline, the mean (SD) plasma sodium level was 140 (3) mEq/L and decreased in response to MDMA by 3 (3) mEq/L. Hyponatremia occurred in 30 participants (31%) with a mean (SD) sodium level of 133 (2) mEq/L. In 15 participants with restricted fluid intake, no hyponatremia occurred, while in the 81 participants with unrestricted fluid intake, hyponatremia occurred in 30 (37%) (P = .002) with a difference in plasma sodium of 4 (95% CI, 2-5) mEq/L (P < .001) between both groups, suggesting that fluid restriction may mitigate the risk of hyponatremia. At baseline, the mean (SD) plasma oxytocin level was 87 (45) pg/mL and increased in response to MDMA by 388 (297) pg/mL (ie, a mean [SD] 433% [431%] increase at 180 minutes), while the mean (SD) copeptin level was 4.9 (3.8) pmol/L and slightly decreased, by 0.8 (3.0) pmol/L. Change in plasma sodium level from baseline to 180 minutes demonstrated a negative correlation with the changes in oxytocin (R = -0.4; P < .001) and MDMA (R = -0.4; P < .001) levels while showing no correlation with the change in copeptin level.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of 4 randomized clinical trials, a high incidence of acute hyponatremia was observed in response to MDMA, which
{"title":"Oxytocin and the Role of Fluid Restriction in MDMA-Induced Hyponatremia: A Secondary Analysis of 4 Randomized Clinical Trials.","authors":"Cihan Atila, Isabelle Straumann, Patrick Vizeli, Julia Beck, Sophie Monnerat, Friederike Holze, Matthias E Liechti, Mirjam Christ-Crain","doi":"10.1001/jamanetworkopen.2024.45278","DOIUrl":"10.1001/jamanetworkopen.2024.45278","url":null,"abstract":"<p><strong>Importance: </strong>3,4-Methylenedioxymethamphetamine (MDMA, or ecstasy) is a recreational drug being investigated for the treatment of posttraumatic stress disorder. Acute hyponatremia is a potentially serious complication after even a single dose of MDMA. The assumed etiology has been a vasopressin release inducing the syndrome of inappropriate antidiuresis combined with increased thirst, causing polydipsia and water intoxication.</p><p><strong>Objective: </strong>To investigate the incidence and severity of hyponatremia after a single dose of MDMA, underlying neuroendocrine mechanisms of action, and the potential effect of fluid restriction on lowering the incidence of hyponatremia.</p><p><strong>Design, setting, and participants: </strong>This ad hoc secondary analysis pooled data from 4 placebo-controlled crossover randomized clinical trials conducted at the University Hospital Basel, Basel, Switzerland. The 96 participants received experimental doses of MDMA between March 1, 2017, and August 31, 2022.</p><p><strong>Intervention: </strong>A single oral 100- or 125-mg dose of MDMA. Fluid intake was not restricted in 81 participants; it was restricted in 15.</p><p><strong>Main outcomes and measures: </strong>Plasma oxytocin, copeptin (marker of vasopressin), and sodium levels were measured repeatedly within 360 minutes after MDMA intake. The association of plasma oxytocin or copeptin levels with plasma sodium level at 180 minutes (peak concentration of MDMA) was determined.</p><p><strong>Results: </strong>Among the 96 participants, the mean (SD) age was 29 (7) years, and 62 (65%) were men. A total of 39 participants (41%) received a 100-mg dose of MDMA, and 57 (59%) received a 125-mg dose. At baseline, the mean (SD) plasma sodium level was 140 (3) mEq/L and decreased in response to MDMA by 3 (3) mEq/L. Hyponatremia occurred in 30 participants (31%) with a mean (SD) sodium level of 133 (2) mEq/L. In 15 participants with restricted fluid intake, no hyponatremia occurred, while in the 81 participants with unrestricted fluid intake, hyponatremia occurred in 30 (37%) (P = .002) with a difference in plasma sodium of 4 (95% CI, 2-5) mEq/L (P < .001) between both groups, suggesting that fluid restriction may mitigate the risk of hyponatremia. At baseline, the mean (SD) plasma oxytocin level was 87 (45) pg/mL and increased in response to MDMA by 388 (297) pg/mL (ie, a mean [SD] 433% [431%] increase at 180 minutes), while the mean (SD) copeptin level was 4.9 (3.8) pmol/L and slightly decreased, by 0.8 (3.0) pmol/L. Change in plasma sodium level from baseline to 180 minutes demonstrated a negative correlation with the changes in oxytocin (R = -0.4; P < .001) and MDMA (R = -0.4; P < .001) levels while showing no correlation with the change in copeptin level.</p><p><strong>Conclusions and relevance: </strong>In this secondary analysis of 4 randomized clinical trials, a high incidence of acute hyponatremia was observed in response to MDMA, which","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2445278"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.43893
Richard S Saver
<p><strong>Importance: </strong>False medical information disseminated dangerously during the COVID-19 pandemic, with certain physicians playing a surprisingly prominent role. Medical boards engendered widespread criticism for not imposing forceful sanctions, but considerable uncertainty remains about how the professional licensure system regulates physician-spread misinformation.</p><p><strong>Objective: </strong>To compare the level of professional discipline of physicians for spreading medical misinformation relative to discipline for other offenses.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed and coded publicly reported medical board disciplinary actions in the 5 most populous US states. The analysis included data from January 1, 2020, through May 30, 2023, for California, Florida, New York, and Pennsylvania and from January 1, 2020, through March 30, 2022, for Texas.</p><p><strong>Main outcomes and measures: </strong>Medical board disciplinary proceedings that resulted in some form of sanction were analyzed. Codes were assigned for the different types of offenses relied on by medical boards for imposing physician discipline.</p><p><strong>Results: </strong>Among 3128 medical board disciplinary proceedings in the 5 most populous states, spreading misinformation to the community was the least common reason for medical board discipline of physicians (6 [0.1%] of all identified offenses). Two reasons tied for third least common: patient-directed misinformation (21 [0.3%]) and inappropriate advertising or patient solicitation (21 [0.3%]). The frequency of misinformation conduct was exponentially lower than more common reasons for discipline, such as physician negligence (1911 [28.7%]), problematic record-keeping (990 [14.9%]), and inappropriate prescribing (901 [13.5%]). Patient-directed misinformation provided a basis for discipline 3 times as often as spreading misinformation to the community. The frequency of disciplinary actions for any reasons related to COVID-19 care, even if not about misinformation, was also quite low (10 [0.2%]). Sanctions in misinformation actions tended to be relatively light.</p><p><strong>Conclusions and relevance: </strong>The frequency of discipline for physician-spread misinformation observed in this cross-sectional study was quite low despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods. These findings suggest that there is a serious disconnect between regulatory guidance and enforcement and that medical boards relied on spreading misinformation to patients as a reason for discipline 3 times more frequently than disseminating falsehoods to the public. These results shed light on important policy concerns about professional licensure, including why, under current patient-centered frameworks, this form of regulation may be particularly ill-suited to address medical misinfo
{"title":"Medical Board Discipline of Physicians for Spreading Medical Misinformation.","authors":"Richard S Saver","doi":"10.1001/jamanetworkopen.2024.43893","DOIUrl":"10.1001/jamanetworkopen.2024.43893","url":null,"abstract":"<p><strong>Importance: </strong>False medical information disseminated dangerously during the COVID-19 pandemic, with certain physicians playing a surprisingly prominent role. Medical boards engendered widespread criticism for not imposing forceful sanctions, but considerable uncertainty remains about how the professional licensure system regulates physician-spread misinformation.</p><p><strong>Objective: </strong>To compare the level of professional discipline of physicians for spreading medical misinformation relative to discipline for other offenses.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed and coded publicly reported medical board disciplinary actions in the 5 most populous US states. The analysis included data from January 1, 2020, through May 30, 2023, for California, Florida, New York, and Pennsylvania and from January 1, 2020, through March 30, 2022, for Texas.</p><p><strong>Main outcomes and measures: </strong>Medical board disciplinary proceedings that resulted in some form of sanction were analyzed. Codes were assigned for the different types of offenses relied on by medical boards for imposing physician discipline.</p><p><strong>Results: </strong>Among 3128 medical board disciplinary proceedings in the 5 most populous states, spreading misinformation to the community was the least common reason for medical board discipline of physicians (6 [0.1%] of all identified offenses). Two reasons tied for third least common: patient-directed misinformation (21 [0.3%]) and inappropriate advertising or patient solicitation (21 [0.3%]). The frequency of misinformation conduct was exponentially lower than more common reasons for discipline, such as physician negligence (1911 [28.7%]), problematic record-keeping (990 [14.9%]), and inappropriate prescribing (901 [13.5%]). Patient-directed misinformation provided a basis for discipline 3 times as often as spreading misinformation to the community. The frequency of disciplinary actions for any reasons related to COVID-19 care, even if not about misinformation, was also quite low (10 [0.2%]). Sanctions in misinformation actions tended to be relatively light.</p><p><strong>Conclusions and relevance: </strong>The frequency of discipline for physician-spread misinformation observed in this cross-sectional study was quite low despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods. These findings suggest that there is a serious disconnect between regulatory guidance and enforcement and that medical boards relied on spreading misinformation to patients as a reason for discipline 3 times more frequently than disseminating falsehoods to the public. These results shed light on important policy concerns about professional licensure, including why, under current patient-centered frameworks, this form of regulation may be particularly ill-suited to address medical misinfo","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443893"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Importance: </strong>Discontinuation of denosumab without transitioning to another antiresorptive agent results in rapid bone loss and an increased risk of fracture. Previous randomized studies reported inconsistent results regarding the efficacy of zoledronate as sequential therapy.</p><p><strong>Objective: </strong>To investigate the use of sequential therapy with zoledronate to prevent bone loss and decreased bone mineral density (BMD) after denosumab discontinuation in the first year.</p><p><strong>Design, setting, and participants: </strong>The Denosumab Sequential Therapy prospective, open-label, parallel-group randomized clinical trial was conducted at a referral center and 2 affiliated hospitals in Taiwan. Recruitment was conducted from April 1, 2019, to May 31, 2021, and a 2-year follow-up was planned. The trial included postmenopausal women and men aged 50 years or older who received regular denosumab treatment for at least 2 years and did not have previous exposure to other antiosteoporosis medication or meet other exclusion criteria.</p><p><strong>Intervention: </strong>Participants were assigned via stratified randomization to 1 of 2 groups: group A received continuous denosumab treatment (60 mg twice yearly) as the positive control, whereas group ZOL received 1 dose of zoledronate (5 mg) in the first year.</p><p><strong>Main outcomes and measures: </strong>The coprimary outcomes were BMD percentage changes in the lumbar spine (LS-BMD), total hip (TH-BMD), and femoral neck (FN-BMD), respectively. An intention-to-treat analysis was performed.</p><p><strong>Results: </strong>This study included 101 patients (95 women [94.1%]; median age, 72.0 [IQR, 67.0-76.0] years). There were 25 patients in group A (23 women [92.0%]; median age, 74.0 [IQR, 70.0 to 78.0] years) and 76 in group ZOL (72 women [94.7%]; median age, 71.0 [IQR, 65.7 to 76.0] years). In the first year, group ZOL had a significant median decrease in LS-BMD (-0.68% [IQR, -3.22% to 2.75%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .03). No significant differences between groups A and ZOL were observed for TH-BMD (median, 1.12% [IQR, -0.06% to 2.25%] vs 0% [-1.47% to 2.15%]) (P = .24) and FN-BMD (median, 0.17% [IQR, -2.29% to 2.90%] vs 0.18% [-2.73% to 3.88%]) (P = .71). We observed a significant difference in the median LS-BMD percentage change for the ZOL subgroup with 3 or more years of denosumab treatment before enrollment (-3.20% [IQR, -7.89% to 0.68%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .003).</p><p><strong>Conclusions and relevance: </strong>In this randomized trial of sequential therapy after denosumab discontinuation, bone loss was observed in LS-BMD in the first year among patients receiving zoledronate. A longer duration of denosumab treatment was associated with a further decrease in LS-BMD after zoledronate sequential therapy. Further randomized clinical trials and large-scale studies that investigate the strategies
重要性：停用地诺单抗而不过渡到另一种抗骨吸收药物会导致骨量快速流失，增加骨折风险。之前的随机研究报告显示，唑来膦酸钠作为序贯疗法的疗效并不一致：目的：研究使用唑来膦酸钠进行序贯治疗，以防止在停用地诺单抗第一年后出现骨丢失和骨矿物质密度（BMD）降低：地诺单抗序贯疗法前瞻性、开放标签、平行组随机临床试验在台湾的一家转诊中心和两家附属医院进行。招募时间为2019年4月1日至2021年5月31日，计划随访2年。试验对象包括50岁或以上的绝经后女性和男性，他们接受正规的地诺单抗治疗至少2年，既往未使用过其他抗骨质疏松症药物，也不符合其他排除标准：干预措施：通过分层随机法将参与者分配到两组中的一组：A组接受持续的地诺单抗治疗（60毫克，每年两次）作为阳性对照，而ZOL组在第一年接受1次唑来膦酸钠（5毫克）治疗：主要结果和测量指标：主要结果是腰椎（LS-BMD）、全髋（TH-BMD）和股骨颈（FN-BMD）的BMD百分比变化。研究进行了意向治疗分析：本研究共纳入 101 名患者（95 名女性 [94.1%]；中位年龄 72.0 [IQR, 67.0-76.0] 岁）。A 组有 25 名患者（23 名女性 [92.0%]；中位年龄 74.0 [IQR，70.0-78.0]岁），ZOL 组有 76 名患者（72 名女性 [94.7%]；中位年龄 71.0 [IQR，65.7-76.0]岁）。与 A 组（1.30% [IQR, -0.68% to 5.24%]）相比，ZOL 组在第一年的 LS-BMD 中位数显著下降（-0.68% [IQR, -3.22% to 2.75%]）（P = .03）。A组和ZOL组在TH-BMD（中位数，1.12% [IQR, -0.06% to 2.25%] vs 0% [-1.47% to 2.15%]）（P = .24）和FN-BMD（中位数，0.17% [IQR, -2.29% to 2.90%] vs 0.18% [-2.73% to 3.88%]）（P = .71）方面无明显差异。我们观察到，与 A 组（1.30% [IQR, -0.68% to 5.24%]）相比，入组前接受过 3 年或 3 年以上地诺单抗治疗的 ZOL 亚组的 LS-BMD 百分比变化中位数（-3.20% [IQR, -7.89% to 0.68%]）有显著差异（P = .003）：在这项关于停用地诺单抗后序贯治疗的随机试验中，观察到接受唑来膦酸钠治疗的患者第一年的 LS-BMD 骨量有所下降。在接受唑来膦酸盐序贯疗法后，地诺单抗治疗时间的延长与LS-BMD的进一步下降有关。需要进一步开展随机临床试验和大规模研究，探讨长期使用地诺单抗治疗后的序贯治疗策略：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT03868033。
{"title":"Zoledronate Sequential Therapy After Denosumab Discontinuation to Prevent Bone Mineral Density Reduction: A Randomized Clinical Trial.","authors":"Chia-Che Lee, Chen-Yu Wang, Hung-Kuan Yen, Chih-Chien Hung, Cheng-Yo Lai, Ming-Hsiao Hu, Ting-Ming Wang, Chung-Yi Li, Shau-Huai Fu","doi":"10.1001/jamanetworkopen.2024.43899","DOIUrl":"10.1001/jamanetworkopen.2024.43899","url":null,"abstract":"<p><strong>Importance: </strong>Discontinuation of denosumab without transitioning to another antiresorptive agent results in rapid bone loss and an increased risk of fracture. Previous randomized studies reported inconsistent results regarding the efficacy of zoledronate as sequential therapy.</p><p><strong>Objective: </strong>To investigate the use of sequential therapy with zoledronate to prevent bone loss and decreased bone mineral density (BMD) after denosumab discontinuation in the first year.</p><p><strong>Design, setting, and participants: </strong>The Denosumab Sequential Therapy prospective, open-label, parallel-group randomized clinical trial was conducted at a referral center and 2 affiliated hospitals in Taiwan. Recruitment was conducted from April 1, 2019, to May 31, 2021, and a 2-year follow-up was planned. The trial included postmenopausal women and men aged 50 years or older who received regular denosumab treatment for at least 2 years and did not have previous exposure to other antiosteoporosis medication or meet other exclusion criteria.</p><p><strong>Intervention: </strong>Participants were assigned via stratified randomization to 1 of 2 groups: group A received continuous denosumab treatment (60 mg twice yearly) as the positive control, whereas group ZOL received 1 dose of zoledronate (5 mg) in the first year.</p><p><strong>Main outcomes and measures: </strong>The coprimary outcomes were BMD percentage changes in the lumbar spine (LS-BMD), total hip (TH-BMD), and femoral neck (FN-BMD), respectively. An intention-to-treat analysis was performed.</p><p><strong>Results: </strong>This study included 101 patients (95 women [94.1%]; median age, 72.0 [IQR, 67.0-76.0] years). There were 25 patients in group A (23 women [92.0%]; median age, 74.0 [IQR, 70.0 to 78.0] years) and 76 in group ZOL (72 women [94.7%]; median age, 71.0 [IQR, 65.7 to 76.0] years). In the first year, group ZOL had a significant median decrease in LS-BMD (-0.68% [IQR, -3.22% to 2.75%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .03). No significant differences between groups A and ZOL were observed for TH-BMD (median, 1.12% [IQR, -0.06% to 2.25%] vs 0% [-1.47% to 2.15%]) (P = .24) and FN-BMD (median, 0.17% [IQR, -2.29% to 2.90%] vs 0.18% [-2.73% to 3.88%]) (P = .71). We observed a significant difference in the median LS-BMD percentage change for the ZOL subgroup with 3 or more years of denosumab treatment before enrollment (-3.20% [IQR, -7.89% to 0.68%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .003).</p><p><strong>Conclusions and relevance: </strong>In this randomized trial of sequential therapy after denosumab discontinuation, bone loss was observed in LS-BMD in the first year among patients receiving zoledronate. A longer duration of denosumab treatment was associated with a further decrease in LS-BMD after zoledronate sequential therapy. Further randomized clinical trials and large-scale studies that investigate the strategies ","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2443899"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.42803
Nicholas J Christopher-Hayes, Sarah C Haynes, Nicholas J Kenyon, Vidya D Merchant, Julie B Schweitzer, Simona Ghetti
<p><strong>Importance: </strong>Asthma is a chronic respiratory disease affecting approximately 5 million children in the US. Rodent models of asthma indicate memory deficits, but little is known about whether asthma alters children's memory development.</p><p><strong>Objective: </strong>To assess whether childhood asthma is associated with lower memory abilities in children.</p><p><strong>Design, setting, and participants: </strong>This cohort study used observational data from the Adolescent Brain Cognitive Development (ABCD) Study, a multisite longitudinal investigation that began enrollment in 2015. Approximately 11 800 children aged 9 to 10 years were enrolled at baseline with follow-up at 1 and 2 years. Participants were selected based on exposures described subsequently to determine longitudinal and cross-sectional associations between asthma and memory. Data were analyzed from Month year to Month year.</p><p><strong>Exposures: </strong>Asthma was determined from parent reports. For the longitudinal analysis, children were selected if they had asthma at baseline and at the 2-year follow-up (earlier childhood onset), at the 2-year follow-up only (later childhood onset), or no history of asthma. For the cross-sectional analysis, children were selected if they had asthma at any time point, or no history of asthma. The comparison group of children with asthma history was matched on demographic and health covariates for each analysis.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was episodic memory. Secondary outcomes included processing speed, inhibition and attention.</p><p><strong>Results: </strong>Four hundred seventy-four children were included in the longitudinal analysis (earlier childhood onset: 135 children; mean [SD] age, 9.90 [0.63] years; 76 [56%] male; 53 [28%] Black, 29 [21%] Hispanic or Latino, and 91 [48%] White; later childhood onset: 102 children; mean [SD] age 9.88 [0.59] years; 54 [53%] female; 22 [17%] Black, 19 [19%] Hispanic or Latino, and 83 [63%] White; comparison: 237 children; mean [SD] age, 9.89 [0.59] years; 121 [51%] male; 47 [15%] Black, 48 [20%] Hispanic or Latino, and 194 [62%] White). Children with earlier onset of asthma exhibited lower rates of longitudinal memory improvements relative to the comparison group (β = -0.17; 95% CI, -0.28 to -0.05; P = .01). Two thousand sixty-two children were selected for the cross-sectional analysis (with asthma: 1031 children; mean [SD] age, 11.99 [0.66] years; 588 [57%] male; 360 [27%] Black, 186 [18%] Hispanic or Latino, and 719 [54%] White; without asthma: 1031 children; mean [SD] age 12.00 [0.66] years; 477 [54%] female; 273 [21%] Black, 242 [23%] Hispanic or Latino, and 782 [59%] White). Children with asthma (1031 children) showed lower scores on episodic memory (β = -0.09; 95% CI, -0.18 to -0.01; P = .04), processing speed (β = -0.13; 95% CI, -0.22 to -0.03; P = .01), and inhibition and attention (β = -0.11; 95% CI, -0.21 to -0.02; P = .02).</p
{"title":"Asthma and Memory Function in Children.","authors":"Nicholas J Christopher-Hayes, Sarah C Haynes, Nicholas J Kenyon, Vidya D Merchant, Julie B Schweitzer, Simona Ghetti","doi":"10.1001/jamanetworkopen.2024.42803","DOIUrl":"10.1001/jamanetworkopen.2024.42803","url":null,"abstract":"<p><strong>Importance: </strong>Asthma is a chronic respiratory disease affecting approximately 5 million children in the US. Rodent models of asthma indicate memory deficits, but little is known about whether asthma alters children's memory development.</p><p><strong>Objective: </strong>To assess whether childhood asthma is associated with lower memory abilities in children.</p><p><strong>Design, setting, and participants: </strong>This cohort study used observational data from the Adolescent Brain Cognitive Development (ABCD) Study, a multisite longitudinal investigation that began enrollment in 2015. Approximately 11 800 children aged 9 to 10 years were enrolled at baseline with follow-up at 1 and 2 years. Participants were selected based on exposures described subsequently to determine longitudinal and cross-sectional associations between asthma and memory. Data were analyzed from Month year to Month year.</p><p><strong>Exposures: </strong>Asthma was determined from parent reports. For the longitudinal analysis, children were selected if they had asthma at baseline and at the 2-year follow-up (earlier childhood onset), at the 2-year follow-up only (later childhood onset), or no history of asthma. For the cross-sectional analysis, children were selected if they had asthma at any time point, or no history of asthma. The comparison group of children with asthma history was matched on demographic and health covariates for each analysis.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was episodic memory. Secondary outcomes included processing speed, inhibition and attention.</p><p><strong>Results: </strong>Four hundred seventy-four children were included in the longitudinal analysis (earlier childhood onset: 135 children; mean [SD] age, 9.90 [0.63] years; 76 [56%] male; 53 [28%] Black, 29 [21%] Hispanic or Latino, and 91 [48%] White; later childhood onset: 102 children; mean [SD] age 9.88 [0.59] years; 54 [53%] female; 22 [17%] Black, 19 [19%] Hispanic or Latino, and 83 [63%] White; comparison: 237 children; mean [SD] age, 9.89 [0.59] years; 121 [51%] male; 47 [15%] Black, 48 [20%] Hispanic or Latino, and 194 [62%] White). Children with earlier onset of asthma exhibited lower rates of longitudinal memory improvements relative to the comparison group (β = -0.17; 95% CI, -0.28 to -0.05; P = .01). Two thousand sixty-two children were selected for the cross-sectional analysis (with asthma: 1031 children; mean [SD] age, 11.99 [0.66] years; 588 [57%] male; 360 [27%] Black, 186 [18%] Hispanic or Latino, and 719 [54%] White; without asthma: 1031 children; mean [SD] age 12.00 [0.66] years; 477 [54%] female; 273 [21%] Black, 242 [23%] Hispanic or Latino, and 782 [59%] White). Children with asthma (1031 children) showed lower scores on episodic memory (β = -0.09; 95% CI, -0.18 to -0.01; P = .04), processing speed (β = -0.13; 95% CI, -0.22 to -0.03; P = .01), and inhibition and attention (β = -0.11; 95% CI, -0.21 to -0.02; P = .02).</p","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2442803"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.44756
Fiona P Havers, Michael Whitaker, Michael Melgar, Huong Pham, Shua J Chai, Elizabeth Austin, James Meek, Kyle P Openo, Patricia A Ryan, Chloe Brown, Kathryn Como-Sabetti, Daniel M Sosin, Grant Barney, Brenda L Tesini, Melissa Sutton, H Keipp Talbot, Ryan Chatelain, Pam Daily Kirley, Isaac Armistead, Kimberly Yousey-Hindes, Maya L Monroe, Val Tellez Nunez, Ruth Lynfield, Chelsea L Esquibel, Kerianne Engesser, Kevin Popham, Arilene Novak, William Schaffner, Tiffanie M Markus, Ashley Swain, Monica E Patton, Lindsay Kim
<p><strong>Importance: </strong>Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.</p><p><strong>Objective: </strong>To describe the demographic characteristics of adults hospitalized with laboratory-confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used data from the RSV Hospitalization Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022-2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.</p><p><strong>Exposure: </strong>Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.</p><p><strong>Main outcomes and measures: </strong>Hospitalization rates per 100 000 adult population, stratified by age group. After adjusting for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.</p><p><strong>Results: </strong>From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]). Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 100 000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100 000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100 000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100 000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100 000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100 000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84 000-230 000) in 2016 to 2017 to 193 000 (95% CI, 140 000-311 000) in 2017 to 2018. Annual ICU admission estimates ranged from 24 400 (95% CI, 16 700-44 800) to 34 900 (95% CI, 25 500-55 600) for the same seasons. Estimated annual in-hospital deaths ranged from 4680 (95% CI, 3570-6820) in 2018 to 2019 to 8620 (95% CI, 6220-14 090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (ran
{"title":"Burden of Respiratory Syncytial Virus-Associated Hospitalizations in US Adults, October 2016 to September 2023.","authors":"Fiona P Havers, Michael Whitaker, Michael Melgar, Huong Pham, Shua J Chai, Elizabeth Austin, James Meek, Kyle P Openo, Patricia A Ryan, Chloe Brown, Kathryn Como-Sabetti, Daniel M Sosin, Grant Barney, Brenda L Tesini, Melissa Sutton, H Keipp Talbot, Ryan Chatelain, Pam Daily Kirley, Isaac Armistead, Kimberly Yousey-Hindes, Maya L Monroe, Val Tellez Nunez, Ruth Lynfield, Chelsea L Esquibel, Kerianne Engesser, Kevin Popham, Arilene Novak, William Schaffner, Tiffanie M Markus, Ashley Swain, Monica E Patton, Lindsay Kim","doi":"10.1001/jamanetworkopen.2024.44756","DOIUrl":"10.1001/jamanetworkopen.2024.44756","url":null,"abstract":"<p><strong>Importance: </strong>Respiratory syncytial virus (RSV) infection can cause severe illness in adults. However, there is considerable uncertainty in the burden of RSV-associated hospitalizations among adults prior to RSV vaccine introduction.</p><p><strong>Objective: </strong>To describe the demographic characteristics of adults hospitalized with laboratory-confirmed RSV and to estimate annual rates and numbers of RSV-associated hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used data from the RSV Hospitalization Surveillance Network (RSV-NET), a population-based surveillance platform that captures RSV-associated hospitalizations in 58 counties in 12 states, covering approximately 8% of the US population. The study period spanned 7 surveillance seasons from 2016-2017 through 2022-2023. Included cases from RSV-NET were nonpregnant hospitalized adults aged 18 years or older residing in the surveillance catchment area and with a positive RSV test result.</p><p><strong>Exposure: </strong>Laboratory-confirmed RSV-associated hospitalization, defined as a positive RSV test result within 14 days before or during hospitalization.</p><p><strong>Main outcomes and measures: </strong>Hospitalization rates per 100 000 adult population, stratified by age group. After adjusting for test sensitivity and undertesting for RSV in adults hospitalized with acute respiratory illnesses, rates were extrapolated to the US population to estimate annual numbers of RSV-associated hospitalizations. Clinical outcome data were used to estimate RSV-associated ICU admissions and in-hospital deaths.</p><p><strong>Results: </strong>From the 2016 to 2017 through the 2022 to 2023 RSV seasons, there were 16 575 RSV-associated hospitalizations in adults (median [IQR] age, 70 [58-81] years; 9641 females [58.2%]). Excluding the 2020 to 2021 and the 2021 to 2022 seasons, when the COVID-19 pandemic affected RSV circulation, hospitalization rates ranged from 48.9 (95% CI, 33.4-91.5) per 100 000 adults in 2016 to 2017 to 76.2 (95% CI, 55.2-122.7) per 100 000 adults in 2017 to 2018. Rates were lowest among adults aged 18 to 49 years (8.6 [95% CI, 5.7-16.8] per 100 000 adults in 2016-2017 to 13.1 [95% CI, 11.0-16.1] per 100 000 adults in 2022-2023) and highest among adults 75 years or older (244.7 [95% CI, 207.9-297.3] per 100 000 adults in 2022-2023 to 411.4 [95% CI, 292.1-695.4] per 100 000 adults in 2017-2018). Annual hospitalization estimates ranged from 123 000 (95% CI, 84 000-230 000) in 2016 to 2017 to 193 000 (95% CI, 140 000-311 000) in 2017 to 2018. Annual ICU admission estimates ranged from 24 400 (95% CI, 16 700-44 800) to 34 900 (95% CI, 25 500-55 600) for the same seasons. Estimated annual in-hospital deaths ranged from 4680 (95% CI, 3570-6820) in 2018 to 2019 to 8620 (95% CI, 6220-14 090) in 2017 to 2018. Adults 75 years or older accounted for 45.6% (ran","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444756"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.44836
Eve Lin, Alyssa Bilinski, Philip A Collender, Vivian Lee, Sohil R Sud, Tomás M León, Lauren A White, Justin V Remais, Jennifer R Head
<p><strong>Importance: </strong>Understanding the role of school attendance on transmission of SARS-CoV-2 among children is of importance for responding to future epidemics. Estimating discontinuities in outcomes by age of eligibility for school attendance has been used to examine associations between school attendance and a variety of outcomes, but has yet to be applied to describe associations between school attendance and communicable disease transmission.</p><p><strong>Objective: </strong>To estimate the association between eligibility for elementary school and COVID-19 incidence.</p><p><strong>Design, setting, and participants: </strong>This case series used data on all pediatric COVID-19 cases reported to California's disease surveillance system between May 16, 2020, and December 15, 2022, among children within 24 months of the age threshold for school eligibility.</p><p><strong>Exposure: </strong>Birthdate before or after the age threshold for elementary school eligibility during periods when school was remote vs in person.</p><p><strong>Main outcomes and measures: </strong>COVID-19 cases and hospitalizations.</p><p><strong>Results: </strong>Between May 16, 2020, and December 15, 2022, there were 688 278 cases of COVID-19 (348 957 cases [50.7%] among boys) and 1423 hospitalizations among children who turned 5 years within 24 months of September 1 of the school year when their infection occurred. The mean (SD) age of the study sample was 5.0 (1.3) years. After adjusting for higher rates of testing in schooled populations, the estimated pooled incidence rate ratio among kindergarten-eligible individuals (eg, those born just before the age threshold for school eligibility) compared with those born just after the eligibility threshold for in-person fall 2021 semester was 1.52 (95% CI, 1.36-1.68), for in-person spring 2022 semester was 1.26 (95% CI, 1.15-1.39), and for in-person fall 2022 semester was 1.19 (95% CI, 1.03-1.38). Reported incidence rates among school-eligible children remained higher during the month-long winter 2021-2022 school break but were lower during the longer summer break that followed. The findings were unable to establish whether associations between school eligibility and COVID-19 incidence were based on in-school vs out-of-school routes (eg, classrooms vs school buses). The study lacked power to detect associations between school attendance and hospitalization. Results were robust to functional form. A simulation study was conducted to demonstrate bias associated with nonadjustment for differential case acquisition by exposure status.</p><p><strong>Conclusions and relevance: </strong>In this case series of children in California, the magnitude of the association between school eligibility and COVID-19 incidence decreased over time and was generally lower than other published associations between out-of-school child social interactions and COVID-19 incidence. This regression discontinuity design approach could be adapte
{"title":"COVID-19 Incidence and Age Eligibility for Elementary School.","authors":"Eve Lin, Alyssa Bilinski, Philip A Collender, Vivian Lee, Sohil R Sud, Tomás M León, Lauren A White, Justin V Remais, Jennifer R Head","doi":"10.1001/jamanetworkopen.2024.44836","DOIUrl":"https://doi.org/10.1001/jamanetworkopen.2024.44836","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the role of school attendance on transmission of SARS-CoV-2 among children is of importance for responding to future epidemics. Estimating discontinuities in outcomes by age of eligibility for school attendance has been used to examine associations between school attendance and a variety of outcomes, but has yet to be applied to describe associations between school attendance and communicable disease transmission.</p><p><strong>Objective: </strong>To estimate the association between eligibility for elementary school and COVID-19 incidence.</p><p><strong>Design, setting, and participants: </strong>This case series used data on all pediatric COVID-19 cases reported to California's disease surveillance system between May 16, 2020, and December 15, 2022, among children within 24 months of the age threshold for school eligibility.</p><p><strong>Exposure: </strong>Birthdate before or after the age threshold for elementary school eligibility during periods when school was remote vs in person.</p><p><strong>Main outcomes and measures: </strong>COVID-19 cases and hospitalizations.</p><p><strong>Results: </strong>Between May 16, 2020, and December 15, 2022, there were 688 278 cases of COVID-19 (348 957 cases [50.7%] among boys) and 1423 hospitalizations among children who turned 5 years within 24 months of September 1 of the school year when their infection occurred. The mean (SD) age of the study sample was 5.0 (1.3) years. After adjusting for higher rates of testing in schooled populations, the estimated pooled incidence rate ratio among kindergarten-eligible individuals (eg, those born just before the age threshold for school eligibility) compared with those born just after the eligibility threshold for in-person fall 2021 semester was 1.52 (95% CI, 1.36-1.68), for in-person spring 2022 semester was 1.26 (95% CI, 1.15-1.39), and for in-person fall 2022 semester was 1.19 (95% CI, 1.03-1.38). Reported incidence rates among school-eligible children remained higher during the month-long winter 2021-2022 school break but were lower during the longer summer break that followed. The findings were unable to establish whether associations between school eligibility and COVID-19 incidence were based on in-school vs out-of-school routes (eg, classrooms vs school buses). The study lacked power to detect associations between school attendance and hospitalization. Results were robust to functional form. A simulation study was conducted to demonstrate bias associated with nonadjustment for differential case acquisition by exposure status.</p><p><strong>Conclusions and relevance: </strong>In this case series of children in California, the magnitude of the association between school eligibility and COVID-19 incidence decreased over time and was generally lower than other published associations between out-of-school child social interactions and COVID-19 incidence. This regression discontinuity design approach could be adapte","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2444836"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1001/jamanetworkopen.2024.42633
Ciara Duggan, Adam L Beckman, Ishani Ganguli, Mark Soto, E John Orav, Thomas C Tsai, Austin Frakt, Jose F Figueroa
Importance: Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a national level on the prevalence of LVS utilization among MA vs TM beneficiaries and whether LVS utilization rates vary among the largest MA insurers.
Objective: To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers.
Design, setting, and participants: This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information. Eligible TM beneficiaries were enrolled in Parts A, B, and D, and eligible MA beneficiaries were enrolled in Part C with Part D coverage. Data analysis was conducted between February 2022 and August 2024.
Exposures: Medicare plan type.
Main outcomes and measures: The primary outcome was utlization of 35 LVS defined by the Milliman Health Waste Calculator. An overdispersed Poisson regression model was used to calculate estimated margins comparing risk-adjusted rates of LVS in TM vs MA, overall and across the 7 largest MA insurers.
Results: The study sample included 3 671 364 unique TM beneficiaries (mean [SD] age, 75.7 [7.7] years; 1 502 631 female [40.9%]) and 2 299 618 unique MA beneficiaries (mean [SD] age, 75.3 [7.3] years; 983 592 female [42.8%]). LVS utilization was lower among those enrolled in MA compared with TM (50.02 vs 52.48 services per 100 beneficiary-years; adjusted absolute difference, -2.46 services per 100 beneficiary-years; 95% CI, -3.16 to -1.75 services per 100 beneficiary-years; P < .001). Within MA, LVS utilization was lower among beneficiaries enrolled in HMOs vs PPOs (48.03 vs 52.66 services per 100 beneficiary-years; adjusted absolute difference, -4.63 services per 100 beneficiary-years; 95% CI, -5.53 to -3.74 services per 100 beneficiary-years; P < .001). While MA beneficiaries enrolled in UnitedHealth, Humana, Centene, and smaller MA insurers had lower rates of LVS compared with those in TM, beneficiaries enrolled in CVS, Cigna, and Anthem showed no differences. Blue Cross Blue Shield Association plans had higher rates of LVS compared with TM.
Conclusions and relevance: In this cross-sectional study of nearly 6 million Medicare beneficiaries, utilization of LVS was on average lower among MA beneficiaries compared with TM beneficiaries, possibly owing to stronger financial incentives in MA to reduce LVS; however, meaningful differences existed across some of the largest MA insurers, suggesting that MA insurers may have variable ability to influence LVS reduction.
重要性：与传统的医疗保险（TM）相比，医疗保险优势（MA）保险公司有更大的经济激励来减少低价值服务（LVS）的提供；然而，在全国范围内，关于医疗保险受益人与传统医疗保险受益人使用低价值服务的普遍性以及最大的医疗保险保险公司之间低价值服务使用率是否存在差异的证据却很有限：目的：确定向加入医疗保险与加入临时医疗保险的医疗保险受益人提供 LVS 的比率是否存在差异，总体上以及 7 家最大的医疗保险保险公司之间是否存在差异：这项横断面研究包括 2018 年居住在美国的 65 岁及以上、具有完整人口统计学信息的医疗保险受益人。符合条件的 TM 受益人参加了 A、B 和 D 部分，符合条件的 MA 受益人参加了 C 部分和 D 部分保险。数据分析在 2022 年 2 月至 2024 年 8 月期间进行：医疗保险计划类型：主要结果是使用 Milliman 健康浪费计算器定义的 35 种 LVS。使用过度分散泊松回归模型计算估计差值，比较 TM 与 MA 的风险调整后 LVS 率，整体以及 7 家最大的 MA 保险公司：研究样本包括 3 671 364 名 TM 受益人（平均 [SD] 年龄 75.7 [7.7] 岁；1 502 631 名女性 [40.9%]）和 2 299 618 名 MA 受益人（平均 [SD] 年龄 75.3 [7.3] 岁；983 592 名女性 [42.8%]）。与 TM 相比，加入 MA 的 LVS 使用率较低（50.02 vs 52.48 services per 100 beneficiary-years；调整后绝对差异，-2.46 services per 100 beneficiary-years；95% CI，-3.16 to -1.75 services per 100 beneficiary-years；P 结论及意义：在这项针对近 600 万名医疗保险受益人的横断面研究中，与 TM 受益人相比，医疗保险受益人的 LVS 使用率平均较低，这可能是由于医疗保险在减少 LVS 方面具有更强的经济激励机制；然而，一些最大的医疗保险公司之间也存在着显著差异，这表明医疗保险公司在影响减少 LVS 方面可能具有不同的能力。
{"title":"Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.","authors":"Ciara Duggan, Adam L Beckman, Ishani Ganguli, Mark Soto, E John Orav, Thomas C Tsai, Austin Frakt, Jose F Figueroa","doi":"10.1001/jamanetworkopen.2024.42633","DOIUrl":"10.1001/jamanetworkopen.2024.42633","url":null,"abstract":"<p><strong>Importance: </strong>Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a national level on the prevalence of LVS utilization among MA vs TM beneficiaries and whether LVS utilization rates vary among the largest MA insurers.</p><p><strong>Objective: </strong>To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information. Eligible TM beneficiaries were enrolled in Parts A, B, and D, and eligible MA beneficiaries were enrolled in Part C with Part D coverage. Data analysis was conducted between February 2022 and August 2024.</p><p><strong>Exposures: </strong>Medicare plan type.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was utlization of 35 LVS defined by the Milliman Health Waste Calculator. An overdispersed Poisson regression model was used to calculate estimated margins comparing risk-adjusted rates of LVS in TM vs MA, overall and across the 7 largest MA insurers.</p><p><strong>Results: </strong>The study sample included 3 671 364 unique TM beneficiaries (mean [SD] age, 75.7 [7.7] years; 1 502 631 female [40.9%]) and 2 299 618 unique MA beneficiaries (mean [SD] age, 75.3 [7.3] years; 983 592 female [42.8%]). LVS utilization was lower among those enrolled in MA compared with TM (50.02 vs 52.48 services per 100 beneficiary-years; adjusted absolute difference, -2.46 services per 100 beneficiary-years; 95% CI, -3.16 to -1.75 services per 100 beneficiary-years; P < .001). Within MA, LVS utilization was lower among beneficiaries enrolled in HMOs vs PPOs (48.03 vs 52.66 services per 100 beneficiary-years; adjusted absolute difference, -4.63 services per 100 beneficiary-years; 95% CI, -5.53 to -3.74 services per 100 beneficiary-years; P < .001). While MA beneficiaries enrolled in UnitedHealth, Humana, Centene, and smaller MA insurers had lower rates of LVS compared with those in TM, beneficiaries enrolled in CVS, Cigna, and Anthem showed no differences. Blue Cross Blue Shield Association plans had higher rates of LVS compared with TM.</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study of nearly 6 million Medicare beneficiaries, utilization of LVS was on average lower among MA beneficiaries compared with TM beneficiaries, possibly owing to stronger financial incentives in MA to reduce LVS; however, meaningful differences existed across some of the largest MA insurers, suggesting that MA insurers may have variable ability to influence LVS reduction.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"7 11","pages":"e2442633"},"PeriodicalIF":10.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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